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APPLICATION AND
<br />PLUMBING PERMIT
<br />(TYPEWRITE OB PRINT IN INK)
<br />e o CITY OF SANTA ANA
<br />206 W 4ih Slreet
<br />667-273A
<br />6r'
<br />q
<br />Izo
<br />oo,
<br />,b(esidentiat (] lnduslrial E Commercial EACHJOB AOOFESSe26s ur)
<br />NG AOOBESS
<br />CITY--4 -[L."'Fil2D1,,
<br />5.00
<br />1.00
<br />GAS SERVICE 1 to 4 Outlets
<br />Repair or Replace Gas Piping
<br />Ea. Add l Outlet
<br />5.00
<br />Ortf,-llrt(hr O.ct .!ron
<br />I horeby afi.n rhar r em erenpl lrom tie Contr.cto/s trcolo ta* to, lhe ,ollophg re656 (S&
<br />7031 5. Busrness and Poless'ons Cod? Any cny orcounty whrch.€qw€sa pe.mrt to construcl,
<br />alter. rm9rove, demolEh. or repar riy slrucllre, prc, to (3 Bsuanca. atso requtres lhe appt'cs.tbr socn permrl lo lils r sgned 3t6teDe.t th.r he B trcens€d pu6ua to ttE p,ovB'ons o, the
<br />Co.lr.cror's trce.se Le (Ch.prs 9 (comh€nctng *{h S€ctio. 7@) ot D'vi.lon 3 ot th€
<br />Susrness ,hd Prol6sons Code) or ftat he
<br />'3
<br />er.mpt th€retrom and lhe bas's lo. the a .g€d
<br />sxempl'on Any solanon ol SEton 7031 5by anyapptlcant lor 5 p€,mll sbiects th€.pptica.t lo
<br />a civrr p.nally ol not oore th.n 6ve hundred drll66 (lslb)
<br />E s*r,on rooa r. .s o,ner ol rhe prop€ny or my empoyeos *rlh wag6 .s thetr sote compen
<br />sal'on. wrlldo he *ort and lhe sructu
<br />d.^ ,*orr as o*ne, o, rh.
<br />re 6 nor rnlended or oliered lor sale
<br />:;;;/ru 100.00
<br />5.00
<br />10.00
<br />8.00
<br />4.00
<br />ADOFESS
<br />10.00CITYSTATE/ZIP
<br />6.00
<br />10.00
<br />8.00
<br />5.00
<br />I h6..by allnh rhal r am lr@sed undorlhe provls@ns o, chrptd 9, Div.$on3otlheEusin6!and
<br />Pro,o6.'ons Code, &d my lrcanse,s rn tull lor.e lnd 6fioct
<br />$odd Co r.flruon O.ctr.tb. ,
<br />I t€rebyatnrmlhat I have a cenrl.ar€ ol @.se. o setl ns!.e or3cen icateot wo d's com-
<br />pensitDn lnsu,an@ Csrrned copy rs rrred * h the Ory burtdr.g rnsletr@ depanmenr
<br />l, alid matrng lhrs C€.rrlcare oi Eremplo., you shootd be.ome slq€d to rh€ Wo.ke/s Comp*
<br />sallo. prov6Dns ot lhe f.6o. code. y@ musi ,onhwtth con ry f,nh soch pdrsons o. thE
<br />,€.mrr shall b€ demod r€voted
<br />rs b$ed, l 3n.ll .ol mploy any
<br />Expnos
<br />-
<br />verin€d 8y (S,9 )
<br />I cenry lhal '.lhepenormarcepe6on rn .ny
<br />C.hlorn'a
<br />*,".//'r'Vffi ^*,
<br />Device 2" or Less
<br />(m tntmum $3s.00)
<br />3.00
<br />10.00
<br />10.00
<br />10.00
<br />5.00
<br />5.00
<br />1.00
<br />Deck Drain Syslem - Per Drajn
<br />Repair/Att. Drainage or Vent
<br />Vacuum Breakers 1-5
<br />Over 2'
<br />Vlhter Service Ea. 100'
<br />Sublotal
<br />Penalty Fee (when applicable)
<br />Violalion Fee
<br />Check (Adjusiment)
<br />lssuance Fee
<br />TOTAL PERMIT FEE
<br />oarc / / -
<br />(50.00)
<br />Dale
<br />(minimum 20.00)
<br />PEFMIT NO.
<br />Receipt f,lo.Pc#
<br />Crrt?doi
<br />Tha perhn sh.ll *p,e !y timiraio !.d becorn€ nul a.d vod il th. ro.t luthoriz.d by thi3p.rm( u nor comnr€ncod wihan r m dty! rroh tha date ot lni! p.rmi or n roA .ulho,tscd by nt3p..m[ is su6p€ndcd or .b.ndon€d ar a.y tm. .ft, the worr ir comG...d tor t periin ot t6O
<br />&ys A ner p..m( $.fl b. obriinfir lirst D€to'3 .lJch woa cln t ocohrl€ncsd.
<br />ltl..lll O.d-dal
<br />I clniry lhal I niv6 ,e.d |hG apl icanon and stsrs thd $s .bo,o rnto.mrton b co..!ct. I 4r.. io
<br />coDply *'rh .rr .,ry ordrha.cB .nd st.te rsE retat
<br />aulhon2ed eorenlalDn ollhs c y to e.t6 upon the
<br />::"LgA
<br />TOTAL
<br />FIXTURES
<br />each plumbing f ixture/kap
<br />Dental Unit or l\redical Gases
<br />SEWER
<br />lst 100'+Conn.
<br />Ea. Add'l Conn.
<br />Ea. Add l 100'or Fraction
<br />ftivate Sewag€ Disp. System
<br />GAS PIPING
<br />Temporary Gas Service
<br />MISCELLANEOUS
<br />Whter Heater - Eleclric or Gas
<br />Waler Piping Ea. 100'a
<br />Water Sottner
<br />Alt. or Bepair ol Drainage - Vent Piping
<br />Lawn Sp.inkler
<br />Rain Syslem - Per Drain
<br />lnd. Waste lnterceptor
<br />Pool Traps
<br />10.00
<br />o 5.00
<br />10.00
<br />15.00
<br />5.00
<br />5.00
<br />30.00
<br />5
<br />A-&--E!*8,1P,{L{"\,,,,".,,",n,PEFMIT ISSUEO BY (SE )
<br />ONLY)
<br />0
<br />{ACCOUNT TIT-ata
<br />O'llnbunon t hspeclor Copy 2 FrreCopy 3 Finance
<br />cs 6ri
<br />APPLICANT FILL IN AREA BELOW
<br />{.,
<br />N!i\t-.I
<br />l$
<br />t.
<br />i
<br />NO,
<br />Rain t /ater Piping (buried) Ea. 1OO'
<br />O\€r 5
<br />y'z
<br />Plan Check 65% of subtotal
<br />Conrraclor (Siq )
<br />na- 5"
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