HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (59)I o
APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
667-273€W
APPLICANT FILL IN AREA BELOW
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I hereby atlarm that I am exempt trom the Contraclor's Lrcmse Law lor the lollowing reason (Sec.
7031 5. Business and Pror6sions Code. Any city or county which .€quiras a pormil lo construct.
alter, improre. demolBh. or repair any structure. prior lo ils itsuance. al3o roquiras the applicant
lor such permit to lile 8 3igned statemenl lhal he is licensed pursuant to tho provisions ot the
Contrsclor's Licens€ Law (Chapter I (commencing wilh Setion 7(m) ol Oivision 3 ot the
Busines and Pror$ron3 Code) or lMt ha rs axompl thorerrom and the b63i8 tor the alloged
oxmption. Any violstrm ol Section 7m1.5 by 8ny applrcanl lor a p€rmat subiocls the spplicrnt lo
a civil penally o, not mor6 than riva hundrBd dollaE (tsoo)l
E S*tion 7(x4A l. as ownsr ol th6 proporly. or myemploy$s wrthwag€sas thearsolocompen-
salion. will do the mrt. rnd the gtructure is rcl inlmdod or otldsd lor sale
E S*tlon 70448 l, as owner ol the properly, am axclu8ively cont.actrng with licons€d
conlraclors lo conslruct the prolet
Oale Owner (Sr9 )
Conlrcto[ t r. Only
B€sidential !lndustrial ECommercial
Alt. or Repair of Drainage - Vent Piping
5-
NO.EACH TOTAL
5.00
10.00
15.00
30.00
5.00
5.00
s.00
100.00
1.00
5.00
Water Heater - Electric or Gas
Water Piping Ea. 100'
Water Softner
Rain Water Piping (buried) Ea. 100'
5.00
10.00
10.00
4.00
8.00
Dental Unit or Medical Gases
Temporary Gas Service
SEWER
Repair or Replace Gas Piping
'lst 100'+Conn.
Ea. Add'l Outlet
Ea. Add'l Conn.
GAS SERVICE't to 4 Outlets
Ea. Add'l t00' or Fraction
Prilate Sewage Disp System
PIPING
each plumbing fixture/trap
FIXTURES
/.7 4-070 7
PHONE
J*t-bz-? --t
"'" Xr-L, f/o STATE/ZIPQ773o Larn Sprinkler 6.00
Rain System - Per Drain 10.00
lnd. Wbste lnterceptor 8.00
. Pool Traps 5.00
I hereby affirm lhat I am licensd unde, the provisions ot Chapter 3ol the Busia/
(SE )
my licens is in lull lsce and ellect
Deck Drain System - Per Drain 3.00
Repair/Alt. Drainage or Vent 10.00
Vacuum Breakers 1-5 I 5.00
1.00Owr5
d/rfi*, Danice 2" or Less 5.00
10.00
10.00
taodc. To ADellcrl:
It aller mahrng thrs Cenrficateo,Eremplron. you should b6omesubistlotheWorke/sComp€n-
provrsrons ol the Labor Code, yo must lorlhwilh comply wilh such provisaons or this
shall be dsmed rsvoked.
Wo,t6r's Com-
Vefl fied
Calilornia
I hereby sltirm thal I have 8
OGlratlon
ol @nsml to sll-insure.
copy is liled wrth the Cily
Applicent (Sig.)
lhe perltrmErceolth€
subjoct
pensatron lnsuaance
Oats
-
Applicanl (Sig.)
this permit is issusd, I shall not6mployany
to the Wo.ke/s Compen$lion Laws ol
Oate
Erprres
L8.79 (minimum 20.00)
Pc#2Q l$ oate
(s0.00)
Over 2"
Water Service Ea. 100'
Subtotal
Fenahy Fee (when applicable)
Plan Check (Adjustment)
Violation Fee
Plan Check 650/" of subtotal
Receipt No.
lssuance Fee
TOTAL PERMIT FEE
DATE PERMIT
10.00
o-
Errr.do.r
ThB p€rmit shall erpirs by limitrlion end bocomo null and void if tho wort ruthoriz€d by thls
ftsrmit is not commncod wilhin 180 d8ys from lhe dalo ot lhi3 p€rmil or il mrk rulhorizod by thas
is suspended or absndon€d at any time alter the work is commncod lor a penod ol 180
A n* pdmit shall be obt8ingd tact belora such work can ba Gcommncad.
Appl8 nll D.d.rdqr
I cerlity that I hsve rcad this applielion and 3lale lhat tlr€ sboyo I a9,6 to
Applicant or Aganl (Sig.)
ol this cily to 6nttr
with 8ll end stste laws to
Y1^0-slbal (sig )VERIFIED
BUILOING
PERMIT No PERMIT ISSUEO BY (Sig.)
lrt t 17O
It
Oistnbution I ospeclot 2 File Copy 3 Frnance Copy 4 Applrcsnl Copy
cs-61 I
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M]SCELLANEOUS
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4(minimum $35.00)
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PLUMBING INSPECTION RECORDS
Romarkr
Ground Work (Soil)
Ground Work (Wale0
Water Servic€ (Ground)
Gas Servico and Underground
Lawn Sprinklers
Waste lnterceptor
Pool Traps
Sewer
Rool Drains
Waler Heaters
Water Soltner
Rental or Medical Gases
Rough Plumbang
Final Plumbing o
Temporary Gas Service
Noles
l'u
D.t.ln.p.ctor Approval(3lgn.tur.)
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