|
o oAPPLICATION AND
<br />PLUMB!NG PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />CITY OF SANTA ANA
<br />206 W. 4lh Slreel
<br />667-273€
<br />APPLICANT FILL IN AREA BELOW
<br />4ry
<br />.7dO2-?t V*L.-,JOB AODRESS
<br />ILING A
<br />-3 aB
<br />cn\ y' -r- ,- I
<br />-XLr,*--qt, Ll/-1-zt----2
<br />STATE/ZIPQazoc
<br />OrE-adld r O.dribn
<br />I nereb, altrrm h l am ereh lrom the Co.tractois Lrce.* ta* lor th. ,otto*rng rcason (SE
<br />7@1 5 AusrBs and Plol6sons Co<re Any cny or cou.ty whrcn.equ(esa p€rmf toconsrruct.
<br />alrer. 'dprove dehorrln. or regatr .ny st tucture. pnor to rts rssu6hce. also r€qur6s the !pph6.t
<br />lor soch permd lo lle 3 egned slaleme thst he 's hce.sd pu6ua.t to the previsro.s oi rh.
<br />Conlr.cio.s L€e^* La* {Chaprer 9 (comoencr.g w h S..tton 7@) o, Orv6.on 3 or tne
<br />Busrnes3 and Pro,63ro.s Code) or ln.t he rs sremDr therekom and lhe bG6 lor th. 6fl,e9od
<br />erempton a.y vor.lr6 ol secron 7031 5by any apph@nt lor a pDrmn sub,ets the.pgtlcait lo
<br />a c,v'l pe.arry or nor more lha. rrve hund,€d .torraB (S5O0l
<br />E ser'o.7oa4a r,.s owne,ol rhep@oeny. ormyemproyecaw'ln wrges.slne(soDcompen-
<br />3.1'On w l do rne {or* and lhe ll.uctu.e E rcl nlsnded or otlered toi sale
<br />E selDn /o.r.A I as ownd oi the p.ope.ry. am ercrusrery conractrng w h rrcens€d
<br />conlracloR ro cohskucl lhe 9rotecl
<br />VLH, 3,,)^ -, tnto , / 24 -07{
<br />SIAIE/zIP a
<br />AOORESS
<br />CITY
<br />tno*y,nir{y'n t^r,,*,*ondo'lh€ p.dbio.lr ot cn.ri.. q Dllil|on 3ortl€ Bl,.lncrtnd
<br />ftol6.Jo.B Co(b. Ild my lic€rE€ a i. tull to.ca .nd .ttscr o//4 7'tb
<br />o.te /'/-z -ff co.rrlcror (sig )
<br />,"**".*9La12u*
<br />r.rt . Coi$.rdo.! O.clr.do.!
<br />I h€reby alitro rhar I h.ve . c.niliere o, cons€nt to solt-in3oE, or . @dinc.te ot tryb or'3 Cohp6i$rlo. l.su.anc€ c€n i6d copy E tilod *Ih rho oly b!'rdmg r.sp6.tion (bp!rlm.t.
<br />1ce iiy rhd in rh6 p..lo,mMca ol the roit ior f,hich thi. Fmn i! illood, I lhrtt iot €nptoy !.ry
<br />prLson in .ny m.n.r.r io 6 ro b.com !!bl.cr ro the Wort./. Compen$llon t- 3 ol
<br />lo!c. ro APrlb.rt
<br />rl aner mak'n9 rh's cerlrlrcareolErempt,o.. youshoutd become sub|ect to the wor*els compe6-
<br />sat'o^ Fovrs,ons ol rhe L.bor code yor musl loahw{h corpry rrth $ch prdEon3 or lh,s
<br />Perm'l shallb€ demcd revoted
<br />4L{a
<br />2,2 '? -t I
<br />CrpEo.
<br />ThE p.m .n!I olPrc by lmrtlrio. and t€coFe nulr md,oid it th6 ro.r rdno.iud by this
<br />p€rm'r a nor comm.nced eihi. l8O @ys toF $e dar. ot lht! p.rhlt or at *ort ,urho.a..d !y thi!
<br />p6rm[ b $lp€nd€d or .bindon€d .r r.y rim€ .fi.r lh. worx b cornnEocod tor . p..i, ol 1&
<br />d.y! A n.w p€rmn sndl b€ obtsinsd lir.t b.tor6 such eort ci. b. rlcomm€.E d
<br />AtPt .nl'. D.crd(.r
<br />I c€n y thd I n e6 E d rhi. lpplEar'oi lnd rlalc ihat lh6 rboy! intormrtion i. co.E 1. I ro.d to
<br />comply wirh rll cary o.dn nc6 and 3i't€ lr*s rd!ri.! io building cst!tuctb.. .nr, h.r.!y
<br />&lho.i.od r.pr6.nhrion ot hr! cny ro .nr6 upon thc !bo\.{h.ntion€d prop.ny lor ii!p..ii,on
<br />Appncanr or Ags (S€ )
<br />ial O lnduslrial E Commercial NO.TOTAL
<br />FIXTURES
<br />each plumbing fixtue/trap
<br />Dental Unit or Medical Gases
<br />SEWER
<br />1st 100' + Conn.'t 5.00
<br />Ea. Add'l C,onn.5.00
<br />Ea. Add'l 100' or Fraction 5.00
<br />Private Sewage Oisp. System 30.00
<br />GAS PIPING
<br />GAS SERVICE 1 to 4 Outlets 5.00
<br />Ea. Add l Outlel 1.00
<br />Repair or Replace Gas Piping 5.00
<br />Temporary Gas Service 100.00
<br />MISCELLANEOUS
<br />Whter Heater - Eleclric or Gas 5.00
<br />r^/aler Piping Ea. 100'10.00
<br />Rain Water Piping (buded) Ea. 100'8.00
<br />Water Softner 4.00
<br />Alt. or R€pair of Drainage - Vent Pidr€10.00
<br />Lalrn Sprinkler 6.00
<br />Rain System - Per Drain 10.00
<br />lnd. Waste lnlerceptor 8.00
<br />Pool Traps 5.00
<br />H( Drain System - Per Drain 3.00
<br />Repair/Alt. Drainage or Venl 10.00
<br />Vacuum BGakers 1-5 5.00
<br />Over 5 1.00
<br />5.00
<br />Ovet 2"10.00
<br />\ fater Service Ea. 100'10.00
<br />Subtotal
<br />Penalty F€e (when applicable)
<br />Violation Fee (50.00)
<br />(minimum 20.00)
<br />Receipt No Pc#Date
<br />Plan Check (Adjustment)
<br />lssuance Fee 10.00
<br />TOTAL PEBMIT FEE (minimum $35.00)3J--
<br />DATE PEBMIT
<br />{5.00
<br />10.00
<br />\ [,--L?1.A----+iEr.rtEo sy t ,etAUILOING '"-.,[* 5q
<br />VALIOATION {OFFICE USE ONLY)
<br />{ACCOIJNT '1r..1?l
<br />tilrl|
<br />olsrnbunon r ri3plcro. copy z Fite coot 3 r,na"cetfi[l\fi$pr4l6fffl Cffil $E.m
<br />CS-611
<br />l,,c
<br />Izo
<br />0oa
<br />I
<br />EACH
<br />Backflow Device 2" or Less
<br />Plan Check 65'/. ol subtotal
<br />o,a l/- ) f?
<br />PEFTMTT ISSUEO AY {Sig }
<br />a-",.., a7,O-, .
|