HomeMy WebLinkAbout10202701 - Permit4{.BUILDING PERMITCity of Santa Ana PROJECT
ADDRESS:615 N. BRISTOL ST
SUITE #:SUITE
RANGE:JOBTYPE: UULTI /AL
511-553 rADORESS
RANGE:BUILDING f:DECK WORK
NATURE
OFWORK:
1 Bl@k: NA
LEGAL
OESCRIPTION: Lot CONDOS W/DET GARAGES
NO. OF EXISTING
BUILOINGS & USE:
rract: 1og G 1 VN
ryPE OF
@NSTRUCTION:R1 /U1@CUPANCY
GROUP:
405-08L-23ASSESSOR'S
PARCEL
':
undcr p.nalty ot p.riury that I .m Gxcmpt ftom thG ontractoE'
thr tolliling rcaen:
as M"r ot tl)c pDpcrty, or my cmployccs with mges as
will do tho rcrk, and thc structuG is not intcndsd or
l, aB Mcr of thc prcpGrty, .m crcBiEly ontracting with
construcl thc prcjcct
affirm
for
Scction 7O44A, l,
70!,48.
IENANT IMPROVEMENT
ANO / OR REMOOEL AREAI tbffi: x-o
owNER: SHADOyg WOOD HOA NEW / ADDL,
lst FLR. SO FT.:
NEW / ADDL,
OTHER SO, FT
NEW / AOOL.
GARAGE SQ. FT611 N BRISTOL STADDRESS:NEW/ADDL.
2nd FLR. SQ. FT.:
SANTA ANA, CA 92703 ZONltlG: R- 1 vALUAnoN: LSOO . OO
PHoNE: 7L4/542-3525 LLPLANNING
APPROVAL BY;LL /02 / eeDATE:
CONTRAGTOR:BLDG, SAFETY
PLAN CHECK BY:DATE:
JKAPERMIT
ISSUED LL /@2 /eeDATE:ADDRESS
NIMPROVEMENTS
REQUIRED:NLANDSCAPING
REOUIRED:
PHONE:
OWNERSTATE
LICENSE #:TYPE:
SANTA ANA
BUSINESS LICENSE #:
pcnatty ot psrjury on6 of thc lollrying Occlarations:
a Ccrtificatr Ol Consnt to Sclf-lnsurc lor WorkcB'
ol the rcrk to, which this pcrmit is issucd, I
asl
the
@Bgc is unlawrul, and
lot
rcquircd by
which thas
numb€r
arc:
WorkeE
lor the
so as b*ome theto WorkeE'subjecl
ifthat should b@ome thotoa9 ree subject
criminal
in addition
the Laborof
ofcost @mp€nstion,
andintcrcst,
inpeEonany
ol Calitornia.
Section 37@ of tho Labo, Cod., I shall
WARNING: Failura to surc WorkcE'
Policy
ccrtify that in the
not
p6mit is issucd. My
have and will
37m of thc
I hcroby effim r
I haw and
GFpcnsation,
padmancc ot
(this $ction
or lcss).
S€ction 3700 ot the Labor Coda, ior th€
this Pcmit is bsued.
ENGINEER/ARCHITECT:
ADDRESS:
PHONE:
I undcr p@isions ot
of thc Businoss and
I
eft*t.
Dat!: Contraclor:
Liccnsc
ts tn
LICENSE ':
THIS PMT REPLACES LOL22855.
RESURFACE/WEATHERPROOF DECKS.T
HANDOUT GTVEN.
JOB DESCRIPTION:
Santa Ca.92701
206 W. 4th. Street
2nd Floor
(714) 647-s800
City of Santa Ana
Building Safety Div. M-I9
P.O. Box 1988
5
2
1
t_L.@O
FEES:PERMIT FEE
ISSUANCE
FEE TOTALPAID TO DATEBALANCE DUE
502l @o
oo
7L
@
7L
@@
@o
oo
I hcrcby alfim under pGnally ol pGrjury thal thcrc is a
ior thc pcrfomanco ol tha mrk tor which this parmit i
DGmolition Pemits-Asbesbs Notif ication Fedcral
_RcquirGd Lcttcr o, NotiliBtion.
_l ccrtity that thG tcdcBl Ggulations rcgardang asb.stos
.pplicabl6 to tii3 projcct.
40, Pad 6)
arc not
is
is
agcncy
Civ. C.)
la6
purPoses.
this Crty
Lcndc/s
Lcndc/s
Applicant or agcnt sig.
P.mit6 n.mc (print):
OWNER.BUILDER DECLARATION
WORKERS COMPENSATION DECLARATION
LICENSED CONTRACTT)RS DECLARATION
CONSTRUCTION LENDIN(T AGENCY
APPLICANT'S DECLARATICN
Mailing Address Public Counter
This permil shall expire by limilation and become null and void iI lhe work aulhorizEd
by this permil is nol commenced wilhin 180 days from lhe date of this permil, or if the
work aulhorized by this permil is suspended or abandoned for 180 days, al any time
after work was commenced, ln such case a new permit shall firsl be obtainad before
such work can be recommenced.
LO20270LPERMIT NO
Account No. 011-01-5911 - Pemrt Vafidation CS-6os
.INSPECTOR COPY.
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