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SaNTA 4 <br />Name (First, MI, Last) <br />Project Address <br />City, State, Zip Code <br />Name (First, MI, Last) <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School District <br />Building Owner <br />Telephone <br />H18et/Y1AFUI1fix 9q9 <br />b2d W Orton Aye <br />San-Io Ago--, CA 9 2 --d 3 <br />Tract/Parcel <br />CITY OF SANTA ANA <br />Planning and Building Agency <br />5228 <br />Approved <br />FOR PERMIT ISSUANCE <br />4 <br />9- <br />10tt2'CZ438 <br />Telephone <br />Use of Building (check) Type of Project (check) <br />Residential [� Commercial ❑ Senior Housing ❑ New d Addition ❑ Alteration ❑ <br />Description of Project <br />�1ew -ached ,ADU <br />Number of Square Feet of <br />Residential Space 800 Sq.Ft x <br />Number of Square Feet of <br />Commercial Space <br />Sq.Ft x $ <br />S.R <br />(Dev. Fee) <br />(Dev. Fee) <br />Total $ 4,1'Nb.00 <br />Total $ <br />The above representations as to square footage are true. Applicant agrees that if it is later determined that such <br />representations are not true, then this certificate shall automatically terminate, and the appropriate City/County shall be <br />notified. Applicant is hereby noticed that any party filing a protest regarding the imposition of fees pursuant to <br />Government Code Section 53080 must do so within 90 days from the payment of the fee. <br />Applicant Nam (Please Print) Date <br />Sign tore <br />This certifies that the above -named Applicant has paid school facility fees in compliance with all existing and applicable <br />sections of the Government Code and Education Code. <br />�► 13 2 S <br />S t Ana Unified School District Aut ized Representative Date <br />DISTM UTION <br />White - City/County <br />Canary - Applicant <br />Pink - Facilities <br />