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PLEASE PRINT <br />PROJECT ADDRESS: <br />USE OF BUILDING: <br />CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />2102 North Tustin Avenue SUITE: N.A. <br />RESIDENTIAL X COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Blda.App.Worksht <br />SAPIN #10177-79,2_- <br />MASTER ID# <br />NATURE OF WORK XNEW ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <br />.IEW/ADDITION/Al TFRATION· <br />' 1 ST FL.5,580 SF BASEMENT: YES/NO <br />N.A. <br />f 2ND FL..SF PATIO/ENCL. PATIO: <br />TOTAL OF OTHER FLS:None <br />SF RES. REMODEL: <br />N.A. <br />GARAGE/CARPORT: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 seereverseside ofthis applicatipn) : New single story retail/ <br />professional building on grade.q>avid % lot <br />BUILDING OWNER'S NAME:Modj Rajaeeyan <br />ADDRESS: 2355 Pieper Lane <br />TENANT'S NAME (Comm/Ind):None <br />CONTRACTOR'S 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: Beverly Hills <br />PHONE NO: 310- <br />PHONE NO: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. LlC. #: <br />PHONENO: 310-962-3252 <br />STATE: CA ZIP: 90212 <br />962-3252 <br />E-MAIL ADDRESS:jes@synergyarchitecture.com <br />OFFICE UhE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #:600 22 P/C FEE PD $ <br />800 e <br />TYPE OF CONSTR:VALUATION: $30/000 SUBMITTAL DATE:122 le <br />FIRE SPKR: YES / NO A/C: YES/NO FLOOD ZONE:PROCESSED KN- <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />n / L/'PAA -*1 1 -10 1 -L <br />PLANNING OK TO CHECK & DATE '2/027 i " . & 7 BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: