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APPLICATION FOP OK TO CH ECK a CITY OF SANTA ANA <br />20 CIVIC CENTEFI PLAZA <br />834-4186BYOATE <br />I her.bv .flirm th.r I .m lic.o.€d und.r rho p.ovi.io^. ol Ch.pr <br />3o,th. Bu3in.3r .nd Prore..ions Code, .nd my rrc <br />Cr <br />6 8t <br />C <br />OENA qt DG <br />WOR KE RS COMPE NSAT ION ECLA Tto <br />h.t I have . c.rt'lrc.te oi arr'1 <br />ic.t. of Wort..'s Comp6nratron lnlur.n <br />Cly bu'rd'np 'nrpecrV.,.8:26 <br />/, ".,,,," ,n., ," ,n.( t rr'crr ""t "-prov r <br />Work.r.3 CornDe^sr <br />".,J\€k6 <br />o.rfo.h.hco of th <br />ny p.r.on 'n .^v m.nn.r.o <br />io^ L.wr or C.lifernr.. <br />ecom€ tubj.cr ro rhe <br />ooo,,fi <br />NOTICE TO APPLICANT ll, .1r.. m.ting rhir C.rritic.t. ol Eremprio^, <br />Vos rhould bocom. rlbjo.i lo thG Worl.r'r Comp.nr.lon provirio^r ol <br />L.bor Cod., you musr lorrhwith comply with ruch proviiioni or thit <br />rt rh!l| b. d..m.d r <br />CONSTRUCTIOI{ LENDERh.r.by .lirrm thlr th.r. ir . con3tructio. r.ndinC !0on.y to. rh. p..lor <br />.n.e ol rh. work lor whrch rh'r oerm'l '. rt.!.d (S.c 3O97. C'v C.) <br />l'{o uc <br />APPLI ANT'S DEC ARATI N <br />I c.rltv rh.r I h.v. r..d I <br />ia corr.cr I .e,@ <br />ro buildi^9 co^srt <br />to.ntar opon rha a <br />r.^ca ba/<- / o <br />IL iL tovl S t3 AcD <br />3e1 <br />o 5 <br />I <br />I <br />{-/A-2 <br />New Addn Alter Conv R epa Move Demo <br />Comm lndust the <br />.2 <br />lPPDrert */,i.ES <br />as HDIL <br />/L/, fDA t /t 5.1 NT /+ A Nn- <br />LEC IDARilN M <br />,,rr+73l'tJtz 73 <br />L,O f/ t /TtE e n qa{.ca <br />I hcr.by .ltirm th.t I .m e!.6pr from th. cootr..ror'r l'.en.. l.w lor tho <br />Res. <br />Cf-Jrwrth I'c€rBed conrr.cto, i ro <br />""," 3\s\<s".", <br />23-23e- <br />B-*2eo oTtot la./z**e a 5O*'lnt s,^rElrte4 <br />GEl'5 <br />,." Ll <br />f-*r-cr <br />t <br />,.,D ""U <br />z3 <br />illi l0 <br />6k-Lr?4A,f\SK <br />LESJ.THA too <br />'a/@8AO (rSrgnarure ot ApDl,c.nr o. As.^! <br />BUILDING PERMIT <br />(TYPEWRITE OR PRINT IN INK} <br />t <br />APPLICAI{T FILL IN AR€A BELOW AND ON RCVERSE SIDE <br />,trzrdr:l:,: <br />D Se"tio" 704/tA l, rs own.r ol rh. p'op.rry, or my ahploy..s wirh <br />wao.s aa rh.r, ror€ .oop.niar,on, w'lr do rha work, 6nd th€ <br />'"t."Fo o, otl.,ed lo, l.l. <br />t-J Secrron 70448 l, rs own€' ol rh. propsrry, .m.xclu3rv.ry conrra.rrnC <br />I <br />d <br />dB <br />I <br />3 <br />tr <br />234 <br />I <br />?{