HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (16)\
o aAPPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OB PRINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
667-2736
APPLICANT FILL IN AREA BELOW
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>G&Ldsntial Elndustrial DCommercial NO.EACH rorfr-
Y-rh*v;,h-dft-Pt 6NE
54 z -o//a"ry;TZ -/.,',u,,-)zZ""/?ooL- )rr-r----STATE/ZIPq2LzL
24)
or Gas
FIXTURES
Ea. Add'l Outlet
each plumbing fixture/trap
GAS SERVICE 1 to 4 Outlets
Dental Unit or Medical Gases
SEWER
1st 100'+Conn.
Ea. Add'l Conn.
Ea. Add'l 100' or Fraction
Private Disp.
PIPING
5.00
10.00
15.00
30.00
s.00
5.00
5.00
5.00
1.00
Temporary Gas Service 100.00
MISCELLANEOUS
Ourt-ldl(bt O.d.tfbn
I hereby allirm that I am exmpl trom lha Contracto/s Lic€ns Law lor the lollowing r6Bm (Se
761 5. Eusrne$ and Pror6aons Codg Any city or county which roquira ! p€rmil to con3lrrcl.
all6r. imp.ove. demolish. or .opaar any 3lructur6, prio. to als Bsuanca, ds roquirB lhe spplicant
lor such p€rmat to ,il6 r sqnod llalom6nt lhal he as lic€nsod puGuanl lo the prcvisions ol lha
Conlractor's Lacan3s Lsr (Chapler 9 (comm€ncing with Soction 7@0) ol OivBion 3 ot lhe
8usano$ 8nd Prot€asiofis Code) or thrt hs i3 erompt lhererrom 8nd lhe bais tor lhe 8ll€9€d
exgmptaon. Any vDlalion ol Soction N)3 1.5 by rny epplic8nl tor a permil subiocts the applactnl lo
a civil pemlty o, nol mor6 than tiva hundrsd do1186 (35m):
E Sclbn 7Or4.lA l. 83 ownor ol tho property. or my amplolEs wath wages !3lheir 3olo compan-
salion, will do lh€ mrk, snd tho strrclure is nol inlmdod s ofterod l,or Salo
E S*tio, 7(N48 l. ss owner ol lha propony. am cxclusivoly contr*ting r,rn iir.rd
conlrecloB to conSlruct thg proigct.
Oate Owner {Sig )
5.00
Contrrclo[ l,rar Only A3 '10.00 43o'o"'i)'12 L /
Water Heater - Electric or Gas
Water Piping Ea. 100'
Rain lrtJat€r Piping (buried) Ea. 100'2 2.5a It 8.00
Water Softner 4.00\Azr-Z- %zJ- 47v4p/>2/ /AOORESS
Alt. or Repair ol Drainage - Vent Piping 10.00"'%L-D-' o.G- -%tzoa,{-t
STATE/ZIP
?2 b47 Lawn Sprinkler 6.00
Rain System - Per Drain 10.00
lnd. Waste lnterceptor 8.00
Pool Traps 5.00
undor the provisions ol Chapter 9, Oivision 3ollhe Busin6sand
eOete
City //
I he.eby allirm thal I 8m
Code, and B an lull 8nd et *t
3.00Deck Drain System - Per Drain
Repair/Alt. Drainage or Vent 10.00
Vacuum Beakers 1-5 5.00
Owr5 'r .00
trolt.rr CG.tpilalbn Oaarrdon
I hsrcby Itlirm that I herc e ertiricrte ot @n3€nt to $lt-insure. or a cerlitiete ol Wo,td's Com-
p€ilon in any manmr so a lo becom subiocl lo lh€ Worto/s Componsalion Law3 ol
Calilomo
,aolb. To Afrfcrrl:
It afier making lhis CgtiricstaotEramption. you should b€@m6subiet to thaWo.ta/sCompefr
salion provBions ot lhc L8bor Cod€. you must loilhwrlh comply with sch provisions d this
permrl shall ba demsd ra.olcd
wilh the departmenl.
I certify that in the p€rldmarceof thispermit is bsad. l shall rctemployany
Dste
-
Appliont (sig.)
** 0 -S-K?
^ppriclnr
(sre.
pensaton lnsurante furfiod @py E filsd
*i1"" cl-tt - veri,i6d By (s,e )
Backllow Device 2" or Less
Water Service Ea. 100'
Over 2"
5.00
10.00
10.00
Subtotal
lssuance Fee
Fenatty tue (when applicable)
Violation Fee
Plan Check 657" of subtotal
Pc#Receipt No.
Plan Check
(s0.oo)
Date
(minimum 20.00)
10.00
7.
EiDartldt
This permicsh.ll expira by limilltion and bocomo null andvoid i, t,io rorl authdi:od by this
permil is not commncod within lEoday3 rom thodrlo o, lhis permit d ilrcrtaulhorizod by this
p€rmit as Suspended d rbendoned et any lim 8lltr ths uort is cmmncsd lor I poriod ol 180
days. A n* pamit 3h8ll be obtainod tiBl b€lss Such worl cln bo racommonc€d.
ArDlonl'.E don
I cenity thal I hava rEd thB applicatim end stele lhrnh€ lbove
euthorized repr@ntation ol thas cily to 6nttr upon the
Oate :s-
to
Applicant or Agent
I a9r6 to
h6reby@m9ly wilh 8ll crly ordimncos and slato laws
(minimum $35.00)
NoI r839
rOTAL PERMIT FEE
-8?
\l*-B!*i,ifr, iAh s */,,, o ",,.,n,PERMIT ISSUED BY (Sig.)
"/-ot0l3?
vALroATroN (oFFrcE usE oNLY)
(ACCOUNT r11-412)
L
Oistribution: 1. lnspeclor Copy 2. File Copy 3
'.637.m cs-61 I
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PLUMBING INSPECTION RECORDS
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Rcm!rkr
Ground Work (SoiU
Ground Work (Wat€r)
Water Service (Ground)
Gas Servico and Underground
Lawn Sprinklers
Wasle lnterceptor
Pool Traps
Sewer
Bool Drains
Waler H€aters
Water Soltner
Bental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Noles -(r,or- /* - , i rz.,il (/tD A c<-y' 4,r Or.r rn.- .E , *
D!t.Inrpcctor Approvrl
(Slgneturo)
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