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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 />