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epirurcATroN AND t <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />APPLICANT FILL IN AREA BELOW Z"^ <br />c0g <br />7Izo <br />oof) <br />m(, <br />U) <br />(,{ <br />8 <br />@ <br />Brf <br />0, <br />rE <br />o <br />ts-Hts <br />or <br />rOo <br />UnP. <br />o <br />rro <br />0,aP.5(o <br />oHt <br />HtP.oo <br />'l <br />'"3fffi"Su"La Fe viltage DRive-Leasing office <br />MAILING <br />CITY <br />OWNERSunflower Associates <br />OillrJ-Bu[&t D.dt abn <br />I hereby atlirm that I am exmpl lrom ths Conlraclo/s Licensa Lil lqlhe tollowing ressm (Se. <br />7031.5. Business and Prol63ions Cod€. Any cily or counly which requires a permil to congtrucl. <br />alter, improve. demoli3h. or reprar aary structurc. prior to its isuan@. also roquir6 lho lpplicant <br />tor such permit to lile a signod statomsnt thet hs is licensod puEuant lo the provisionS ol the <br />Contraclor's Lic6s Lil (ChEpter I (@mmencing with Soction 7m) ot Division 3 ol the <br />Busin8s and Prol€asions Code) or thst ho is sxempl thorotrom end ths bBE lor tho allsged <br />axompton. Any violstion ol Selion 7031.5 by any epplimnl lor r p€rmil ebiccB the epplicsnl to <br />a crvil psnalty ol not more lhan livo hundrod dollars (9500)i <br />O Ssction 7O{4A I, as owner ol the propony. or my employcos with wa96 s lhairsle comp€n- <br />sation. will do the work. and lhe structure b ml intmded or ottorod lor sale. <br />E S*tion 704,18 l. a owns ol th6 property. am exclusivsly conttacting wilh licensed <br />@nlracl06 Io construct the pro,scl. <br />Oate Owrer (Sig.) <br />Contrr{o[ t,'. Only <br />3I8O Broken arrow <br />STATE/ZIP <br />cA 91710 <br />CONTRACTOR <br />ADDRESS <br />fl Residential D lnduslrial b Commercial <br />EACH FURNACE INCL. DUCTS AND VENTS <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Heat Rrmp Compressor less than 5 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Outdoor Dual Packaged Healing or Cooling <br />Repair, Alt. or Add. to any Heating/Cooling sys. <br />Range Hood with Ducl and Fan (Type l) <br />EACH TOTALNO. <br />Up to 100,000 BTU <br />Over 100,000 BTU <br />EACH ABSORPTION S\ETEM <br />100,000 BTU to 1,000,000 BTU <br />1,000,001 BTU to 2,000,000 BTU <br />5HPto30HP <br />31 to 50 HP <br />Over 50 HP <br />Air Handling less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Orcr'10,000 CFM <br />MISCELLANEOUS <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Dryer Vents <br />Decorati\re Fireplace (Wood or Gas) <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />25.00 <br />40.00 <br />25.00 <br />30.00 <br />10.00 <br />10.00 <br />10.00 <br />25.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />15.00 <br />15.00 <br />I hsreby a,lirm that I am licensed under the provisions of Chaptg 9. Oivision 3o, the Busin€a3 snd <br />my <br />7 e1 I27 <br />Protessrons Code, md <br />Cont,actor <br />liceme is in lull torca and atl*l <br />Cl6sLrcense No <br />55071 c20 <br />on" l2'L74 Each Vent Fan Connected to a Duct )15.00 ?n rlr) <br />tffi.rt CorDallalbo Dadrralon <br />I hffeby erlirm thal I have I certilicate o, @nst to s€lf-insure. or 8 cerlilicats ol Worier's Com <br />p6metion lnsurence. Certitied @py is liled with the City building inspoclion d€panmanl. <br />pctson in 8ny mannd so B to b€om€ subiecl to the Wdl6r's ComperBation LawS of <br />Calitomis <br />Noilc. fo Appllcrtl: <br />ll alter makrng lhrs Ce.trtrcale of Exomptron. you should become sublrct to lhe Worker's Compen- <br />salion provrsrons ol the Labor Code, you must lorthwilh comply w[h such provisions or this <br />permrl shall be demed revoked <br />ob <br />Date Applicsnt <br />Dat e Applicanl (Sig.) <br />I cerlify that rn the lo,whichthis I shall nbl employ any <br />Bil?* 4..90 vorinod By (si{,.) <br />Erplr.lbn <br />This permil shall €xpirs by limitation and become null and void il lh6 work authorizsd by lhis <br />permit B not commoncod within 180 deys trom the date o, thi3 p€rmit or il work authdized by lhis <br />tErmil is suspandsd or ab.ndm€d at any time atls th€ worl is commsnc6d lor a poriod ot 160 <br />d8ys A nd psmil shall be obtained li'3t b€loro 8uch work en bs recommgncsd. <br />ADDllcrnl'r hrAlm <br />I cenit that I hsve read this applicatiqr and 6tate thal the above inlormrtion is correct. I a0r€a to <br />comply with all city ordinancea and state lsws relsting lo building cmstuclion, and horoby <br />Applicanl or Agent <br />reprBentataon of lhas c[y to ontor upon lho prop€rly tor inspeclion <br />o,ntZ'L7fl <br />aulhoiized <br />pu,pos6. <br />Plan Check 650/o of subtotal 5e ,5O (minimum 20.00) <br />0 <br />or <br />this nolbul <br />Fan Coil lnstallation <br />Hood with Duct and Fan (Type ll) <br />Fire Extinguishing System <br />Each Evaporative Cooler <br />lncidental Gas Piping <br />Fire Damper lnstallation <br />by <br />abow <br />20.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />10.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee (s0.00) <br />DatePc#Receipt No. <br />Plan Check <br />lssuance Fee <br />TOTAL PERMIT FEE (minimum $35.00) <br />PERMIT NO. <br />10.00 <br />-0- <br />DArE L2-28-89 <br />Atrb <br />VERIFIEO BY (Sig ) <br />AtlftlU r.. <br />BUILDING <br />PERMIT No PEBMIT ISSUED BY (s'g ) <br />-- <br />.b _S?_ <br />Jr4/A l ,L - L7 - {)7 A11 rees lnid on t"t1o86s <br />USE ONLY) <br />Ct- . <br />vALroATroN (oFFrcE <br />(ACCOUNT fi r-412) <br />D-istribulion I lnspector Copy 2 File Copy 3 Finance Copy 4 Applicanl Copy <br />cs-618 <br />I <br />t <br />I <br />1 20-oo <br />PHONE <br />Norco