Laserfiche WebLink
CITY OF SANTA ANA <br />PLEASE PRINT <br />PROJECT ADDRESS: <br />USE OF BUILDING: <br />BUILDING PERMIT APPLICATION WORKSHEET <br />2102 North Tustin Avehue SUITE: N.A. <br />RESIDENTIAL X COMMERCIAL INDUSTRIAL OTHER 4 <br />.- 3/2/05:forms/Blda App.Worksheet <br />SAPIN.#IOill-1 9 1 <br />·«e ' a,., MASTER ID# <br />NATURE OF WORK: XNEW ADD ALTER/T.I.DEMO REROOF REPAIR SIGN tMISC <br />OA,/AnDITION/Al TFRATION <br />5,580 <br />N.A. <br />6 2ND FL.. <br />116 NoneTOTAL OF OTHER FLS: <br />N.A. <br />GARAGE/CARPORT: <br />*A 1r/V-1/1 <br />.C 1ST FL SF BASEMENT: YES/NO <br />SF PATIO/ENCL. PATIO: <br />SF RES. REMODEL: <br />SF ALTER/T. I.: <br />NO <br />N.A. <br />N.A. <br />N.A. <br />SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />ONE <br />33'-11 1/2" <br />Retail/Prof. <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : New single story retail / <br />professional building on grade. <br />BUILDING OWNER'S NAME:Modj Rajaeeyan <br />ADDRESS: 2355 Pieper Lane <br />TENANT'S NAME (Comm/Ind)None <br />CONTRACTORS NAME: None selected. <br />ADDRESS: <br />WORKERS COMP. POLICY#EXP. DATE: <br />ARCHITECT/ENGINEER: Synergy Architecture <br />ADDRESS: 9701 Wilshire Blvd.,Ste.1000 <br />CONTACT NAME:John Siebel <br />CITY:Tustin <br />STATE CONTR. #: <br />CITY: <br />INSURANCE COMPANY: <br />STATE LICENSE #: C-8393 <br />CITY: Bevierly Hills <br />PHONE NO: 310 <br />PHONENO: 949-929-2630 <br />STATE: CA ZIP:92782 <br />PHONE NO:N.A. <br />LICENSE CLASS:PHONE NO: <br />STATE:ZIP: <br />SANTA ANA BUS. LIC. #: <br />PHONENO: 310-962-3252 <br />STATE: CA ZIP: 90212 <br />-962-3252 <br />E-MAILADDRESS:jes@synergyarchitecture.com <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #:Goo 62 7 P/C FEE PD $44 27 e <br />TYPE OF CONSTR:VALUATION: $4 (027 9 SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSEDV <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OKTOCHECK& DATE ty uu • 6 9 BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />Ill I1 11 0 i /1- <br />KJ-