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City of Santa Ana PRq.lECT <br />ADORESS:611 N. BRISTOL ST <br />SUrrE*: oFFICE SUITE <br />RANGE:JOBTYPE: MULTI /AL <br />5t L-553AOORESS <br />RANGE:BUILOING #:ALTERNATURE <br />OF WORK:I NA <br />Blck: <br />LEGAL <br />OESCRImON: Lot <br />CONDO COMPLEXNO. OF EXISTING <br />EUILOINGS & UsEl <br />rnct 1c,8 5 L V-NTYPE OF <br />CONSTRUCTION: <br />BOCCUPANCY <br />GROUP: <br />s@5-oaL-23ASSESSOR',S <br />PARCEL il: <br />I h.cby etfim undsi prnalty of pcrjury that I am axempt ftom thc contracloG' <br />liccns law for thc folliling ,6aen: <br />_ Scction 7044A. l. as omer ot thc prcpcrty, or my cmployG with Mgcs as <br />thrir slc ffipGnstion, will do thc rcrk, and tha structuG is not intcnd6d or <br />offcrcd lor slc. <br />t <br />70448, l, as mcr thc with <br />@nskuc't <br />TENANI IMPROVEMENT <br />ANO / OR REMODEL AREA: <br />x-@FLOOO <br />ZONE: <br />owNER: SHADOW WOOD HOA <br />NEW / AOOL, <br />1st FLR. SQ. FT.: <br />NEW/ADOL. <br />OTHER SQ, FT.: <br />NEW / ADDL. <br />GARAGE M, FT,: <br />ADDRESS: %MANUEL SEPULVEDA NEW / ADOL. <br />2nd FLR. SQ. FT.: <br />511 N BRISTOL ST ZONING: R- 1 VALUATION: <br />SANTA ANA, CA PHONE:VCPLANNING <br />APPROVAL BY:DArE: @A / t1 / 99 <br />CONTRACTOR:BLDG. SAFEW <br />PLAN CHECK BY:/,DATE: <br />HjE'J.", 6-aoN @8/L7/9eDATE:ADDRESS:rr .r rr-rv nnl:C\EIl\/nTll/.\NlJlvllvlul\l I <br />^F I tln I Af I r.\t\ I <br />I f f-f E\)l-l I vr-r I '\'zr !DIMPROVEMENTS <br />REOUIREO: <br />LANDSCAPING <br />REOUIRED: <br />i <br />I <br />I h.rcby atfim und.r pOnalty of p.riury one of thc tolliling O@laEtions: <br />I haE and will maintain a Ccrtificatc Ot Consont to S.lt-lnsurc tor WorkcB'ffi'pcnstion, as p@idcd ,or by SGction 37OO of the Labor Cod6, for thc <br />pcriormencc of thr rcIk tor which this Pemit is issucd. <br />_l haE and will maintain WorkcB' Compcnstion lnsunncc, as rcquired by <br />S6lion 37m ot the Labor Codc, for thc pcrfomancc of thc rcrk ,or wtrich thispomil is issucd. My Workc6' Compcnstion lnsuran@ caricr and policy numb€r <br />a16: <br />PolicvNury:fyF#f-"' : <br />that in the perrormance of the rcrk for which this prrmit is issued, I <br />any pe6on in any manner so as to brcome <br />WARNING: Failurc to surr WorkeE' Compansation coerage is unlaw'ul, and <br />shall subj6ct an cmployer lo criminal ponalties and civil rines up loonc hundred <br />thousand dollaE ($1m,0m), in addition to the cost of compcnsation, damaEcs as <br />prwidod for in Soction 3706 of ihe Labor Code, interest, and attorney's tees. <br />i] <br />subjacl <br />of <br />A <br />to the <br />and agree that if I <br />I shallof Scction 3700 <br />thos <br />ADDRESS: <br />PHONE: <br />I hcrcby .ftim undcr penalty ol perjury that I am licen$d under prdisions of <br />Chaplu I (@mmcncing with &ction 7000) o, DMsion 3 ol thc Busincss and <br />Prclcssions Codc, and my lic.ns is in full torcc and cttccl. <br />Lionia Clas:_ Liccn$ No. <br />Datc: -Contraclor:LICENSE #: <br />INSTALL DRYWALL IN OFFICE <br />X'U BE /EHIFIED BY <br />FIELD INSPECTION <br />JOB DESCRIPTION: <br />f-/ <br />Santa Ca.92701 <br />BY/DAT <br />PER: <br />206 W. 4th. Street <br />2nd Floor <br />(714) 647-5800 <br />City of Santa Ana <br />Building Safety Div. M-19 <br />P.O. Box 1988 <br />1 <br />1 <br />1 <br />1 <br />FEE TOTALPAID TO DATE <br />BALANCE DUE <br />FEES:PERMIT FEE <br />INVESTIGATION <br />PENALTY <br />ISSUANCE <br />232.@@ <br />@.oo <br />232 . OO <br />20 <br />55135 <br />2L <br />@o <br />oo <br />oo <br />oo <br />20 <br />55 <br />135 <br />2L <br />oo <br />@@ <br />@@ <br />o@ <br />I hcroby atfirm undcr pGnatty of perjury that thcrc is a conslruction lcnding agcncy <br />for thc pcrlormancc of thG rcrk for which this pcrmit is issuod SGc. 3097, Civ. C.) <br />!-6nda,'s namc' <br />D.molition PormiB-AsbcstDs Notification Fsd.ral Rcgulations Oitlc 40, Part 6) <br />_Rcquircd Lctt r ol Notifietion. <br />_l crftty that thc lcdcEl rcAulations ragarding asb.st6 rcmffil arc not <br />appliabl. to thE prqrct <br />and County <br />I <br />Lcndc/s <br />cltv <br />r) <br />iooncct. I <br />rclating to <br />and County to <br />and Statc laE <br />P.rmittE namc (print): <br />jPPlient ot .g.nt <br />_l ccrtty that I h.E rc.d this <br />with all <br />OWNER.BUILDER DECLARATION <br />WO RKERS COM PET.ISATIOIi DE CI-A RATIOT{ <br />LICENSED CONTRACTORS DECLARATION <br />CONSTRUCTION LENDING AGENCY <br />APPLICANT'S DECLARATION <br />Mailing Address Puhlic Counter <br />This permit shall expire by limilalion and b€come null and void if lhe work aulhodzed <br />by lhis permil is nol commenced wilhin 180 days from lhe date of lhis permil, or if the <br />work aulhorized by lhis permit is suspended or abandoned for 180 days, at any lime <br />aner work was commenced, ln such case a new permit shall first be oblained before <br />such work can be recommenced. <br />, 2-ro- 27 <br />MBUILDING PERMIT PERMIT NO.LO20242L <br />Account No. 011-01-5911 - Pemit Validation CS-6os <br />?ty, r:s9mfr <br />eL <br />t{IscEL t2s2.m <br />,rvsPEcron coPY ->Avfl)