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aAPPLICATION FOR <br />-AUILDING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o CITY OF SANTA ANA <br />2O CIVIC CENTER PLAZA <br />DAT 834-4186)L ,L <br />" ^"""" 3o1"'i,[or+A S1reet11 6+3 <br />re)+lLloo oo 03 l-/o <br />ulqin #. <br />AnoSart New Addn Ite <br />h...by .tlirm ti.l I .h .i.mpl lrom ltr. contr.ctot'. lk.n- l.w lor th. lurE 9F a"LDtxa <br />] S..rio" 70444 l, .t o*"., or ti" p'op.'tY, o' mv .FproY..r w,th <br />^69.! .r th.i, ror! codp.n3!lio^, will do th. work, .nd th. .lrudur. lt hoi <br />-'.:dcd ci cllcieC 1cr t.1. <br />lRes Comm lndust Other <br />10_ <br />Sect'on 70448 l, .t ow^.r ol e a /(9rsm, <br />5 O ?_l -a €6o ua <br />7 <br />C? TID]E <br />i.c,.!, 3firrr, iliet I am t'..ord utd.r lhe provr.,c.u.! ChlFle'9, D,!'t'on <br />.l or th. Bu.in.t. .n.l P.ol.slo6t Cod., .nd mY lrc.nE r. in turt lor+lnd ,.. Ll\ *. L l (9a'E- _'rdt-ro-c^t (gCr!G- CilY Li6n!.4-;-ttL,t <br />..,d *"rs 6-_8+ <br />b 3 <br />tdtv(4 <br />,nt 0?3 !:L)_!l:Z G <br />WORKERS COMPENSATION DECLARATION <br />- <br />*|2-- <br />r t> 4l- <br />).t! <br />- <br />ADDlic.nt <br />c.rt,ly th.t in th. p.rtor6.hcG ol lh. <br />3h.ll nor.hploy any <br />v!ork.r's Comp.nr.tion-)2 7:3 $oo,i <br />234 <br />' OT ICE iO APFLICAN IYou lhould bacorr. .ubi . Wo.r.r'2. Camnrn..r'on prori.ionr ol <br />*roit $.rr tt d..d.J .tuold, <br />- CONSTRIrcTION LENOER (+o bS.l sh.r.by .flirft th,t th..! ir . conrtruclion l.nding 4..cY tor rh. p6rlor <br />:ac. or !h?.4o.! ro, whi.h ,!ii3 p..hrr ir i.r,,:n tS.. :rO97, Crw C l <br />L.hd.. r AdC.- <br />APPLICA{T5 DECLARATION <br />..rllry rtr.t I h.'. E.d tha @plic.tion .^d rt i. th.i lh! lbo6 iotorm.tion <br />r cor.ct. I .o.- h.ordin.6c6 .n.l .1.t. l.wr .rl.tirE <br />lho.i.a ..p,.r.ntrtivct ot thb .iry <br />y io. .nrp.cr'on purpor.r <br />S <br />lo <br />€-rct'a-! 6ldwl rrl <br />Conv. Repair Move Demo <br />/// "s- <br />q <br />I)-z/"^V-.o,.,/.-r'6- <br />/ /./ie,s,727-f <br />.).-./ - ,/ r''6lss <br />APPLICANT FILL ITI AREA BELOW AND ON REVERSE SIDE <br />IO CHE CK <br />1 <br />f,.t. <br />- <br />Cont..ctor <br />o@J <br />z. <br />eoA <br />r h.rlby .tti.m thrt I irv. . c.nllicrt. ol conrnr to rall inrur.. or ! cc.rlf <br />,c.r. dl work..'. Como.6r.tioh ln.urrnc.. C..ril.', copy i. til.d wlth th. <br />:rrt build iog jntp.ction c,.ptrlm.nr, <br />I <br />.,.*tr