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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:ill3 0 Uth st , 504 Ae , 01 SUITE:SAPIN #lot Bot' a <br />OSE OF BUILDING:RESIDENTIAL/COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK: NEW AD[l/ALTERIT. I.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 ALTERIT.I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />Photo I/01+01! 229;At;•1 Syste'M <br />BUILDING OWNER'S NAME:PHONE NO: <br />Ruben Chagg 714 - <br />ADDRESS:CITY'STATE:2.I UP W /2*h gt , Sa,#2 /|MA-30,141 Alot (11 <br />541 - OVISI <br />ZIP: <br />9 290 3 <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />Truf Power S olow 4 2034/ 0 6 96) (6, 0 46)91% -696-£289 <br />ADDRESS-CITY:STATE*ZIP48 W lambert Ret 844 £4 94£21 <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:STATE LlC NS PHONE NO: <br />Rut tbu£*- Mal C g C ¥F) *fir? I 7 14.-676- tiff <br />ADDRESS'CITY'STATE:ZIP4*l 10 , /»tkert bl Suite )4 b-ed CA q )1 4 <br />CONTACT NAME:J«•l Li K PHONE NO:313-6.3 -71¥4 <br />E-MAIL ADDRESS:J LIU (i) trw-fb *irjolar. copn <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT # -$LAn P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $42 4 DOE)SUBMITTAL DATE: 37 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED <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: