HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (25)t a
APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
667-2738
WAPPLICANT FILL IN AREA BELOW
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AODRESS
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PHONE*It-r-/b* 0/r.*d
E lndustrial fl Commercial NO,EACH TOTAL
5.00
10.00
each plumbing fixture/trap
Dental Unit or Medical GasesNG
SEWER"''[rfu >]1r-*STATE/ZIP
?a tal 15.00 /g-
5.00
5.00Ea. Add'l 100' or Fraction
Private Sewage Disp. System
1 st 1 0O' + Conn.
Ea. Add'l Conn.
30.00
OI'I,-lu[(,.t D.dalbn
I hereby srtirm that I am 6rcmpl lrom the contractor's Lrcens Law lor lhe lollowing ro8on (S€c.
7(I3l 5, Businss and Prcl6sions Code Any cily or county which requaros a p€tmrl to construcl,
alter. improve. dsmolish. or repair any structure, prior to ils issuanco. alSo roquiros the applicant
tor $ch permit to lile s sign€d statem6nt thal he B licensad puBuanl to the provisions ol the
Conlraclds Licm$ Lil (Chaptar 9 (comm€ncing with Setion 7@O) ol Oivbaon 3 ot th6
Eusrnoss end Prole3sioB @de) or that he is exompt th€relrom and the baSas tor the allegod
exemption AnyviolstaonotS€clion70:rl.Sbyanyepplicantlorapermilsubiectsth€spplicantto
6 crvil p€nally ol not mora than rive hundrod (bll8B (35m):
E S*tio, zOlu l. as owner ot lhe propeny. or myemployaas wilh wag6a3 thoirsolecompen-
s€tion. will do the mrt, end the strcture is nol intefld€d d ot d€d tor sale.
E S*tion 70448 L as owner ol tho proporly. am oxclusively conlracting with licslod
contraclm to conslrucl lhe proioct.
Oate Own6r (Sig.)
Conlrxio[ t a. Only
V;T:'i,^) ^. 0 0 A b t), ;tA- .t /.'14 - narfl
PHONE
STATE/ZIP
ADDRESS
I here(y afrirm thal I am licensed under lha provisions ot
PrdEms Code. ild mv tcense rs
,Y,?"o*"fl$ogi ",*"IaGEAGT contractor
3orthe Businsslnd
7an lull lorce and etlfft.
(sig.)
subiect to tho Wdkor's Compensetion Laws ol
l5tlc. To Aepllcil:
ll afler makrng thrs Ce.lricate ot Eremplaon. you should become sublst to the Workeas Compen-
p.ovisions ol the Lsbor Code. you must lorllilith comply with 6uch provisaons s this
shsll bo demed ,evolgd
Crpardon
This p€rmil shrll axpiro by limilatim and bocomo null and void il lh€ rcrk authorizod by this
p€rmit is not commncsd wilhin 100 day3 trcm lhe dsle ol lhis pormil or i, work 8uthotiz€d by thas
pormat ls susp€ndod o( abandoned at any tim srtd the woIt is commonced tor s perbd ol 180
A new permil shall be obtained ,i6t belore such work c8n bs Ecommanced.
Apefc..ra.. O.d.rdqr
I ceAity thst I have 6d lhis applicrtim and slat6 thst lhe ebove
Oclrrlbr
thal lhe
,iledis lhewithcopy
Applicanl or Agenl
Applicant
Date (Sig 1
Expires
cerlilacste ol Worter's Com-
depanmsnl
this parmit is issued. I shell nol 6mployBny
I eore to
with all city ordrnanm and state laws
ot lhis city to amer upon
I hereby atlirm lhat I have I ot consenl to
pensatron
Oale
p€M in any mnffi I a lo
Csliromia
Alt. or Repair of Drainage - Vent Piping
10.00
(minimum
I
GAS PIPING
Water Service Ea. 100'
GAS SERVICE 1 to 4 Outlets
Oyer2"
Ea. Add'l Outlet
Backflow Device 2" or Less
Repair or Replace Gas Piping
Owr5
Temporary Gas Service
Vacuum Breakers l-5
MISCELLANEOUS
Repair/Alt. Drainage or Vent
Water Heater - Electric or Gas
Water Ea. 100'
Rain Wbter 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
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
3.00
8.00
5.00
Subtotal
Penalty Fee (when applicable)
Violation Fee
Plan Check 650/o of sublotal
Pc#Receipt
Plan Check (Adjustment)
lssuance Fee
TOTAL PERMIT FEE
(50.00)
Date
(minimum 20.00)
>r.l* S1 oPEBMIT ISSUED BY (Sig,)tiJii?,yss4bL7u,^n,,K,,\ l,-
6J), ,l.r-* p ar), *"rt 141 17D s-/3- rl
,pta,rc 4 P't't-
VALIDATION (OFFICE USE ONLY)
(ACCOUNT
'r
1-ar2)
Orsl.ibulion 1 lnspector Copy 2. Fale Copy 3. Finance Copy 4 Applicenl Copy
CS-61 I
FIXTURES
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PLUMBING INSPECTION RECORDS
Rcm!.kr
Ground Work (Soil)
GroundWork {Waler)
Water Service (Ground)
Gas Service ahd Underground
tawn Sprinklers
Wasle lnlerceplor
Pool Traps
Sewer
Rool Drains
Waler Heaters
Waler Sottner
Flental or Meclical Gases
Bough Plumbing
Final Plumbing
' ' Temporary Gas Service
Notes
Datc ln.p.ctor Approvll
(8lgn.tur.)
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