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PROJECT
<br />AOORESS:508 N. BRISTOI, STCity of Santa Ana
<br />SUITE '
<br />SU TE
<br />RANGE JOB TYPE RF:S /NE
<br />NA
<br />AOORESS
<br />RANGE]BUILO NG 'CLEAR I.OT
<br />NATURE
<br />LEGAL
<br />DESCRIPTION: Lotl LO Bl@k: NA SFD ANN GAPA(IE
<br />NO, OF Ei(STING
<br />AUILDINGS & USE
<br />rhclr 1152 VN
<br />TYPE OF
<br />CONSTRUCTION:R3./tr1
<br />OCCUPANCY
<br />GROUP:
<br />lh.6by.ftm und.r p.n.rv ol pc'uryth.l l.h.x6mpr lrom lh..onlEctors'lic.ns.l.w lor th6 loll@i.q G.$.
<br />_ S.clron 7044A, I, as M.r ol lh. pmp.ny or my .mploy.6s wilh wages .s
<br />!h.t .ol. comp.ns.tio., will do th6 wlk, .nd th. stuctrr. is nol inl$d.d ot
<br />_ S.cton 70taB l, .. osd o, th. prcpcrty .h .rcusEly @.lr.ctng wnh
<br />lic.nE d @ntr.cto6 !o consirud th. prci.ct.
<br />405 -07 3- L7ASSESSOR'S
<br />(
<br />'TENANT IMPROVEMENT
<br />ANO / OR REMODEL AREA x-oFLOOD
<br />lzoNE
<br />OWNER: CTTY OT SANTA ANA o @
<br />oNEW/ADOL,20 CIVIC CENTER PZAOORESS o2nd FLR SO. FT
<br />zoNrNG sP-1 (O/CSANTA ANA, CA r,/SuAnoN 6500 . OO
<br />ATTN: BOB HAUFFM.AI tsrorue 71{/555-4008 JRPLANNING OATE oe/23/e7
<br />coNrRAcroR: AII{ERICAN CONCRETE CUTTING BLOG, SAFETY
<br />PLAN CHEC( BY.DATE
<br />,KU"ISSUED BY
<br />520 POINSETTIA STAOORESS OATE.oe /2t/ s7
<br />rMPRovEyd(Jrs NREOU REO NLANOSCAPING
<br />REOUIREO
<br />SANTA ANA, C^ 927@L
<br />3907s
<br />k-o
<br />ENGINEERYARCHITECT:
<br />ryPESTATE
<br />LICENSE 3
<br />BUSINESS LICENSE *
<br />I h.Gby.fiim undr p.nafiy ot p.ryry on. ol tn6 iollolei.g D.cl.rrlion!:
<br />l neE .nd will maintain a C.tiric.l. Ot Cons.nt io S.lf-lns'r€ tor Wo 66'
<br />66p.n..lion, es provid.d ior by S.ction 37@ o, th. L.bor Cod., ior th.p.dmancc oi th. rc.t lo. whrch th8 P.mn is Bso.d.
<br />_.lzahav. and willm.inLi. wo.k B comp.nsaton lnrur.ic., .. r.qur.d by
<br />Seno. 37m ol th. trbo, Cod., lor th. p..lona.c. ol th. rcrk lor which this
<br />pofinn i6 issu.d. My Work.ls' Comp6ns:tio. lnsuran.. c.ri.r.nd policy numb€.
<br />Policy Numb.r_
<br />$is;6ctDn.@@
<br />Wo.k.6' Comp..salDn prdisDns d SaclDn
<br />WARNING F.'lur.lo !€cur. Wo,k.rs' Co+p€nsal'on c@rage 's unlawlul .nd
<br />sr.! sub.cl an.Fployer to cnF n.lpenart.s aad c'rll.n.s uDtoon. hLnoredlioG.nd doll.6 (!100,0OO), ih addtion tolh€cosiol comp.nsnon, damages as
<br />prdid.d tor i. Soction 3706 ol th. LaborCod.. rnt 16(.nd ano.n.y's l4s
<br />lc.ft'fv thai in lh. oedorma.c. ol
<br />iFa_ll nor rri'ptoy any pcrcn rn any ma
<br />Comp.nsi@n LaE ol Caliomia, a.d I
<br />the rc.k lo. Ftich this p6.mt is rssu.d I
<br />si,bj@t io th6 wodeE'
<br />ld beom. sublecl to lh6
<br />)T f'a.n a\
<br />ADDRESS:
<br />PHONE
<br />L]CENSE '
<br />I he..by.tn.m under pc.alty or peru.ylhatl.m lE6nsd und6. p@ieons ol
<br />Chaplet9 (comm.n.ins wilh Seclion 7000) o, Oivision 3 ol the gosi.ess and
<br />Prol.ssiona Cod., .nd hy lic.nse is in lulltorco and
<br />+t,5{
<br />PEII{O SFR AND GARAGE AND CLEARLgT / CTTY PROJECT*92A7 ,76A3.7626.1440w.Q.* 48657 , ACC* 325s16631.
<br />( urD BRISTOL')
<br />JOS OESCRIPTION
<br />p 11')t 7
<br />CL
<br />0q
<br />206 W. 4th. Street
<br />2nd Floor
<br />(7 14) 647 -s800
<br />City of Santa Ana
<br />Building Safety Div. M-19
<br />P.O. Box l9EE
<br />Santa Ana, Ca.92701
<br />OTY
<br />1
<br />1
<br />1
<br />AI,IOUNTLts.OO
<br />20.o@
<br />FEE115.O0
<br />FEES:
<br />PERI,IIT FEEI SSUANCECITY JOB
<br />o.ooo.@oo,oorEE TOTALPAID TO DATE
<br />20
<br />8
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<br />o
<br />@
<br />o
<br />.@o
<br />:88
<br />.oo.oo
<br />.o@
<br />- 13t
<br />o
<br />8g
<br />@@
<br />l h.r.by.tfrm dnd.r p...lryol p€lurythat$.r. rs..omltucnon l.nd,rt.s.ncy
<br />tor th. p.rlom.nc. ol d'. e,k lor wnrch tnrs pcrmn 15 is3u.d Se 3097. Cd C )
<br />O.molilio. P.,mits-Asb.stos Notific.tion F6d.6l R.golalioni Oitl. zO P.n 8)
<br />.rLa*rot .*, ,
<br />"rr-oon_l c.tit that h. H.El .c!ul.non3 Elerding .3b..!o3 r.movel ar. nol
<br />.pplic.bl. to this prol.ct
<br />,,ry'
<br />L
<br />-r..r l.9r..lo
<br />Pcnin.. nemc (print)
<br />_l c.rt, th.l I h.6 ,..d this a znd stat. thal th. abd. i.lomatron rs
<br />Couovodin.nc6 and st t l.s
<br />r.pr6e.LtiEs ol lhis Cfy
<br />OWNER-BUILDER DECLARATION
<br />WORKERS COMPENSATIO]'I DECLARATIOT.I
<br />LICENSED CONTRACTORS DECLARATION
<br />CONSTRUCTION LENOING AGENCY
<br />Mailing Addrcss Puhlic Count€r
<br />This p€rmil shalle4rre by limilation and become nulland void iflhewo* ardh.izdd
<br />by lhis permil is nol commenc€d wilhin 180 days lrom lhe dale of lhis perm'l. or if lhe
<br />wort aulho.ized by lhis p€rmil is suspend€d or abandoned for 1 80 days, al any trme
<br />afler \ rort was commencsd. ln such case a new p€rmit shall lirsl b€ oblained before
<br />such v,Jorl can be recommenced.
<br />BUILDING PERMIT PERMIT NO. LoL!4sza
<br />Account No.011-01-5911 - Pafinit Validatioa Cs-ms
<br />- INSPECTOR COPY _
<br />NEW/AOOL.
<br />15i FLR SO FT:
<br />NEW/AOOL.
<br />OTHER SO ET,:
<br />tr a qll
<br />APPLICANTS DECL,ARATION
<br />#r57
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