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4{.BUILDING PERMITCity of Santa Ana PROJECT <br />ADDRESS:615 N. BRISTOL ST <br />SUITE #:SUITE <br />RANGE:JOBTYPE: UULTI /AL <br />511-553 rADORESS <br />RANGE:BUILDING f:DECK WORK <br />NATURE <br />OFWORK: <br />1 Bl@k: NA <br />LEGAL <br />OESCRIPTION: Lot CONDOS W/DET GARAGES <br />NO. OF EXISTING <br />BUILOINGS & USE: <br />rract: 1og G 1 VN <br />ryPE OF <br />@NSTRUCTION:R1 /U1@CUPANCY <br />GROUP: <br />405-08L-23ASSESSOR'S <br />PARCEL <br />': <br />undcr p.nalty ot p.riury that I .m Gxcmpt ftom thG ontractoE' <br />thr tolliling rcaen: <br />as M"r ot tl)c pDpcrty, or my cmployccs with mges as <br />will do tho rcrk, and thc structuG is not intcndsd or <br />l, aB Mcr of thc prcpGrty, .m crcBiEly ontracting with <br />construcl thc prcjcct <br />affirm <br />for <br />Scction 7O44A, l, <br />70!,48. <br />IENANT IMPROVEMENT <br />ANO / OR REMOOEL AREAI tbffi: x-o <br />owNER: SHADOyg WOOD HOA NEW / ADDL, <br />lst FLR. SO FT.: <br />NEW / ADDL, <br />OTHER SO, FT <br />NEW / AOOL. <br />GARAGE SQ. FT611 N BRISTOL STADDRESS:NEW/ADDL. <br />2nd FLR. SQ. FT.: <br />SANTA ANA, CA 92703 ZONltlG: R- 1 vALUAnoN: LSOO . OO <br />PHoNE: 7L4/542-3525 LLPLANNING <br />APPROVAL BY;LL /02 / eeDATE: <br />CONTRAGTOR:BLDG, SAFETY <br />PLAN CHECK BY:DATE: <br />JKAPERMIT <br />ISSUED LL /@2 /eeDATE:ADDRESS <br />NIMPROVEMENTS <br />REQUIRED:NLANDSCAPING <br />REOUIRED: <br />PHONE: <br />OWNERSTATE <br />LICENSE #:TYPE: <br />SANTA ANA <br />BUSINESS LICENSE #: <br />pcnatty ot psrjury on6 of thc lollrying Occlarations: <br />a Ccrtificatr Ol Consnt to Sclf-lnsurc lor WorkcB' <br />ol the rcrk to, which this pcrmit is issucd, I <br />asl <br />the <br />@Bgc is unlawrul, and <br />lot <br />rcquircd by <br />which thas <br />numb€r <br />arc: <br />WorkeE <br />lor the <br />so as b*ome theto WorkeE'subjecl <br />ifthat should b@ome thotoa9 ree subject <br />criminal <br />in addition <br />the Laborof <br />ofcost @mp€nstion, <br />andintcrcst, <br />inpeEonany <br />ol Calitornia. <br />Section 37@ of tho Labo, Cod., I shall <br />WARNING: Failura to surc WorkcE' <br />Policy <br />ccrtify that in the <br />not <br />p6mit is issucd. My <br />have and will <br />37m of thc <br />I hcroby effim r <br />I haw and <br />GFpcnsation, <br />padmancc ot <br />(this $ction <br />or lcss). <br />S€ction 3700 ot the Labor Coda, ior th€ <br />this Pcmit is bsued. <br />ENGINEER/ARCHITECT: <br />ADDRESS: <br />PHONE: <br />I undcr p@isions ot <br />of thc Businoss and <br />I <br />eft*t. <br />Dat!: Contraclor: <br />Liccnsc <br />ts tn <br />LICENSE ': <br />THIS PMT REPLACES LOL22855. <br />RESURFACE/WEATHERPROOF DECKS.T <br />HANDOUT GTVEN. <br />JOB DESCRIPTION: <br />Santa Ca.92701 <br />206 W. 4th. Street <br />2nd Floor <br />(714) 647-s800 <br />City of Santa Ana <br />Building Safety Div. M-I9 <br />P.O. Box 1988 <br />5 <br />2 <br />1 <br />t_L.@O <br />FEES:PERMIT FEE <br />ISSUANCE <br />FEE TOTALPAID TO DATEBALANCE DUE <br />502l @o <br />oo <br />7L <br />@ <br />7L <br />@@ <br />@o <br />oo <br />I hcrcby alfim under pGnally ol pGrjury thal thcrc is a <br />ior thc pcrfomanco ol tha mrk tor which this parmit i <br />DGmolition Pemits-Asbesbs Notif ication Fedcral <br />_RcquirGd Lcttcr o, NotiliBtion. <br />_l ccrtity that thG tcdcBl Ggulations rcgardang asb.stos <br />.pplicabl6 to tii3 projcct. <br />40, Pad 6) <br />arc not <br />is <br />is <br />agcncy <br />Civ. C.) <br />la6 <br />purPoses. <br />this Crty <br />Lcndc/s <br />Lcndc/s <br />Applicant or agcnt sig. <br />P.mit6 n.mc (print): <br />OWNER.BUILDER DECLARATION <br />WORKERS COMPENSATION DECLARATION <br />LICENSED CONTRACTT)RS DECLARATION <br />CONSTRUCTION LENDIN(T AGENCY <br />APPLICANT'S DECLARATICN <br />Mailing Address Public Counter <br />This permil shall expire by limilation and become null and void iI lhe work aulhorizEd <br />by this permil is nol commenced wilhin 180 days from lhe date of this permil, or if the <br />work aulhorized by this permil is suspended or abandoned for 180 days, al any time <br />after work was commenced, ln such case a new permit shall firsl be obtainad before <br />such work can be recommenced. <br />LO20270LPERMIT NO <br />Account No. 011-01-5911 - Pemrt Vafidation CS-6os <br />.INSPECTOR COPY.