HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (46)o o
APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
CITY OF SANTA ANA
206 W 4th Street
667-2738
APPLICANT FILL IN AREA BELOW
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OWNER
Sur.tftoqre€ ASSoc-
Residential Ulndustrial DCommercial NO.EACH
Dental Unit or Medical Gases
5.00
10.00
each plumbing fixture/trap
FIXTURES
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MAILING AODBESS
CITYCos-tl freSg trl'42ac
Ourr-edld r D.dr.lloo
I haraby sllirm lhal I am exemgt lrom th6 Contracto/s Lrcens Law tor the lollowing rBaSon (Sec.
7001 5. Busina$ and Prol6sions Cods. Any city or county which requir6 6 permit to construcl.
alter. rmprove. dmd,sh. or rapsar any structurs. prior lo rls r$uance, ds requiros the applicant
lor such permil lo ,ale a sign€d ltatement thsl he rs licensad puBuant to th6 provasions ot the
Conlractor's License Lil (Chapl€r 9 (commncing with Soction 7@0) ol Oivisaon 3 ol the
Busine3s 8nd Protossiofls Code) or that he is oxempl lhorsrrom 6nd tho b836 ,ot thc sllegod
axemptaon Any violation ot Seclion 7!31 5 by any applicant tor a pormit 3ubiects tha 8pplicrnl lo
a civil p€n8lty of not more than live hundr€d dollaB (t5O0):
El S""tion zOla l. es owner ol the property. ormyomploy€Bwilhwag6 6 theirslscomp€n-
ralion. will do the rcrt. and tho struclure is nol intend€d or ollgred lor s8le.
f] S*tion 7(X4B l. as ownd ol tha prop€rty. am €xclusivaly cmtreling with licensed
conlracloG lo conslrucl ths proirct.
Dale
-
Owner (Srg )
Conhrclo[ lrtr Only
/cA f"Vtl-otot
ADORESS
DOLO
Oivrsion 3of the
subjocl lo lhe Worker's Comp€nstion Laws o,
ltofca To ArPllcrl:
ll alter makrng lhrs Certricaie ol Exemplroo, you should become subjcl to lhe Worker's Compen-
satron provrsrons ol the Labor Code. you must lonhw[h comply wrth such provasions or thrs
permrt shall be demed revoked
ol Worker's
Cily
?ou,*r,
rfofnra
Oate Applicant (Si9.)
OGlrdlon
I heraby
Pensatron
permil is issued. I shallmt employany
copy is liled
ol consenl to
anymenner$slo
in tha pertormsnco ol the
Applrcanl (Sig.)
Oate
Erprr6s
SEWER
1st 100'+Conn.15.00 oO
Ea. Add'l Conn.5.00
Ea. Add'l l0O' or Fraction 5.00
Private Sewage Disp. System 30.00
PIPING
GAS SERVICE 1 to 4 Outlets 5.00
Ea. Add'l Outlet 1.00
Repair or Replace Gas Piping 5.00
Temporary Gas Service 100.00
Water Heater - Electric or Gas 5.00
Water Piping Ea. '100'10.00
Rain Water (buried) Ea. 100'8.00
Water Softner 4.00
Alt. or Repair ol Drainage - Vent Piping 10.00
Lawn Sprinkler {i 6.00
System - Per Drain 10.00
lnd. Whste lnterceptor 8.00
Pool Traps 5.00
Dec* Drain System - Per Drain 3.00
Repair/Alt. Drainage or Venl 10.00
Vacuum Breakers 1-5 I 5.00 (P
Over 5 1.00
Backflow Device 2" or Less 5.00
Over 2"10.00
Water Service Ea. 100'10.00 a)
Subtotal
Penalty Fee (when applicable)
Violation Fee (s0.00)
Plan Check 65% ol subtotal (minimum 20.00)
Receipt t{o.16'l Pc#Date
Plan Chec'k (Adjustment)
lssuance Fee 10.00
Erpanuo.r
ThB parmit shall erpire by limitalion end bocome null and void it th€ work authdiz€d by this
parmil B not comm€ncod within t8o dsys rrcm the dat6 ot thb permil o( il wort 8uthorized by lhis
p€rmil B surp€ndgd or abandonod at any limo afltr lh€ work is cmmncod ,or a potiod ol 160
days. A n* pdmit shsll be obtainad liBt b€rde 3uch wort can ba |@mmncad.
r carrry rhar r have rsld rh.s appri*,mltffi*"
comply with 6ll cily ordimncB and stat€ lswg rolsting lo
I agrm
Oate Applicaot d Agenl
ol this city loSuthori:ed
purposes
VERI
BUILOING
PERMIT No PERMIT ISSUEO BY (Sig.
At- c-r\- o?gp. 0Ar,0
(ACCOUNT 1-41 2)
Oislribution: l. lnspstor Copy 2. Fils Copy 3. Finance Copy 4 Applicsnt CoPy
cs-61 r
rortrt
C t/ss
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MISCELLANEOUS
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TOTAL PERMIT FEE (mlnimum $115.00)rc] | 511 I
Code. and my lrense rs in
No '1laoQ3
Conlractor
ot
lorce and
Ia
PLUMBING INSPECTION RECORDS
Rcmrrkr
Ground Work (Soil)
Ground Work (Wateo
Water Service (Ground)
Gas Service and Underground
Lawn Sprinklers
Wasle lnterceptor
Pool Traps
Sewer
Rool Drains
Water Heaters
Wal€r Sorlner
Bental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Noles
O.t.ln.poctor Approval
(Sl9n.tur.)
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