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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WOEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS: 015 u.1 -_I gy SUITE: --<SAPIN #101€OF%110€ <br />USE; OF BUILDING:RESIDENTIAL 4-EOMMEEC) INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTER/T.I.DEMO REROOF REPAIR Ge MISC <br />NEW/ADDITION/ALTERATION· <br />1ST FL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGECARPORT <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) :9,0-ball duvel Ulue,ing:16-Ted lugil :Ge tri <br />g <br />BUILDING OWNER'S NAME: <br />L L 8<9061 0,Qe·oY-0 65 <br />ADDRESS CITY' <br />416 6+60 20,5 Au#e ·dE.320 belqvt-cs 8c€ <br />TENANT'S NAME (Comm/Ind): -1-1 £ 0 U.) i re,2653 <br />CONIRACTOR-'S NAME·STATE CONTR. #:1 Ji JifiC( zed 5?ybs tik,--133 053- <br />ADDRESS:CITY'lAoIS C c a €61 i. Aurl -F)UE<diC A (na keIvn <br />PHONE NO <br />95-9 94-7 - 4 635 <br />STATE:Zle <br />004 611676 <br />PHQNE NO: <br />7/4 <br />LICENSE CLASS:PHONE NO: <br />0-45 -Tort-330 <br />STATE:ZIP: <br />CA'92<60-7 <br />WORKERS COMP. POLICY#: <br />w rn 3 £103)9200 <br />ARCHITECT/ENGINEER: <br />EAP. DATE: <br />3--25. N <br />INSURANCE COMPANY:L f \ \:44560-CO <br />STATE LICENSE # <br />SANTA ANA BUS. LlC. #: <br />PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:6:clcY Jo tivaoc«PHONE NO: 7 1 4 - 7 0 1- 1330 <br />E-MAILADDRESS: Cti U-€-V-'*44 eC)'Ste vis,a prock'Tf. a€-7- <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC GROUP:RECEIPT#·P/C FEE PD $ <br />OO <br />TYPE OF CONSTR:VALUATION: $ 34 000 .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 />PLANNING OK TO CHECK & DATE ---191BLDG. DEPT. APPROVAL & DATE · h u j__>___ u * <br />PLNG CONDITIONS:Lell.1 I n 1 1 ...iBa l I l l 1 -3