HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (53)e IAPPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
667-273a /h*
APPLICANT FILL IN AREA BELOW
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*'4'f'6"/" Jr-,f.- Vu Urlln uo b'Y^ l,lr, ,- - on*ry%- o//a
NO.EACH TOTAL
FIXTURES
Dental Unit or Medical Gases
each plumbing fixture/trap s.00
10.00
ING A
Cl STA 2L SEWER
1st 100'+Conn./15.00 /{
Ea. Add'l Conn.5.00
Ea. Add'l 100' or Fraction 5.00
Private Sewage Disp. System
GAS SEBVICE 1 lo 4 Outlets
30.00
s.00
1.00
5.00
Ea. Add'l Outlet
Repair or Replace Gas Piping
OIrr.r-ed(l.r D.dr.l5n
I hereby atlirm that I am exempt trom lhe Conlracto,/s Lrcens Law tor lho tollowing reasm (Se
TCBl 5. Eusine3s and Prolossaons Code Any city or county whach roquirga a pormal lo conslrucl.
allor. amprov€, d€molish. or reEEir any slrucluB. pflo, lo als isuanco. alro raquires lh€ applient
lor such psmit to tila a signod statam€nl lh8l he is licgm€d punguant to lhs prDvisioG ot lhe
Contretor's Lcens Lil (Cheptar 9 (commncing wilh Soction 7@0) ol OavBim 3 ot lhe
Bwiness and Prol6sams Codo) or that hG b sxampt lherotrom and lhe batB td the alloged
€romption. Any vDlslloo ol S€clon 7(Xil 5 by any rpplicsnl tor s p€rmil sbicts tha spplicanl lo
a civil penalty o, nol mtro then live hundrad dollaB (35mrl
E S*fion ZOaa l. as owner ol the prop€dy. or my omplo!€es wrlh w!C63I thoir sole comp€n-
sation. will do lh€ mrl. and th€ strrcturo ia mt rnlend€d o, ofltrgd lor sle
E S*rion 704/aB l. ss owmr o, the prope.ly. .m srclusivGly conlreling walh liceolod
contiaclm to con{rucl lhe proi6ct.
Dale Owrer (S'g )
Water Heater - Electric or Gas
100.00
5.00
Contirl,or t ra Only
Water Piping Ea. 100'10.00CONTRACTOR
7h- A "-,, " .-!, /l-AA),, rt)bzlozozPHONE
Rain Water Piping (buried) Ea. 100'8.00
Water Softner 4.00I
AODRESS
Alt. or Repair ol Drainage - Vent Piping 10.00STATE/ZIP?Aazo Lawn Sprinkler 6.00
Rain System - Per Drain 10.00
lnd. Waste lnterceptor 8.00
5.00
I heraby alli,m lhal I am lrcensed under the provisions ol Chaptor 3ol the
Proressrons
Vlfr€""
Code, 8nd my licanso rs in full torco and etlocl.
3.00
10.00
Deck Drain System - Per Drain
Repair/Alt. Drainage or Vent
Vacuum Breakers 1-5
-Pool Traps
5.00
Over 5 1.00
Backflovv Device 2" or Less 5.00
Over 2"10.00
Water Service Ea. 100'10.00
pensalion Insurance Certried copy is ,iled with the City
,:olb. To ApPllcrl:
It atter makrng lhrs Cerlrfrcale ol Exemplron. you should become subrst to the Work€r's Compen-
satron provrsrons ol lhe Labor Code. you musl lorlhwrth comply wrlh such provisrons or lhrs
permrt shall be demed revoked
Oclmllon
this pormit is issuod, I shall not 6mployany
to the Workor's Comp€nsation Laws ol
which
sub,mt
Applicant (Sig.)Oate
anymannerssto
i n I he perrormanca ol ths
Applrcant
Calilornra
Oste
Expires
I hersby sttirm lhat I
Subtotal
Fee (when applicable)
Violation Fee
Plan Check 65% of subtotal
Pc#Receipt No.
Check (Adjustment)
(s0.00)
Date
(minimum 20.00)
ErCrdc.r
This p€rmit shsll oxpire by limilslion rnd b.como null and void i, the wt luthorizod by lhia
pcrmit B not @mmonc6d wilhin 1&)deys lrom lh€ (tato or lha! pormit or ilworkaulho{ized by tht3
is susp€nded or abandonod al any time atld th6 wort rs cmmncad lor a porod ol 18O
A n* pdmat thall b€ oblainad tiBt b€lore such wort crn bo o@mmoncod
ADelcrf.t hrdar
I cerlily thal I hsve rsd lhis rpglicrlaon lnd Jl.lo lhal Ute aboro lo
Applicant or Agont
with 8ll and slate rclsling to
th6this city to
PERMIT
(minimum
lssuance Fee
TOTAL PERi'IT FEE
5-t 7-
o-
10.00
PIPING
5:-
.5
MISCELLANEOUS
Gas Service
?yl*,yfi,SruG (sig )tu O-PERMIT ISSUEO BY (Sig.)
"U" ealq tU7?7Od-tL
(ACCOUNT r-4r2)
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o Copy 2 Fle Cogy 3. Frnsnce Copy 4 Applicent Copy
cs-61'l
Edesidential !lndustrial !Commercial
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PLUMBING INSPECTION RECORDS
Remarkr
>-
Ground Work (Soil)
Grouncl Worh (Waler)
Waler Service (Ground)
Gas Service and Underground
Lawn Sprinklers
Waste lnterceptor
Pool Traps
Sewer
Roof Drains
Waler Heaters
Waler Soltner
Rental or Medical Gases
Bough Plumbing
Final Plumbing
TemporaryGas Service
Noles {ilo /bz/-*.tQ
D.t.ln.pactor ApproYll
(Slgneturc)
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