BUILDING
<br /> y° .rr df 'f PERMIT PRo Ecr PERMIT NO. ]
<br /> ADDRESS: -. AEn_ _L _ PP.Rh ,�)R
<br /> OWNER-BUILDER DECLARATION SUITE JOB TYP�k .' ?P
<br /> RANGE: -
<br /> I thereby affirm that I am exempt from the contractor.beans.law for me ADDRESS NATURE �F y RANGE: '� BUILDING I. OF WORK: ]IolfpwiW moon:
<br /> Section 7044A.1,as owner of the proper,y,or in, weir epee LEGAL NO.OF EXISTINGE1 ' C r D
<br /> emdoYdda DESCRIPTION: LOC ` Block:'�' BUILDINGS A US fJ
<br /> b,lair•oat compensation,will de the work,and the structure is not Intended or
<br /> offered for•all. tM Tna: `it] TYPE OF OCCUPANCY
<br /> - CONSTRUCTION: GROUP:
<br /> Section as o e en 7044B,I, wnr of the Incident.
<br /> prii, usi
<br /> r,am excvely comncnnp
<br /> w'nh limreed convadws b coreruct pwjnaa. ASSESSOR'S _ _ TENANT IMPROVEMENT ROOD
<br /> PARCEL/: ��-� � - AND/OR REMODEL AREA: ZONE:
<br /> Dab Owner OWNER: �(1%�R iiC l,Jp^ L NEW/ADDL NEW/ADDL.
<br /> fat FLR.SO.FT.: OTHER SO.FT.:
<br /> • • • • • ADDRESS: 17 ti 1E -r F _ NEW I ADDL _- NEW,ADDL.
<br /> Znd FUR.SO.FT.: GARAGE S0.FT.:
<br /> I hereby all that I urn hearial brier Provisions of Chapter B,Division 0 of the ZONING
<br /> ---- :! - - - -
<br /> : VALUATION:
<br /> Busirw and Prof....`` Cede,and my license b in Intl force andy affect.
<br /> Data -2 Canuo"o, e LL�1�/ �J•4l Lh -� PHONE' _ - - APPROVPLANNINAL
<br /> _ DATE:
<br /> APPROVAL BY:
<br /> •' • •100a CONTRACTOR: SLOG,SAFETY DATE:
<br /> PLAN CHECK BY:
<br /> I her ebr atbrm that I has.I .cant f cat.of consem.. iled insure,or a C B.,Id, a of PERMIT
<br /> Worker o Cwnpansei on Insurarxa.Cart Fed copy-e filed with the City Buildup ADDRESS: - r ISSUED BY.�,.�' DATE:
<br /> Inspection Opwtmmt.
<br /> L IMPROVEMENTS LANDSCAPING
<br /> Date of Spnenee� Insurance Exprat on Data - REQUIRED: REQUIRED:
<br /> spnaweof Apdiunti'- ,.�r��` ' e<L `. PH ON E:. _ JOB DESCRIPTION:
<br /> I certify that in the performance of 1M work for when this 1 i•tued I•hall STATE 1 1 _
<br /> TYPE
<br /> not employ m,oulum n any meaner so as ls become bubs,1 m,the Worker. LICENSE I: - -- - - - -
<br /> Compareetion Iona of Cal fwNa. — -- - -- - -
<br /> SANTA ANA
<br /> Dole Applicant BUSINESS LICENSE I: - ✓ _ ,
<br /> NOTICE TO APPLICANT:If,after mabW this Certificate of Exemption,you ENGINEER/ARCHITECT: r -
<br /> shchad became bullet,to the Work-'.Ci mpens•tien provisions of this Labor -
<br /> Code,you must forfhwdh comp,with such wovisions or IN•Permit.hall be ADDRESSCONSTRUCTION LENDER
<br /> deemed rboksd.
<br /> I hereby affirm that Bee•ra a construction lendop apencY for the performance of PHONE'.
<br /> the work for which this permit is aboard(Sec.0097,Cw.Code).
<br /> LICENSE/:
<br /> Lender.Nsme: �+��LL {{�� �f �j I� q�
<br /> Lender.Address: __— FEES: fit..... ,.. _ _- r.7lr�OKL�.. DE tl Cah"TORS
<br /> APPLICANT'S DECLARATION R'
<br /> Demdrtion Permlb Asbesbs Notification Federal R gulnlons ITid•40.Part B) -
<br /> Re,oired latter of notification.
<br /> mrtify,,hot the Federal RWdedons rWandiry bbaatw removot are not
<br /> pplicablo to 1Na protect.
<br /> Mailing Address: Public Counter:
<br /> entity that I have rend dkb application and bate that NI,nd above
<br /> information is correct.I Wide to comply with all the city ordinances.also Intl CITY OF SANTA ANA 206 W.4T11.STREET
<br /> federal laws ralatirp to bnaldi,p constnkfipn and thereby..nor..u p esemativea
<br /> of the try to and•,won Ito wpyo-m.miwed properly for inepddl,n Purposes. BUILDING SAFETY DIV. M-19 god FLOOR
<br /> Sionsv.of - _ - P.O.BOX 1988 PHONE NUMBER
<br /> APdicen w Apenr. !+� [.�•r ,�.b:L 1 - - _ SANTA ANA,CA, 92701 (714) 647-SHOO
<br /> ri ACCOUNT NO. 011-01-5911 --PERMIT VALIDATION CS-605
<br /> ffNO3l95 9:MAM -5911 S 93_90
<br /> I ED days.III any time after work wI,%-mmenct I In such case a new Permit
<br /> %hall fits,be obtained before such work orn be ircorturienceill W,,"I calk C(WY
<br /> e, E',
<br />
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