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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: /420 8 W lr?0( 82, <br />USE OF BUILDING:02MAL COMMERCIAL <br />SUITE: <br />INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN #3767¥935.27 <br />-/ <br />2- t'35 -11=>ll10 <br />MASTER ID# <br />NATURE OF WORK:NEW 'D ALTERIT.1.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITIONiAI TFRATION· <br />1ST FL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGE/CARPORT: <br />SF BASEMENT: YES/NO <br />SF PATIO/ENCL. PATIO: <br />SF RES. REMODEL: <br />SF ALTER/T. I.: <br />SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />/4 L roc>F rwourkied. pt/?5+0 vo 1 +A' c nabol u ( EX tva l./4,5 0-5 <br />BUILDING OWNER'S NAME:PHONE NO:bu (te n , (9¥\ CA cio 7/4 -560- 05-3-1 <br />ADDRESS:CITY:STATE:ZIP·/ 909 UJ lv\C/t S /SAMA-4 ky CA 9-2,103, <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME: <br />5(/WBEES GEDO FE livE- <br />STATE CONTR. #: <br />9-70 59 1 <br />LICENSE CLASS: <br />6, 0 9 6 <br />PHONE NO: <br />7,4 - 6-76 -EWEEr <br />ADDRESS:CITY:STATE:ZIP: <br />95/ W £401 064/+ F&>l , :>11 -L l-L--8 viCA.CA 9.2-7-2.- 1 <br />WORKERS COMP. POLICY#: <br />9 DOS -2-5 4 -/ -3 <br />EXP. DATE: <br />01/-2.0 2 4 <br />INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />Mainiat I.av¥0*m Se,vukes t#VE <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />.IC?s> tj# Ene ; 0u-.42, r-i v" y-1£ 9 -195 -3( 0 Lt <br />ADDRESS:CITY:STATE:ZIP:/ 0-2. Fi non. 1€.e L.8-93 4.,c 096 t/4 esa-CA 92 6 -2-7 <br />CONTACT NAME: 1-ibin (4*-Aowl CA l/PHONE NO: < 2-6 - -3 9 0 -6%2 E- 4 <br />E-MAIL ADDRESS:jy C IAU 9 -EVI/€- 1.9*YSt,\ 0Y . L.6 y'«. <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #-P/CFEEPD $ <br />TYPE OF CONSTR:VALUATION: $ t..4,,sc=,0 SUBMTAL [ <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:P CES5ED <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OKTO CHECK& DATE BLDG. DEPT, APPROVAL & DATE <br />PLNG CONDITIONS: <br />nr