HomeMy WebLinkAboutOC_347145 - Permit ApplicationREGIONAL OFFICE * APPLICATION FOR PLUMBING PERMIT CENTRAL OFFICE
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G-E1T6TDRIVE �COUNTY OF ORANGE .P 0 BOX 404
LAGUf(%L CA 926]] 480 CE
14
70 EMA—REGULATION SANTA ANA, C8
A 92701
W
BUILNNG
ADDRESS��
3
-
TRACT i I LOT NO.TOWN
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OR REA 'I've Lu
'
CONTRACTOR
NEAREST { - 1 ' G
..CROSS STREET
PLAN CHECK
' • " < 1 I
ADDRESS. ..
OWNER t ( A
�G'Ip0 ,:.:CITY
NO f
PROP $ED ... PRESENT i
USE - 1 - = E
'
CERTIFICATION FOR REGULATION PERMIT -
'— =i Contractors '- I <,
I teddy that the following Contr. Uc No • and'ClassKipetlon
Is,in full force and affect Workmen's Compensation Insurance
Certificate on file vanhed� by Expirellon data:
'
I j PERMIT FEES
f.
NO.I TYPE OF FICTURE OR ITEM
FEE
`Other Applicants ` C, -
J hereby cediN I am exempt imm Sec 7031 5o(fhe Buslnaes and Professional Catle,'
DivA, Ch 9r Contra er's License Lew and under the following section:
Chap.
- Mne
y Work nd 9)$100 (Sod7048)or -_-- -
❑Employee Working far wages only (Sect ]053), or 4
-
Certification of Exemption from. Sed 3000 of the California Labor Code, Article 3,
Construction Permit:
KThe permit ja for One Hundred. Dollars ($100) or less
1cedlfy lhalin the performance ofthe Workforwhith Nepermitis issued l shalinot
employ any y, person In any manner so as to.•become subject fo the Workmen's
Compensation laws of California ,.
" If, after making such comificationthe appllcarrt for Nis permltshould bowl me subjectto``
the Workmen's Compensation provisions of the Labor Code, Me applicant shall forthwith--
comply with the provisions of Sect'3700 or this permit shell be teamed revoked.
I hereby acknowledge and state lhatthelnfonnehon l have provided is correct both on the
permitandtheddmate and agree to comply With all County Ordinances and State laws
re Dieting I ing con a IQ
I Data
j WATER CLOSET (TOILET) / a
= BATHTUB _ _ _. - !,.,
SHOWERSTALL
®❑Other
LAVATORY (WASH BASIN)- 00
_ __
' KITCHEN SINK ❑GARBAGE DISPOSAL E]-. (
' LAUNDRY TRAY [I AUTO WASH. MACH.❑
-' DISHWASHER
SERVICE SINK
'. FLOOR SINK '._.. "
FLOOR DRAIN
URINAL -
(AP ants Si natu a Pennll Na
DRINKING FOUNTAIN
I
v INSP CTION RECORD
SAND TRAP ❑ INTERCEPTOR ❑
f t
E t`` -„
SWIMMING POOL FILTER
-
WATER HEATERAPPROVALS
�. DATE<. Inspfor's. Signature
WATER SOFTENER _.._. '_.
`.
GROUND. WORK -SOIL ONLY /•" %'-..%�/ '.
. LAWN;SPRINK LERS RES. C
❑ Q MM. ❑.
'
i
GROUND WORK WITH -
WATERPIPE I]' GASPIPE❑
TRAILER HOOK-UP
'.
ROUGH PLUMBING
f GAS SYSTEM" LPG ❑
i NO OFOUTLETS NAT
GAS PIPING TO • L ;,. j. !t-' �' " + „.u, . IC.,.,f
AUTO. FIRE SPR. SYSTCM
WATER 44011f;r, d'/,,,:af,.•f� e_7
MAIN DRAIN
SEPTIC. TANK
SEEPAGE PIT
-- HOUSE SEWER VALUATION -
`
'SEWER -
SEPTIC TANK
,�-
e i1 iy.,li J[g' J
GAS TEST
! SEEPAGE PITS)
'.
SPRINKLER SYSTEM
LEACHING FIELD -
"FINAL
- PERMIT ISSUANCE `.�.
3 OOr.
UTILITY CO NOTIFIED
BUILD G PER 45N OBER
[�
TOTAL�E
`
RECD BY I PLANS -
CHECKED BY: '
�
VERIFIED BY:
PERMIT ISSUANCE APPROVED:-�-
VALIDATION
R DATE
341, I4W,,.r`
- PERMIT NO..
1-I1..00 +
3
PERMIT. FEE
CODE
PLAN CHECK
111.00
TOTAL