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CITY OF SANTA ANA <br />BUILDING PERMIT WORKSHEET <br />PLEASE PRINT 1/14/09:forms/Bldg,App.Worksheet <br />PROJECT ADDRESS:9 1-1 . 9. H Al J sT SUITE: SAPIN #101/79022 <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK:/NEW/ ADD ALTER/T.I.DEMO REROOF REPAIR SIGN MISC <br />NEW/ADDITION/ALTERATION: <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.1.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />Rj445 90-11 -320+ e *00, <br />BUILDING OWNER'S NAME:PHONE NO: <br />A. 9.An \ 062 <br />ADDRESS:CITY:STATE:ZIP:91-1 9 MA i v 9 - <br />TENANT'S NAME (Comm/Ind):ti»IE NO1%1 -1 t{ f <br />CONTRACTOR'S NAME:A - 97*-8 40 64 19 <br />ADDRESS*\25 \ t© 1% & O-0 th. 5.H <br />WORKERS COMP. POLICY#:EXP. DATE: <br />a<€62-1/ <br />RIATE CONTR. #: <br />6951 9 02> <br />CITY: N <br />Hal #Ar<J- <br />J <br />INSURANCE COMPANY: <br />bcENSE CLASS: PHONE NO: <br />599.40 3 1 1*91L-/6(f <br />STATE:41 05 <br />SANTA ANA BUS. LIC. #: <br />1 \ <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME: €Z.--- W x i --77-"---M,, PHONE NO: <br />E-MAIL ADDRE94'' 0-99307/9 e.4/ » NO: <br />ROFFICE USEpNIY:ACC C*SPC (CIRCLE 01>JEN- ./HRS PE BLDG. FEE $ <br />OCC. GROU P/C FEE PD $ <br />TYPE OF COI SUBMITTAL DATE <br />, <br />FIRE SPKR: YESWO A/C: 'YES /NO 7FLOOD ZONE: - PROCESSESE:@ <br />RES. DEV. FEE: YE2kfRIOB.06VELLINKU!!fES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE <br />PLNG CONDITIONS: <br />BLDG. DE;I. APPROVAL & DATE .r l, <br />Ce #07 MT 1(A)- 9%1"(6,( 4-n <br />(: y i ¥ 59 . 4,7 (9 <br />6,