HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (15)7. APPLICATION AND
PLUMBING PERMIT
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CITY OF SANTA ANA
206 W. 4th Slreet
667-2738
(TYPEWBITE OR PRINT IN INK)&*?P APPLICANT FILL IN AREA BELOW
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PHoNE (7/4)
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TOTAL
FIXTURES
Dental Unit or Medical Gases 10.00UAILING AO,FESS- ; ,-i f 7,or-t-r-t_,5 ,,/*A_
SEWERcrrY &rz:* h-'*'--STATE/ZIP
A, / ?L 2b 1st 100'+Conn.15.00 /r-. oo
Ea. Add'l Conn.5.00
5.00Ea. Add'l 100' or Fraction
O[rr-lulld.r DadtalbG
I horoby sllirm thal I am oxmpl trom tho Conlractor's Lrcm* Law tor the lollowing rgaaon (S€c.
7031 5. Busioess and Prcl6sion3 Code. Any city or county which requires a pormit to con3truct,
all6r, rmprovo. demolash. or repair any slructure. prior to its issuance. al$ requires the applicant
lor such permit lo lile I signed 3tal6m6nt thal ho is licensed puBuanl lo the prcvisions ol the
Contractor's License Lil (Chaptsr 9 (commsncang with S€ction 7m0) ot Division 3 o, the
Busrness and Prol6sions Code) or lhal he is exempl thorotrom and lhe basis lor the alleg€d
erampllon. Any violetion ol Section 703t.5 by rny applicanl ,or I permil sbicE th6 applrcant to
a ciyil pomlly ol nol mors than livo hundr€d (bllrB (35(n)l
E SctronZOqa l.ssowneroltheprop€rty.ormyemployeswilhwagesaslhoarsolscompon-
salion. wrll do lhe mrt, and th€ slructure B rct inhded or otlered tor sale
E S."tion 70448 l. 8s ownd ol lh€ prop€rly. am gxclusively contrrcting with licanled
contracloG lo construcl the plojfil.
Oeto
-
olf,mr (Sig.)
ContIrio[ t !. Only
2lraA--.-,--;-lCONTRACTOR M.o'*;lz 1/ ' 47t2PHONE
l77g/ fu-b-- fuAOORESS
STATE/ZIPq L 33 A
crw -rt/- *--*:.-L
subiocl to th€ Worter's Compcnstion Les ol
tao{c. To ADDllcnl:
ll atler makrng lhrs Certrftcale ol Exemption. you should become subist to lhe Worker's Compen-
salron provrsrons ol the Labor Code. you musl tonhwilh comply w[h such provrsioos or this
permrl shall be demed revoked
3 0l the Bustn6s and
Lrcense No
of Wortd's Cofr
Class
my lien$o/3
amI hcen*d
end
.lhe provBions o, Chapter
lorce end ettect.
which this permit is issued, I shell nol omploy 8ny
pgrson in any manner s s to.
Calilornra
pensaton lnsurence. Cstilied copy
I hereby atta,m that I have
ComFBrlbn Oclrallon
consenl to sll-ansure.
with ths City
Dare
-
Appliant (sig.)
Att. or Repair ol Drainage - Vent Piping
30.00
I
1
(minimum
t- oo
o.ao
6,. o
?..f{
do
7 / LDate 2 7
Water Service Ea. 100
Owr2"
Backllow Device 2" or Less
Oler5
Vacuum Breakers 1-5
Repair/Alt. Drainage or Vent
Private
PIPING
GAS SERVICE 1 to 4 Outlets
Ea. Add'l Outlet
Repair or Replace Gas
Temporary Gas Service
MISCELLANEOUS
Water Heater - Electric or Gas
Water Piping Ea. 100'
Rain Water Piping (buried) Ea. 100'
Water Softner
Lawn Sprinkler
Rain System - Per Drain
lnd. Waste lnterceptor
Pool Traps
- Per DrainDeck Drain
5.00
100.00
1.00
5.00
oo
5.00
10.00
10.00
10.00
8.00
5.00
4.00
1.00
10.00
5.00
6.00
10.00
10.00
s.00
8.00
5.00
Subtotal
Fenalty Fee (when applicable)
lssuance Fee
Violation Fee
Plan Check (Adjustment)
Plan Chec* 65% of subtotal
Receipt No. I Pc#
(50.0o)
7.yO (minimum20.00)
DATE PERMIT lB_
ErDkdo.r
Thrs parmit shall erpire by limilstim snd b6ore null and void al tho work aulho(iz€d by lhi3
pormil is not commancod wilhin l&, deys rrom the date ot lhis p€rmit q it rcrt authdizod by this
p€rmil is 36p€ndcd or abandoned al any timc aner th€ wort is cmmenc€d tor r lEriod ol 180
dty3. A ntr pdmil shall be obtein€d tiBt b€rora $ch worl @n bo rB@mmanced.
comply with 8ll ordrnanc6 and to
corrrc1 I a9r6 to
Applcanl'r hrTatlfi
I csrtaty lhst I hav6 r@d this
authonzed this city lo entd
purpos
Dale Applicanl or Agant
>tly I -o-PERMIT ISSUEO BY (Sio )54b!0 K*,oEUILOING
PEFMIT No
,l 1-'lt2)
o^/z:5 Pt <-0
Orstnbutron 1 lnspector Copy 2 File Copy 3 Finance Copy 4 Applicent Copy
cs-61 r
0
t
(Residential nlndustrial !Commercial NO.EACH
each plumbing fixture/trap /7 5.00
/
/,-4rZf
rOTAL PERMIT FEE
that
Code.
staie thal tho above
\
O a IPLUMBI NG I NSPECTION RECORDS
Rcmerkt
Ground Work (Soil)
Ground Work (Water)
Water Sorvice (Ground)
Gas Service and Underground
Lawn Sprinklers
Wasle lnterceptor
Pool Traps
Sewer
Rool Orains
Waler Heaters
Water Sottner
Bental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Not6s I e.Jf a a 7.'tfr6 n -.7n L-Z*rr faat
I
D!t.lnapactor Approv!l
(Slgn.tuic)
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