HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (41)"'Cff'&q SF,.nA f6 r.l\uuree Otg
sqc-ol laPHONEOWNER
MAILING AOORESS \33\5 Tarra.vie0 RD
"'"c os+A lN€sA INl\zezc
NO.EACH
I
I
5.00
10.00
1 st 1 00' + Conn.
Ea. Add'l 100'or Fraction
Ea. Add'l Conn.
15.00
5.00
5.00
each plumbing fixture/trap
Dental Unit or Medical Gases
FIXTURES
Residential fl lndustrial E Commercial
Rivate Sanage Disp. System 30.00
GAS PIPING
GAS SERVICE 1 to 4 Outlets I 5.00 qe
1.00
5.00
Ea. Add'l Outlet
Repair or Replace Gas Piping
Ou'.r-8dl,.t D.dr.tlon
I hereby allirm lhal I am €xsmpl lrom thc Conlraclo/s Licens Law lor lhe lollowing roaon (Ss.
703.l.5. Busaness and Protessions Codo. Any cily or county wtrich tequites a permil lo conslruct.
altar. improve. d€molish, s repair any struclure, prior to its isuanco. also toquir$ tho Spplicant
for sch permat lo lile a sqned stalomenl thal he B licens€d puBuanl lo the provisbns ol lhe
Contractor's Licenss Law (Chrpter 9 (@mmencing with Seclion 7@0) ol Oivision 3 ot the
Eusiness and Prot6sions @de) or thal he is exempl lhsrelrom 8nd ths basis tor lhe slleg€d
oxemption. Any violslion ol S€clion 7031.5 by 8ny sppli€nt ,or I psrmil subicls th8 spplicant to
a civil penslty ot nol more lhan tive hundrod (blla's (3500):
E Sfrtion 70444 l. a3 owner ot lha property. or my employses with wrCB s lheir sole compen-
salion. will do the wort. rnd th€ 3tructure is rcl anlfldsd or ollded lor $le.
El s*tlon 7(x4B l, a owns ol the proporty. am sxclusivaly contreting wirh licomod
contracloB lo comtrucl th6 project.
Oate Owner (Sig.)
Contrclo[ lrra Only
CONTRACTORlhFr Hnt /.r+L &PPL/.AT/A 4?y-otot
PHONE
u
AOORESS/?Vgt DEvrrTL
I"u'533dCITY/r+KE EtSrtuoae
I hereby aflrrm lhal I am lrcensed uoder the provisions ol Chapler 9.3olthe
Contraclor (Sig.)
and
Oate
ol 1-?
Clsss
rs rn full
I lEEby alfirm that I havc a carlilieto ol @nsl to ssll-insure,
subiocl to lhe Worker's Comp€nstion Laws ol
]aotlc. To AP9llcrt:
ll alter makrng lhrs Ce.trfrcate ol Exemptron. you should become subltrt lo the Worker's Compen-
provrsrons o, llE Labor Code. you musl lorlhwilh comply wilh such ptovBions or lh6
Worksr's Com-
Applrcsnt (Sig.)
OGlJltbn
the
penstpn
Date App[cant (Srg )
Cstali€d copy is lilad wilh th€
Ve.ilied
Calilornia
rn any manner $ a to
rn lha peimil is issued. I shall rct 6mployany
permrt shall be demed,evoked
06te
Expires
Alt. or Repair of Drainage - Vent Piping
100.00
10.00
liemporary Gas Service
Water Service Ea. 100'
MISCELLANEOUS
Owr2"
Water Heater - Electric or Gas
Backfloriv Device 2" or Less
Water Piping Ea. 100'
Owr5
Rain Water Piping (buried) Ea. 100'
Vacuum Breakers 1-5
Water Soflner
Sprinkler
Rain System - for Drain
lnd. Waste lnterceptor
Pool Traps
Deck Drain System - Per Drain
or VentRepair/Alt.
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
Fenalty Fee (when
Violation Fee
Plan Check 650/o of zubtolal
Pc#Receipt No.
Plan Check (Adjustment)
lssuance Fee
TOTAL PERMIT FEE
DATE
(minimum 20.00)
Date
(s0.00)Erplr.ltoo
Thrs permil shrll erpire by limilrtim and bocoma null and vcid il lhe wotk autho.rz€d by lhis
lErmit is not commonced wilhin 1&, dsys lrom the date ol this permit or it work sulhorized by lhis
pe.mit is sBp€ndod d abandoned ,t any timo Ittor lho work is cmmonctd lor a ,Eriod o, 180
drys. A n* pdmrt ghall bg obtainod fiBl b€loro such worl cen ba mmmned.
tcerrity thet I hrve rsd thisapp,,*ffi;ffim,
Applicani or Agont
I agr*
tocomply with all crly ordimncs and stala laws
ol lhrs city lo enls
PERMIT ISSUEO 8Y (Sig.)ehq (sis )PERMIT No
LDING
Aut-PD . oN n- O? 17o -/1-4121
6- tt
o o
APPLICATION AND
'ptutrtBtNc PERMTT
(TYPEWRITE OR PRINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
66,7-2738
APPLICANT FILL IN AREA BELOW
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Drslnbulron I Copy 2 File Copy 3 Finance Copy 4 Applrcsnl Copy
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SEWER
Surs + t-o,rpgR ASSOC.
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PLUMBING INSPECTION RECORDS r
Ramrrk!
Ground Work (Soil)
Ground Work (Water)
Water 56rvic€ (Ground)
Gas Service and Underground
Lawn Sprinklers
Wasle lnl€rceptor
Pool Traps
Sewer
Rool Drains
Water Heaters
Water Softner I
Rental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Notes
D.t.!napaclor Approval
(8lgn.tu..)
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