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BUILDING PERMIT 'SzADDRESS: F.27 N- PPTsror, sr PROJECTCity of Santa Ana SUITE #:J.BTYPE: REs /RP ADORESS RANGE:611-663 *BUILDING #:ReroofNATURE OF WORK: Bl@k: NA LEGAL OESCRIPTION: Lot 1 NO. OF EXISTING BUtLDtNGs& usE:cOndO cOmpleX TYPE OF CONSTRUCTION: V-N R-1OCCUPANCY GROUP:108 61Tract: I hGr.by attirm undcr p.natty of pcriury that I am cxcmpt from thc contEctoE liconslraw ,or the ,ollilinq rea$n: _lU1 Scaion 7044A, l, as Mcr of th6 property, or my employ6s with mges as their $16 compGnstion, will do th6 mrk. and the structuro is nol intrndGd or offcrcd for slc. amSection iiaA;-sed 70448, l, as mcr of thc 4 05 -08 L-23ASSESSOR'S PARCEL #: TENANT IMPROVEMENT AND ' OR REMOOEL AREA: FLOOOzoNE X- 0 owNER: Shadow Wood owners Assoc NEW / AOOL, 1st FLR. SQ. FT NEW/ADDL. OTHER SO, FI NEW / ADDL. GARAGE SO, FTADDRESS; 635 N Bristol St NEW / ADDL- 2nd FLR. SO FT.: zoNlNG: c-5/sP-l/R 895.00JALUAT1ON:Unit 4l Santa Ana, CA 9270ifPHoNE:f t4 / 542-3525 l!lXU.)^'.,", vcr'DArE: Qg /24/96 CONTRACTOR:BLOG. SAFETY PLAN CHECK BY:DATE: cw 0,u)PERMIT ISSUED BY:05/24/96DATE:ADDRESS NIMPROVEMENTS REOUIRED:NLANOSCAPING REOUIRED: PHONE: * OWNER *STATE LICENSE #:TYPE: SANTA ANA BUSINESS LICENSE ': I hcraby atlirm undcr plnalty of p.iury one of tho lollwing Dsclarations: v I haw and ull maintarn a Ccrtificate Of Consant to Selt-lnsurc for Work6B' C-ompcnstion, as prflided for by Section 37OO of the Labor Cods, for the pcrtomancc of thc rcrk lor which this Pemit is issusd. _l hare and will maintain WorksE Compensation lnsuranca, as roquired by Seciion 3700 of the Labor Code, for the performance of thc mrk tor which this pemit is issued. My Workec' Compensation lnsurance carrier and policy number WARNING: Failure to sscure Workers' Cgmpensatron c@era9e rs unlawlul, and shall sub.iect an employer to criminal penahlE and crvrl ines up to one hundred thousand dollaE ($10O,oQO), in addition to the cost o, compensation. damages as prdided tor in Sction 3706 ol the Labor Code, interest, and attorney's fees. nC-9- I is issued, I to the WorkeE' to the are Policy Labor3700provisions those (this section or less). Workers' forthwith ENGINEERYARCHITECT: ADDRESS PHONE: LICENSE #: Licen$ Class:_ Licanse No.:_ prryisions ot Business andof Oivision 3 ot thc is in and oflecl Oat6:_Contractor: replace 4.5comp, handoutf JOB DESCRIPTION: Partial ( approx )Eiven T /O,sqo City of Santa Ana Building Safety Div. M-19 P.O. Box 1988 Santa Ana, Ca.92701 206 W. 4th. Street 2nd Floor (714) 647-5800 AMOUNT QTY32.00 151.00 1 17 .00 1 FEES: FE E FEE ISSUANCE E32.0051.0017.00 FEE TOTALPAID TO DATE BALANCE DUE 100.000.00100.00 PERMIPRE-I TFE NSP I hersby aftirm undsr pcnafty of po4iury that there is a construction lending agency tor the performanco of the rcrk ior which this permit is issued Sâ‚¬c. 3097, Civ. C.) DGmolition Parmits-Asb.stos Notitication Foderal Regulations Fi0c 40, Part 6) _Rcquircd Lclt r of Notfretion. thc fcdcral rcgulations rcgarding asbGstos rcmffil are not_l certity that applipobb to this {tccntvuat pro.iect. to I haw rcad this and statc that the abde information is @tracl. I andwith all ordinanccs and Statc la$ and ot this Cityrclating !o and County to cntcr Applicant or agent sig. Pcrmitt@ namc (print): Lcndc/s Lond./s OWNERSUILDER DECLARATION WORKERS COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION CONSTRUCTION LENDING AGENCY APPLICANT'S DECLARATION Mailing Address Public Counter This petmil shall expirâ‚¬ by limilalion and bocome null and void if lhe work aulhorized by this petmil is nol commenced within 1E0 days from lhe dale of lhis permil, or if the wotk aulhorized by this permit is suspended or abandoned for 180 dafa, al any lime affer work was commenced, ln such case a new permil shall ,irsl be obtained before such work can be recommenced. PERMIT NO. 10110469 Account No.011-01-5911 - Pemrt Vawation cs-6os ztwlt ,N{{?tloa cEW_o47 4 2472_ I surre I neruce,