HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (55)a oAPPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
667-273t)
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APPLICANT FILL IN AREA BELOW
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37oL k ,#, Y o lJr'^l lr-o - *EJOB AODNESS
Ho-,,ih',r.r- b-u*-t 516-o//oPHONE
TOTAL
FIXTURES
Dental Unit or Medical Gases 10.00
STATE/ZIP
G
ZL
MA
CITY SEWER
1 st 1 00' + Conn.1 '15.00 /i-
Ea. Add'l Conn.5.00
Ea. Add'l 100' or Fraclion s.00
Ow-800.r.r O.d-ttbo
I heraby altirm lhat I am ermpl lrom tt? Contraclor's Licens€ Law tor lh€ lollowing reaon (S€c
7031 5, Busrn8s and Prol6saons Codo. Any city or counly whach roquirs a permil lo construct.
rllar, rmprovo. demolish, oi ropair lny slruclure. p.ior to rls rsuanca. also requirs the lppliflnt
,or such permit to ,ila a sign€d 3tatemst thal he is licensed puBuant lo the proyisions o, the
Contractor's Lrcm$ Law (Chapter 9 (commncing with Section 7@0) o, Oivision 3 o, the
Eusinsss and Prot6sions Code) oi thst he is exsmpl tharetrom 8nd the basis lor the sllogod
er6mpton. Any violalion ot Soction 703t.5 by 8ny applicant tor e permit subioctr lhe applicent lo
8 civil psnally of not moro than livo hundred dollaB (35@)r
E SaclaonTO44A l.asownorollheprop€rly.ormysmploy6gswilhwag€sastheirsolecompon-
Eltaon. wrll do the wort, and th€ structure B nol intsd€d or ottgrod tor s8le.
E S*,,on 70448 l. as ownd ot lh€ prop€rty. am orclusivsly co{rtreling with licens€d
contracloG lo construct lhe proi*l
Oete
-
Owmr (Sig.)
Conlracio[ t,tr Only
WTh,;-t alili,t;,lo7l-nto7
PHONE
CITY STATE/ZIP
I hereby Sftirm thal I am licsn$d under lhe provisions ol Chapter_
Prolessrons Code. and mv hcense rs
,{,(R.f:fr,a93 ",,",i,,"r;y'*f contracror
in lull force and etlect
(sig )
subiect to the worker's Comp€nstion Laws ol
Lotca To Appllcrl:
lf atle. makrng thrs Cerlrtrcale ot Exemplron. you should become sublst lo the Worker's Compen-
salron prgvrsrons ol the Labor Code. you musl fonhwrlh comply wrlh such provrsioos or lhrs
permrl shall be demed revoked
ol Wo,t6r's
Dete
Exprres
I the
Ven liod
Calrlo.nra
Dlle
-
Appliclnt (Sig.)
OElrlbnWoitm
of consent to
rs tilsd with the Citypen$tron Insuaance
which this ps.mit rs issu6d, I shall not employ any
any manner 30 a5 to
Applicent
I hereby aflirm that I have a
Erpardo.r
This p€rmit shall expire by limilataon and b€come null and void i, tho rcrk authdizsd by this
FErmit ia mt comrcnc€d wathin 180 doys tom lhe date o, lhis permit tr il rcrk ruthorizod by thi3
p€rmil is suspend€d or abrndoned rt rny tam slls th6 woa is commncod lor a potiod ol 180
day3 A nB pdmit shall bG obtained tiBl b€rqe sch worl can bo ,€@mmenc8d.
897€€ lO
to8nd state@mply with all
this city to enter
Applrcsnl o. Agent
Appllc.il.t Otdf,atlo
I cortity lhol I heve rsd lhis applicatim and thal the ebove
authorizsd
purpos6
Alt. or Repair ol Drainage - Vent Piping
10.00
30.00
Subtotal
DATE
(minimum 20.00)
Private Sanage Disp. System
Whter SeMce Ea. l0O'
PIPING
GAS SERVICE 1 to 4 Outlets
Ea. Add'l Outlet
Repair or Replace Gas Piping
Temporary Gas Service
M]SCELLANEOUS
Water Healer - Eleclric or Gas
Water Piping Ea. 100'
Rain Water Piping (burk#) Ea. 10O'
Water Softner
-tLawn Sprinkler
Rain System - Per Drain
lnd. Waste lnterceptor
Fool Traps
Deck Drain System - Per Drain
Repair/Att. Drainage or Vent
Vacuum Breakers 1-5
Over 5
Backflow Device 2" or Less
Over 2"
5.00
100.00
1.00
s.00
5.00
10.00
10.00
10.00
8.00
s.00
4.00
1.00
10.00
5.00
6.00
10.00
10.00
3.00
8.00
5.00
Fee (when applicable)
Violation Fee
Plan Check 65% ol subtotal
Pc#Receipt l,lo.
Plan Check (Adjustment)
lssuance Fee
TOTAL PERMIT FEE
(50.00)
Date
(minimum
PERMIT
l -U ,g? ,/tA-oPERMIT ISSUED BY (S'9.)I{*ayisrLr? u, *K
O 0 -Lol o * ^ .,', -l- ,9y, llrl 'l q 7D y't,0, hL S./t t9
/vALroATroN (oFFrcE USE ONLY)
(ACCOUNT rl 1-4r2)
Drslnbutron 1 lnsp6ctor 2 File Copy 3. Finance Copy 4 Applicant Copy
cs-6r 1
?_L
! lndustrial ! Commercial NO.EACH
each 5.00
o t
PLUMBING INSPECTION RECORDS
Rcmrrkt
Ground Work (Soil)
Ground Work (Water)
Water Service (Ground)
Gas Service and Underground '.
Lawn Sprinklers
wasle lnterceptor
Pool Traps
Sewer
Rool Drains
Water Healers
Water Sorlner
Rental or Medical Gas€s
Rough Plumbing
Final Plumbing a
Temporary Gas Service
N otes' 1/5/z) rht*/r;*@
In.p.ctor Approv.l
(8lgn.turo)Ort.
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