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CITY OF SANTA ANA <br />PLEASE PRINT /0 58 4*h 94-3/2/05:forms/Bldg.ADD.Worksheet <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PROJECT ADDRESSIOa,E. . 4-7 SUITE:SAPIN #/0 1 90 9/35 <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL <ZBE!80 OTHER <br />MASTER ID# <br />NATURE OF WORK: NEW ADD LiLTERIT.-3 DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION: <br />1ST FL..SF BASEMENT: YES/NO SF NO. OF STORIES: <br />2ND FL.SF PATIO/ENCL. PATIO:SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS:SF RES. REMODEL:SF PROPOSED USE: <br />GARAGE/CARPORT: SF ALTER/T.I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />-3-/41 ALL-MO-'=.( b&-S,Vink' <:7 A.1-*M _ & Pi2-4-7 f.he.17 # <br />80 9 25 <br />BUILDING OWNER'S NAME: <br />ADDRESS: <br />/CD'Kpo C <br />TENANT'S NAME (Comm/Ind) <br />PHONE NO <br />€ Fe fe %4674*45461 A/C_-,-04,7-9 - 9585(P <br />CITY STATE:ZIP: <br />2 - fix•2=z IP- 9 LAHILT 54) 74- A-,2-C-A Of0O 01 <br />PHONE No:14(?ex-- fkyll/1 i -'AAAL -11/C -7,4 3419, 9¢: Cb(-0 <br />- <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />m L 1>(009 0,serr// S )-9,0'*'U·V-lal/94f)796 60<)G-7 -7 -0*/ Ch# <br />ADDRESS:CITY:STATE:ziP: <br />l 3959/0 A-*LA A,€-C t¥»U O £-/t m· 91-7 Kb <br />WORKERS COMP. POLICY#: <br />4(09,7 *(eR SCE>) 01 <br />EXP. DATE: <br />S) 1 / -Zd>)L. <br />INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />CAL'-A,0 $44 Id·•p-:Ca <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:FOk#/0 € 1 L =f:21_PHONE NO:(42£01/ L- 8* 3 j <br />E-MAIL ADDRESS: /n of,-z- /0 .1 1 'r,9,00'hi -,-0 .01 <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $09\ ONE)SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES/NO FLOOD ZONE:PROCESSED9 <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS:OCERea-·Al v- 6 <OO:J\,oe<