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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App.Worksheet <br />PROJECT ADDRESS:13 1 Z AL, # clean Dc SUITE:SAPIN #10 1 *709954 <br />USE OF BUILDING€22SIDENz> COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK ([(j3> ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC-sola r ; FV <br />NFW/ADDITION/Al 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 reverseside ofthis application),1 7kkl DC Roof ?Moud-/ Solar <br />P\/ Syst-c.; 417 ?Module-51 -1 Inverter 9*10.1,04 4 61'*000 <br />BUILDING OWNER'S NAME:Tithya Pe.ou <br />ADDRESS: 1 3 1 9 71. MELeart Dr.CITY 54,1+A And <br />TENANT'S NAME (Comm/Ind): <br />CONTRACTOR'S NAME:5-rt- 64.37 sofor STATE CONTR. #: <br />I,ic. <br />ADDRESS:/6 Fl Commirce - 5¥CITY: <br />(lorena <br />PHONE NO: (1 / t)53?- 0757 <br />STATE:CA ZIP:12703 <br />PHONE NO: <br />LICENSE CLASS:PHONE NO <br />096 6 51)707-43 I 0 <br />STATE:/ A ZIP 92880 <br />WORKERS COMP. POLICY#:EXP DATE INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />90235rl-13 9/0//2 0/ 0 51-ah G..re.•34'o. Inf. <br />ARCHITECT/ENGINEER:STATE UCENSE #PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME: J ur d le 6111'Varcz (.d *Ismael Trru PHONE No: (qll )70 7 - .7( 0 <br />E-MAIL ADDRESS: Snin€-1, s€,U SCACE? cker<ni j , Clorr <br />' <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: $«(133 <br />FIRE SPKR: YES / NO A/C: YES /NO FLOOD ZONE: <br />00 <br />SUBMITTAL DATE:3-3-94 <br />PROCESSED Ck 941 <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: