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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET )90 //79(0 94 <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:280 1 -1A uj MiscArlkor Aa,fulTE:SAPIN # 1013 · tr41 12. <br />USE;iOF BUILDING:RESIDENTIAL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK:ALTER/T. I.DEMO REROOF REPAIR ce MISC( ADD <br />NEW/ADDITION/AL.TERATION· <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 Fla SF RES. REMODEL: SF PROPOSED USE: <br />GARAGE/CARPORT: SF ALTER/T.I.: SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : \ 14 s 466\ 4-,9 6 Sets o <br />C 24.0- UA- VL 41 Le 1-+2 / s cu-a t f 0« o u-ir € 6 .//u-u...r---1-ed <br />BUILDING OWNER'S NAME:.PHONE NO: <br />V K , .T 07 8 * e. 1 LLC (St*,) 90% _1868 <br />ADDRESS.CITY STATE:ZIP: <br />1 00 10 - 8 re--1 8 iva 61€.LA mle C Ck 91 2- 6,3 <br />TENANT'S NAME (Comm/Ind)PHONE NO:L a fette 5 our, e (- AF Gr <br />CONTRACTORIS NAME: <br />/IS/BL,Z Gn....Pgic s <br />STATE CONTR. # <br />195565 <br />LICENSE CLASS: <br />C -4 r <br />PHONE Nor 84&79+-09- 21- <br />ADDRESS:CITY:STATE:ZIP: <br />2,5-2-0 S + r o.tk, r v#C» 0-06 •51. Pi>,1 62.-6 6 91304 <br />WORKERS COMP. POLICY#: <br />CA 0-05-00 416 4 --004 <br />EXP. DATE: <br />05.-,1-,9 <br />INSURANCE COMPANY- <br />COM.QuJ AST <br />SANTA ANA BUS. LIC. #: <br />ARCHITECT/ENGINEER STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY STATE:ZIP: <br />CONTACT NAME: d £.1 5 2 A .·,O ,- 4AO PHONE NO: Sts ,1-02-5-9- 49- <br />E-MAIL ADDRESS: ris 23 v•9, bleGra FUL :c 5 g -c' A <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #:P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $SUBMITTAL DATE: <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 />PLANNINGOKTOCHECK&DATE BLDG. DEPT. APPROVAL & DA 115 -lt =-i--•····-1 <br />PLNG CONDITINS V L - l. \-113 <br />00,4 = <br />----