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APPLICATIONAND <br />PLUMBING PERMIT <br />ITYPEWAITE OR PRINT IN INK) <br />o O c'r"orsoNTAANA <br />20 CIVIC CENTER PLAZA <br />834-4186 <br />@c <br />ozo <br />l" <br />a <br />P <br />= <br />NO.TOTALEACH2pQ2 p6. p6plar <br />JOSADOR€SS <br />FIXTURESPHONE <br />547-14q 1Iirrner 4.006ach plumbing f ixture/trap <br />10.00Dontal lJnitor Medical Gases <br />MAILINGAOOBESS <br />S'IIIE <br />SEWERSTATE/ZIPCITY <br />Santa Ana CA 10.00lst 100' + Conn <br />3.00 <br />3. O0Ea. Add'l 100'or Fraction <br />Private Sewage Disp. System 30.00 <br />GAS PIPING <br />5.00GAS SERVICE 1 tc 4 Outlels <br />1.00Ea. Add'lOutlet <br />20.00Temporary Gas Service <br />MISCELLANEOUS <br />OU|E-aad..D..ffi.r <br />I h.@by afftm $.r I .m exompt lrom dE Cfirelor's U6.36 L.w lor rh. following Ms (S6c. <br />7O3l ,5, Eurn63s and Prot$sio.s Cod.: Any ciry or cdniy which EquaEs . osftit ro cd$Mr. <br />6lbr. amp|@, &Folish, or Ep6jr sny.iirrcrurs, lnor ro its issurM, d$ roquiB. rh€ 6ptli5.r lot <br />such Fml ro fih s $omd ll.tElmr rha tl6 a! licons.d AirJa.t to ltE prdisims ol rh6 Conrrac- <br />ro/s Licons. La* (Ch.pr.r I lcmltr@ing wjth S€cli@ 70OOl ot DMton 3 of dto 8lsimss 6nd <br />Prcfessi<ns Code) d tEt h€ is ex@pl rhor.Irom and 6€ bris d riE alhlEd axmpton, Any tiola_ <br />tb. ol s€clio. 7031 .6 by any 6pdic6nt fo. 3 p€mn subio.ts rh€ aCdica.r ro . cMl Fndiy o, nor <br />m@ the^ liw hundBd dolhrs l$50O1: <br />E S""ri- rO4+a l,I @nor ol 01o p.opeo, o, my emdoy€ss wio wases.s th6n sob com' <br />p€ns€rion, will do rho wo.t, and rha ll'lJciJre B not i.r6nd6d or ot .r6d lor 3ah. <br />E S*ti* ZO&e l, as owior ot rhr p.openy, am etelusiEly c@u&ring wiih li.smsd c* <br />t&1o.s io @.tuct rh6 prc*Fr. <br />D.ra- owftr(Sio. <br />1 500 5-00Water Heater - Electric or Gas <br />Conrrrcror Ulo Onty <br />4.00Water Piping Ea. 100' <br />Mack PlLnnber <br />PHONE <br />859-9005 4.00Bain Water Piping {buriedl Ea. l0O' <br />WaterSottener <br />*R Mr.T.aran IIni + H <br />ADDFESS <br />3.00Alt. or Bepairot Drainage-Vent PipingCITY <br />Irvine <br />STA-TE/ZIP <br />CA 92714 3.00Lawn Sprinkler <br />4.00RainSystem- Per Drain (inside) <br />8.00lnd. Waste lntorceptor <br />5.00PoolTraps <br />I h6r6by affnn lhd I .m ic6m.d {ndsr ltts p.ovisi-s ot ch6pt6. 9, Di'.s'@ 3 oI tlo Bltlla 3nd <br />Preies*ss Codo, lnd my lirc is in tull torc€ an<l sfl€ct. <br />u*/Odq87 cr"* C-16 siy L,.**-J.25I53-- <br />see at5-14-85 <br />3.00Bool Drain System - Per Drain <br />Bepair/Alt. Drainage or Vent <br />5.00Vacuum Breakers 1-5 <br />1.00Over 5 <br />5.00Backflow Device 2" or Less <br />10.00Ovet 2" <br />Waler Service <br />lh.ra ComFllaadoo Mo.r <br />I h@by atli m tul I hav€ a cotuficaro ot coosonl to sell-in$r€, q . c6niricars ol \ivo(or's CoDp6._ <br />sation lns{r8nco. Conifiod cow is fil.d wirh dE City boildi.g arspaclioh doOarrmdl. <br />rs,o , I.r+i€ 3i€kl-cr-- <br />I @nit th.t in tE p€nomanc. of lho m.t lor which rh6 porhrl B issu€d, I $ell nol €mploy any <br />p.rson in 6ny manner so as ro be.mo $bjet ro lhe wdkei's c@p..slion Lr6 of cslirm6 <br />o.r. <br />- <br />aDolh..r lsh.l- <br />oth. To apdc-t: <br />f, .ft6. mitinq $ir C€rrificsro of Ex6mpto., vou sholld b€.lino $biFl lo th6 l b.r€.'s Comp€+ <br />s.lio. prdbids ol irE Lltor Cod6. you flun fo.rhfi$ cdnply with sjch p@ii6is or lhis psmir <br />JBll b. d.3iEd Evor6d. <br />sig )see at <br />oae erpira. (-] 7-r86a ey <br />p"t" 5-14-85 appri""*r <br />s.00Subtotal <br />Ponalty Fee (when applicable) <br />Violation Fee {minimum 335.oo) <br />Plan Check F€e (mininum $15.OO)Acct.* t 1'4O2 <br />PC NoRoceipt No <br />10 00lssuance Fee <br />TOTAL PERMIT FEE (minimum S35.oo) <br />PEBMITNO 5A R4 .. nn <br />Erpddt <br />This pemii sh.ll .xItB bV limii.t on snd bsorn6 null and vord it lho wo.k autndizod bY this pamn is <br />.or cohmic€d stnin 18O days trom lho &r. o, rhb pomil d , wort sutio.iz€d by $B p.mn i3 <br />srsp6.x,.d or.b.i&r6d .r anv rim€ ,lrs, lho ,ort is cmmrcod lc a poiiod ol l8O &y3. A lw <br />Fmir shall b6 oDtriBd ftrst h.toro such wo.t ca. bo €cnmon@d. <br />aefac.rt'3M.r <br />I coniy rhar I h.E ,o!d tnis appli@ud a6d sr.b lhbt ths sbow inrmldd is cffel. I 6groe ro <br />@ndy with all ciw odina..€s and srare |rws ,6hli.g to boilding co.rstructon. and hoEby autnc <br />,i.6 6pE$.t6riv63o, this city ro 6nt r upon lhs abo@€nti@d p.op€rty lor insp.clid pu.poss. <br />o"" 5:-L4=85 Appricanro,Aqo ls€ <br />,--^^-l/-'*-'R---!.-P"-.--lPEBMII ISSUEOBYISig.) <br />BUTLoTNG N/A <br />PERMIT No.------LvERIFIED BY (S's.lCfrr- <br />l 3500 : b 1322tsAVALIOATION IOFFICE USE ON LY) <br />tAccouNT111,4r2l <br />Distribution: l.lnspoctorCopy 2. FileCopy 3. FlnanceCopy 4. ApplicantCopy <br />APPLICANT FILL IN AREA BELOW <br />E Besidonrial n lndustrial ! Commorcial <br />Ea. Add'lConn. <br />4.00 <br />3.00 <br />oarr- 5-22-85 <br />. S,iIR