HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (9)3714 S . Santa Fe VlllageJO8 ADORESS
Sunflower AssociatesOWNER PHONE
"o'''*SSlTtTalrvlew Rd .
Costa MesaCITY seAE/2192626
Oilt.r-tdld.t D.dtdbn
I he,eby a,rirm thal I am axmpt lrom the Contracto/8 Lrcmse L8w lor the tollowing reasm (S€c
703'l 5. Businoss and Prol6sions Code. Any city or county which roquiros a permit lo con3lrucl.
aller, rmprovo. demolish. or repair any slructure, prior to ils issuance. ds rsguires lhe applicant
tor such permit to lile I s€ned stetsment thal h6 is licen3ed puBuant lo the provisroN ol the
Conlraclor's Lrcense Lil (Chepler 9 (commencing with Seclion 7m0) o, Division 3 ol thg
Busrness and Pror6sions Code) or thst he as exampt theretrom end the basis tor the alleged
exemptron Any violalm ol SoclDn 7031 5 by any applient lor I permit subjEts lhe spplicant to
a civil p€nalty ol nol mora lhan tive hundrsd dollars (t500)
E S*tlon zolla l. as ownero, the prop€rly. or mygmployeeswith wa96 as theirslecomp€n-
salion, will do the rcrk. snd lhs structura is mt intondgd or otler€d ,oi sl6
E S*tion 70448 l. as ownar ol th€ prop€rry. !m exclusivoly cmlreling with licensd
contraclors to construct the proiect.
Dale Owner (Sr9 )
Contrrcton lra. Only
CONTRACTOFI
E^-1 ^ Daa{fi^ \f6nl-rrfoa 7 \1 -3222
PHONE
loones5-o- - - -
P-O- Box 11388
STATE/ZIPcA 92627
CITY
Costs Mesa
Alt. or Repair of Drainage - Vent Piping
15.00
5.00
5.00
30.00
NO.EACH TOTAL
1
I lndustrial D Commercial
6.00
1 st 1 00' + Conn.
Private Sewage Disp. System
Ea. Add'l Conn.
Ea. Add'l 100'or Fraction
5.00
10.00
5.00
100.00
1.00
5.00
5.00
5.00
10.00
8.00
8.00
10.00
4.00
6.00
10.00
each plumbing tixture/trap
SEWER
Dental Unit or Medical Gases
Pool Traps
lnd. Waste lnterceplor
Rain System - Fer Drain
Lawn Sprinkler
Water Soflner
Rain Water Piping (buried) Ea. l0O'
PIPING
GAS SERVICE 1 to 4 Outlets
Ea. Add'l Outlet
Repair or Replace Gas Piping
Temporary Gas Service
MISCELLANEOUS
Water Heater - Electric or Gas
Water Ea.100'
3.00Deck Drain System - Per Drain
10.00Repair/Alt. Orainage or Vent
Vacuum Breakers 1-5 5.00
1.00Over 5
Backflow Device 2" or Less 5.00
Over 2"10.00
Water Service Ea. 100'10.00
Subtotal
I hereby allirm that I am lic6nsd under the provisaons ol Chaptor 9. Oivision 3 ol lhe Busin6s and
Uo*an ComFrutbn D.clrrlbn
I lErcby attirm thal I havs a cortatiete ol const lo sll-insure, or a csrllricate ol Wottd's Com-
tlolb. To ApPllcil:
ll atler makrng lhrs Cerlrfrcate ot Exemptron. you should become sub,ct to lhe Worker's Compen-
satron provrsrons ol lhe Labor Code. you musl lorthw{h comply wrth such provrsrons or thrs
permrl shall be dtrmed revoked
ilding insp€ction dep8rlmentoensalion lnsuranceoare 4l cdrtirGd @py is lilad with
lor
subist to
Prol6sions Code. and my lrcense rs rn lull lorce and etfect
0 9109Licens No 420651 cE""C-
o,r" ---2 l.lj19ocon,,"",o, t.,s r
Oata
-
Applicsnt (Siig.)
Expires
-
Veriliad By (Sig
o.n 2 I 15 lg0ppicant 1sie.l
I cerlity that in theperrormrncoolthswork
pe6on an any mnn€r s as lo becomo
CalifoinB
Penalty Fee (when applicable)
Violation Fee (s0.00)
Plan Check 65% ol subtotal (minimum 20.00)
Receipt No.Pc#Date
Plan Check (Adjustment)
ErFa?doa
Thb pe.mit shell exprre by limilatio snd become null and void it the work sulhdizod by lhi3
pErmit is not @mmgncd within 180 dsys lrom the data ol this pormit or il work aulhorized by this
p€rmit is susponded or abandonad at 6ny tim€ stlor the work i3 cmmncod tor I p€riod ol 180
days. A nil psmit shall be oblainsd ti'st balora 3uch work can bo mmmoncod.
AEtc.nl'. O.dr.Idr
I corliry thet I have road this applicatim and slat6 thal lh€ abovo intormation B corrcl. I agrs to
comply wrlh all crly ordinancG and state lam rolating lO
sulhorized reprBontation ol this city lo €nter upon tho
purpos6
2lrs leo Applrcanl or AgentOate
and hereby
tor insp€ction
NO.
lssuance Fee
DATE
TOTAL
25.00
10.00
PERMIT ISSUEO AY (Sig )
P. Lomel-iBUILDTNG 54639-43
PERMTT No. vERtFtEO BY (Sig.)
PL
n? -lI - ? nAl 1f ees Daid I'1-11585
VALIDATION (OFFICE USE ONLY)
(ACCOUNT r1 r-4r2)
APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
t o CITY OF SANTA ANA
206 W. 4th Street
667-273a WAPPLICANT FILL IN AREA BELOW
(I,g-Izo
oof,
mU,o
I
Daslnbulron I lnspector Copy 2 Frla Copy 3 Frnance Copy 4 Applrcant Copy
cs-61 r
FIXTURES
--T--
Worker's
o I
PLUMBING INSPECTION RECORDS
Romarki
Ground Work (Soil)
Ground Work (Wate0
Water Service (Ground)
Gas Service and Underground
Lawn Sprinklers
Wasle lnterceptor
Pool Traps
Sewer
Bool Drains
Waler Heaters
Waler SoItner
Rental or Medacal Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Notes
O!tc lnlpector Approval
(Slgn.turc)
#zl'h,-
7
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