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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:4 4 cA-/4 <br />USE OF BUILDING:RESIDENTIAL C9MRRiAL <br />SUITE:900 <br />INDUSTRIAL OTHER <br />3/2/05:forms/Blda.App.Worksheet <br />SAPIN #)(31 905-63:E <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTEIVT. I.DEMO REROOF REPAIR 0139 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 project* see reverse side of this application) :l N W U All Scs> <br />NON -(A -0 . ,1 4 Aft (41,0 6-1,94"K )68 'r n -2-9 04 <br />1AC\Je,(.JL)f{\ 14:Jrj- /hlAfv,Af O C111rfy< Ir€.4-irs <br />BUILDING OWNER'S NAME: -51 (thic A-+4«560 <br />ADDRESS:CITY: r ,H . 4.1 J·tor-> 64 < 4 -3 30 044 Ae & <br />TENANT'S NAME (Comm/Ind): &-4 10 2 l.r <br />CONTRACTOR'S NAME:-STATE CONTR. #:/5 r ir-2 -3> ped,/fi ST-5 (51* 2 .93% 048 <br />ADDRESS:CITY1 ( { 9. Dic N. + F 9+74 ANA- <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY: <br />9 Ol-09 3 9 6-/3 BZS r )) Li -54*k guA O <br />PHONE NO- 71 V890 -\-10-5 <br />STATE: ZIP:9270 -7 <br />PMONE N?C 7/ Y ) 4 3 2- 470 0 <br />LICENSE CLASS:PHONE No:7'C{ <br />045-6 H{ 00 9 H <br />STATE:ZIP: <br />CA.1270 7 <br />SANTA ANA BUS. LIC. #: <br />198172 <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:tbAC/f o c e-wl.3 PHONE NO: o ( { 7%3 LO 3-0 9 6 0 <br />E-MAILADDRESS: JAui 4 • €-xuLS €515'rispec;,MISTS. C ev- <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: $SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES / NO FLOODZONE: . PROCESSED <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE EX- - v *I7. rT» <br />PLNG CONDITIONS:(J \ 624 f 4323