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BUILDING PERMITCity of Santa Ana PROJECT <br />ADDRESS:414 N EIPTRTNI, CT <br />SUITE #.SUITE <br />RANGE:JOBTYPE: MUI,TT /RR <br />6t 1-663 *ADDRESS <br />RANGE;PAR REROOF <br />NATURE <br />OF WORK: <br />LEGAL <br />OESCRIPTION: Lot 1 Bl@k NA 1 O-UNIT CONDO/RESIDENT <br />NO. OF EXISTING <br />BUILOINGS & USE: <br />rr'ct 10g61 VN <br />TYPE OF <br />CONSTRUCTION:R-1OCCUPANCY <br />GROUP: <br />I hcrcby atfirm undcr p.nalty ot pcriury that I am cxcmpt from th6 @ntractoE <br />lic.n$Jaw tor thc follming rcasn: <br />(*atontOa4A, l, as ilner ol thc propcrty, or my.mploycos with mgcs as <br />thcir elr @mp€ngtion, will do thc rcrk, and tho structurc is not intcndod or <br />with <br />o.,"'? -j-9} <br />S*tion <br />ii-mscd <br />70448, l, as mer of <br />contracloE to construct <br />offucd for slc. <br />405-081-23ASSESSOR'S <br />PARCEL #:0 <br />TENANT IMPROVEMENT <br />ANO / OR REMODEL AREA: <br />FL@OZoNE: X-0 <br />owNER: sHADow wooD H.o.A.0 <br />NEW / AOOL, <br />1st FLR. SO. FT 0 <br />NEW / ADDL, <br />OTHER SQ, FT.: <br />0NEW / ADOL. <br />GARAGE SO, FT611 N BRISTOL ST/OFFICEADORESS:0NEW / ADOL. <br />2nd FLR. SO. FT <br />c-5 /sP-t /lZONING VALUATION 2958.00SANTA ANA, CA 92703 <br />PHoNE: f14/542-3525 APPROVAL BY: <br />PLANNING KH DATE]07 /09/97 <br />CONTRACTOR:BLDG. SAFETY <br />PLAN CHECK BY:DATE; <br />KH YJhPERMIT <br />ISSUED BY,DATE: 07 / Og / 97ADDRESS: <br />NII/PROVEMENTS <br />REOUIRED NLANOSCAPING <br />REOUIREO <br />PHONE <br />* .)wNFp * <br />STATE <br />LICENSE #:TYPE: <br />SANTA ANA <br />BUSINESS LICENSE #: <br />I hcreby affim undcr pcnalty of p6qlury onc ot thr lollwing Delarations: <br />I haw and will maintain a Cerlificate Of Consant to Self-lnsurc lor Workes' <br />e-omp.nsation, as prryided for by Scclion 37OO of the Labor Code, tor thc <br />pat omancc of thr rcrk for which this Pcrmit is issued. <br />_l harc and will mainlain Workc6' Componstion lnsurancG, as required by <br />S€ction 3700 ot the Labor Code, lor the pertormancc of thc rcrk for which this <br />p€rmit is issucd. My Workers' Compensation lnsurance carier and policy number <br />P^li." N,,-h..' <br />(thitection nred not bc completed if thc permit is lor Onr hundred dollaE {$10O}or,l6ss).c <br />that in the performance ol the rcrk to. which this permit is issued, I <br />any peEon in any manner $ as to become sub.i{t to the WorkeB' <br />WARNING: Failure to secure Workers' Compenstion cryerage is unlawful, and <br />shall subject an employer to criminal penalties and civil fines up to onc hundred <br />thousand dollaE ($100,000), in addition to the cost of compsnsation, damages as <br />prryided tor in Srction 3706 ol the Labor Codo, interest. and attorne)/s fces. <br />are <br />prryisions <br />torthwith those <br />of Calirornia,agree that rf I <br />Section 3700 1 <br />subject to the <br />Code, I shall <br />ENGINEERYARCHITECT: <br />ADORESS: <br />PHONEI <br />I hcrcby affirm undcr penatty o, p€rjury that I am lic.n*d undcr pryisions of <br />Chapter 9 (commcncing with Section 7000) of Division 3 of thc Business and <br />Plolcssions Codc, and my liccnse is in tull lorcc and 6ffect. <br />Licanu Class:_ Liccnsc <br />Oats: Cohtractor:LICENSE #: <br />PARTIAL REROOF WB.U.R. AND APPLY NFLAT AREA ONLY <br />HANDOUT GIVENNO TAG <br />PRE-INSPECTION10114252 <br />JOB DESCRIPTION: <br />PAID ON <br />o <br />B <br />-REMOVEU. R. TO <br />City of Santa Ana <br />Building Safety Div. M-19 <br />P.O. Box 1988 <br />Santa Ana, Ca.92701 <br />206 W. 4th. Street <br />2nd Floor <br />(714) 647-s800 <br />/r <br />EW <br />AMOUNT75.0020.000. 000.000. 000. 000.000.000.00 <br />FEE75.0020.000.000. 000.000.000.000.00 <br />0 .0095.000. 0095.00 <br />FEES: <br />a TY <br />1 <br />1 <br />PERMIT FEE <br />ISSUANCE <br />FEE TOTALPAID TO DATE <br />BALANCE DUE <br />I hucby affirm under p.nalty of periury that there is a construction lending agoncy <br />tor thc p.rformancc ol thc rcrk for which this pcrmil is issuGd Scc. 3097, Civ. C.) <br />O.molition Parmits.Asbcstos Notitication Fedsral Ragulations OitlG 40, Part 6) <br />_Rcqurrcd Lcttcr o, Notifietron. <br />thc tcdaral ragulations rcgarding asbastos rcmml ar€ not <br />projcct. <br />@rcct. I with allto <br />\ <br />ol this City <br />Durffies -.+orlinspcction <br />_lpcnity that <br />appli6abtc to ttris <br />/ tccrttyrnat <br />\r! <br />I hevc rGad this <br />and County ordinanccs and Stalc laE <br />and County io <br />relating to <br />Pcrmittcc namc (print): <br />Applicant or agcnt sig. <br />OWNERAULDER DECT-ARATION <br />WORKERS COMPENSATION DECI.ARATION <br />LICENSED CONTRACTORS OECLARATION <br />CONSTRUCTION LENDING AGENCY <br />APPLICANT'S DECLARATION <br />Mailing Addrcss Puhlic Counter <br />This permil shall expire by limilalion and become null and void if the work aulhorized <br />by thjs pemil is nol commenced within 180 days from lhe date of this permit, or if lhe <br />work aulhorized by lhis permit is suspended or abandoned for 180 dairs, al any time <br />afrer work was commenced, ln such case a nernr permil shall lirst be oblained 6efore <br />such work can be recommenced. <br />PERMITNO. rolr+253 <br />Account No.011-01-5911 - Pemit Validation Cs-6o5 <br />/A9/97 3:31P1't - mbfltbroac0rEJn <br />AL <br />f rr,.o,"oo, L <br />" Lr/ <br />s>