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47.,a aAPPI,ICATION AND
<br />JI'IECHANICAL PERMTT
<br />(TYPEWRITE OR PRINT IN INK)
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />834-4186
<br />APPLICANT FILL IN AREA BELOW
<br />@c
<br />Izo
<br />ooa
<br />NO TOTALEACHExesidential n Indusr'ial E Comms.cial
<br />FIXTUflES
<br />I
<br />E
<br />JOBAODFESS
<br />CI., OUCTSANO VENTS
<br />I
<br />j\
<br />M.oooBru r0.00
<br />Over l00.OO0 BTU
<br />EACH AASOAPTTON SYSTEM
<br />CITY
<br />Up ro 1O0,00O BTU 6.00
<br />500.001 io 1.000-000 BTU
<br />1,000,001 to 2,O00.OO0 BTU 22 5A
<br />EACH COMPAESSOB, BOILEB, OB HEAT PUMP
<br />37 50
<br />600Up lo 5 HP
<br />6lo l5 HP 1r.00
<br />l6lo 30 HP 15.00
<br />3l to 50 HP
<br />Own .-Edld.r D.claldo'l
<br />lhersby alrim thal I sm Exohpr f.om ln6 Co.tEcio/s Licen$ Law fo. th€ foll rg rcgson (Se.
<br />7O3I 5. Eusinos 8nd P.ol8doB Cod6r AnV ciry o. county which roqutss a pemir ro consrucl,
<br />3lror. im!.o!o, dsmolish, or rsran any $ructu.e, pnor o irs rssuancB, also r6qui.6s lh6 applicrnr lor
<br />slch p€mir ro lile 6 signed sr.lo@nr lhar tu is ticensed pus@ ro lh€ pdisio.. ot dE Co.lEc-
<br />ro.'s Lic€.se llw lchaOlsr 9 lcommenong wirh Selim 70OOl o! Divisio. 3 ol rhe Busi..s rnd
<br />Prolgssions Codol o. rhar h6 is.xempi ln6,€tDm and lhe basis to. rhe alle!€d exompion. Any vaola-
<br />tim ol Setim 7031.5 by a.y applicEnr lor a @rmt slbj@rs the apdi@nr lo a ciul po.slrY ol nol
<br />mors han,iv€ hundr€d dorl6c ($5OOl:
<br />D Socton ToaaA l, ss ow., ot lhe poo€rry, or my omproves wth wag.s ss |nstr sore c@-p.nslid, will do lho wo,t, a.d rho sftucture is nor i.E.ded or ofler€d ld el6.
<br />l, as orner ol lhe p,openy.! s6cr,on Toaa
<br />Ove. 50 HP 37 50
<br />EACH AIA HANDLING UNIT
<br />up 1o 2,0o0cFM 4.50
<br />Conrr.cror Usa Only
<br />PHONE
<br />4502.001 to 10.000 CFM
<br />Over 1O.O00 CFM I0.00
<br />MISCELLANEOUS
<br />Outdoor Dual Packaged H &20 00,
<br />CITY SIAIE/ZIP
<br />,o o{
<br />I \ r c{00L\dro
<br />Itoo
<br />undor rh6 provisionsofChapler 9, Division 3 ot lhe Busitu+s and
<br />Cont.clo, rSe )-
<br />licens€ is in lull iorc6 End ellecl
<br />\rdoo
<br />sor
<br />Cooting I
<br />t 600
<br />Ductand FanRange Hood 4.50
<br />400
<br />\an cotttnsratft,in I ^
<br />o.ool.r
<br />o\r,".iy'sy""ffi$. tbd
<br />)Jo )
<br />\)u*lnc dsnElGas Pipi
<br />500
<br />t'0.\"Each Appllance or Equipment
<br />lhisCode bul not specirically li
<br />o.ro- Aoor(an slo r-
<br />I cenity lhar in lhe pe ormance ol rhe wod lq which
<br />l{ollc. To Applcant:
<br />ll. afle, makno rhisCerril cale ol Exenpnon. you should beohe subject lo lhe Wor[er's Compen
<br />slron provrsro.sor lhe Labo. Code, you musllonhwnh comply wilh su.h p.ov'srons or lh sperh t
<br />shall be deemed revoked
<br />rsoas ro b€cohe subp.lto the
<br />Oaro Exoir€a V6dDd 8v (Sig
<br />\J'rtl
<br />4t \jP
<br />Hoodwilh Ouci and Fan r
<br />SU
<br />Penally Fee Iwhen applicable )
<br />Violalion Fee {minimuh $35.00}
<br />t0
<br />Plan Check Fee (minimum S15.00)
<br />TOTAL !m S3s.0o)
<br />DAIE
<br />E4lr.don
<br />Th6 pa.mil shallexpne bv lir.ilarion 6nd b€com6 noll3nd void l, the wolk authonzBd bv thG o€rm is
<br />nor commsncod wilhin l80dsys,rom lhe d.le ot rhis pe,mitor il wql aulhori.ed by lhispsrmirG
<br />esp..ded d.b6.doBd.r..v tm6 6h..lhe wqt ir cmmo@d lo.. p6.iod ol l8O d€ys AEw
<br />p6mil sh.ll bo oblai.od li.si belo.s such wo* .an b6 rocmmened
<br />Appllcanf r D.cl..!tlon
<br />ce.1ly thal lhave read rh's6pplcanon and srale rhar rheabove 'nlormaron,s cofecl agree ro
<br />.omply wlh alctV o,dr.ances a.d sraie aws re arng io b! ld,nqconslrucno.. and herebys!rhc
<br />n?e.epre$.ratvesotrhiscirylo6nle.upo.lhe.bo@-ren oned
<br />,"r"?/b Appk6nro.Agsr lS'g I
<br />PEBMIT ISSUEO SY (Siq.l9/VERIFIEO BY (Sig r7
<br />-SATR 3?,5 3500: b 30538
<br />Bt]ILDING
<br />VALIDAT ION IOfTCE USE ONTY
<br />'laccouNTtrl-415t
<br />Distribution: l.lnspectorCopy 2.FileCopy 3 Finance Copy 4. ApplicantCopy
<br />#/-
<br />,rr'?6t?a&.nA
<br />&
<br />\rJbrko6 Comp.nration Doclar.iion
<br />I he'ebv alirm th.l I have a .erri'.ab ol con*nt io sell rnsure, or a cenfrcate o1 Worke. s Cohpen
<br />salonlnsurance Cert,'€d copy
<br />'s
<br />I'red w lh rhe C'ry bu ld'ng nspecron deparlhcnt
<br />100,001 to 50O,O00 BTU
<br />15.00
<br />1100
<br />15.00
<br />Over 2.000,000 BTU
<br />22.50
<br />Froo, Fu,nace I
<br />I
<br />F;:**, (r /{a
<br />-PC
<br />No.
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