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PRoJEcr ADDRESS: Z I l, t4 2r:+SUITE sacw* /OllO279z- <br />USE OF BUILDING:OTHER @,o?o-t5ccs <br />MASTER ID# <br />(nesroenr IA CONTMERCIAL INDUSTRIAL <br />V.c,r.J <br />62qc<) <br />To.<)b( <br />SF <br />SF <br />l( <br />NATURE OFWORK: NEW ADD ALTER/T.|. DEMO REPAIR SIGN MISC <br />non.residentiai proiects s side of this application) : <br />Drlr N/ALTE <br />2ND FLOOR <br />o <br />RES REMODEL <br />1ST FLOOR,NO. OF STORIESI <br />BLDG. HEIGHT: <br />PROPOSED USE: <br />PROJECT VALUE <br />SF PATIO/ENCL PATIO: <br />GARAGFJCARPORT: <br />JOB DESCRIPTION ( <br />ALTER/T I <br />ee revetse <br />-SF <br />SF <br />TOTAL OF OTHER FLS: _ SF <br />SF BASEIVIENT: YES/NO <br />BUILDING OWNER'S NAME: <br />Sr lrrcna< Madnqr.'t 4tfi c8+z <br />PHONE NO <br />1)q <br />ailZ € 9o1^ <br />ADDRESS:ctry <br />.Q^nlo.Arra <br />STATE: <br />/. ,/-1 <br />zlP <br />TENANT'S NAME (Comm/lnd) <br />CONTRACTOR'SFl(v; ? <br />NAI/E: <br />-..l,ns <br />STATE CONTR. #:/c8to /5 C9LICENSE CLASS 3t(;4t63$t <br />ZIP <br />RKERS COMP. POLICY#:EXP. DATE SANTA ANA BUS, LIC, #: <br />CHITECT/ENGINEER PHONE NOI <br />ctry STATE ZIP <br />PHONE NUMBER: f, <br />'l'al /5) <br />a <br />)./qi37 <br />DDRESS <br />STATE LICENSE #: <br />CtTY <br />C) <br />CONTACT NAME; <br />E-MAIL ADDRESS: <br />PLICANT SIGNATURE: <br />INSUMNCE COMPANY, /Stql€ I."nrl <br />CITY OF SANTA ANA <br />BUILDING PERMIT WORKSHEET <br />PLEASE PRINT APP-01 <br />OFFICE USE ONLY; <br />OCC. GROUP: <br />ACC PC (CTRCLE ONE)HRS PER BLDG, FEE $ <br />P/C FEE PD $RECEIPT #: <br />VALUATION. $0 Baa SUBMITTAL DATE <br />PROCESSED <br />T <br />FIRESPKR: YES/NO A/C: YESi NO FLOOD ZONE:* <br />RES. DEV. FEE; YES / NO PRIOR DWELLING UNIT: YES / NO COMI',,IENTS <br />PLANNING OK TO CHECK & OATE BLDG, DEPT, APPROVAL & DATE <br />@D <br />PHONE NO: <br />PHONE NO: <br />STATE: <br />FAX NUMBER: <br />TYPE OF CONSTR: <br />PLNG CONDITIONS: <br />Rev:9/18/2012