HomeMy WebLinkAbout10107174 - Permit BUILDING
y° .rr df 'f PERMIT PRo Ecr PERMIT NO. ]
ADDRESS: -. AEn_ _L _ PP.Rh ,�)R
OWNER-BUILDER DECLARATION SUITE JOB TYP�k .' ?P
RANGE: -
I thereby affirm that I am exempt from the contractor.beans.law for me ADDRESS NATURE �F y RANGE: '� BUILDING I. OF WORK: ]IolfpwiW moon:
Section 7044A.1,as owner of the proper,y,or in, weir epee LEGAL NO.OF EXISTINGE1 ' C r D
emdoYdda DESCRIPTION: LOC ` Block:'�' BUILDINGS A US fJ
b,lair•oat compensation,will de the work,and the structure is not Intended or
offered for•all. tM Tna: `it] TYPE OF OCCUPANCY
- CONSTRUCTION: GROUP:
Section as o e en 7044B,I, wnr of the Incident.
prii, usi
r,am excvely comncnnp
w'nh limreed convadws b coreruct pwjnaa. ASSESSOR'S _ _ TENANT IMPROVEMENT ROOD
PARCEL/: ��-� � - AND/OR REMODEL AREA: ZONE:
Dab Owner OWNER: �(1%�R iiC l,Jp^ L NEW/ADDL NEW/ADDL.
fat FLR.SO.FT.: OTHER SO.FT.:
• • • • • ADDRESS: 17 ti 1E -r F _ NEW I ADDL _- NEW,ADDL.
Znd FUR.SO.FT.: GARAGE S0.FT.:
I hereby all that I urn hearial brier Provisions of Chapter B,Division 0 of the ZONING
---- :! - - - -
: VALUATION:
Busirw and Prof....`` Cede,and my license b in Intl force andy affect.
Data -2 Canuo"o, e LL�1�/ �J•4l Lh -� PHONE' _ - - APPROVPLANNINAL
_ DATE:
APPROVAL BY:
•' • •100a CONTRACTOR: SLOG,SAFETY DATE:
PLAN CHECK BY:
I her ebr atbrm that I has.I .cant f cat.of consem.. iled insure,or a C B.,Id, a of PERMIT
Worker o Cwnpansei on Insurarxa.Cart Fed copy-e filed with the City Buildup ADDRESS: - r ISSUED BY.�,.�' DATE:
Inspection Opwtmmt.
L IMPROVEMENTS LANDSCAPING
Date of Spnenee� Insurance Exprat on Data - REQUIRED: REQUIRED:
spnaweof Apdiunti'- ,.�r��` ' e<L `. PH ON E:. _ JOB DESCRIPTION:
I certify that in the performance of 1M work for when this 1 i•tued I•hall STATE 1 1 _
TYPE
not employ m,oulum n any meaner so as ls become bubs,1 m,the Worker. LICENSE I: - -- - - - -
Compareetion Iona of Cal fwNa. — -- - -- - -
SANTA ANA
Dole Applicant BUSINESS LICENSE I: - ✓ _ ,
NOTICE TO APPLICANT:If,after mabW this Certificate of Exemption,you ENGINEER/ARCHITECT: r -
shchad became bullet,to the Work-'.Ci mpens•tien provisions of this Labor -
Code,you must forfhwdh comp,with such wovisions or IN•Permit.hall be ADDRESSCONSTRUCTION LENDER
deemed rboksd.
I hereby affirm that Bee•ra a construction lendop apencY for the performance of PHONE'.
the work for which this permit is aboard(Sec.0097,Cw.Code).
LICENSE/:
Lender.Nsme: �+��LL {{�� �f �j I� q�
Lender.Address: __— FEES: fit..... ,.. _ _- r.7lr�OKL�.. DE tl Cah"TORS
APPLICANT'S DECLARATION R'
Demdrtion Permlb Asbesbs Notification Federal R gulnlons ITid•40.Part B) -
Re,oired latter of notification.
mrtify,,hot the Federal RWdedons rWandiry bbaatw removot are not
pplicablo to 1Na protect.
Mailing Address: Public Counter:
entity that I have rend dkb application and bate that NI,nd above
information is correct.I Wide to comply with all the city ordinances.also Intl CITY OF SANTA ANA 206 W.4T11.STREET
federal laws ralatirp to bnaldi,p constnkfipn and thereby..nor..u p esemativea
of the try to and•,won Ito wpyo-m.miwed properly for inepddl,n Purposes. BUILDING SAFETY DIV. M-19 god FLOOR
Sionsv.of - _ - P.O.BOX 1988 PHONE NUMBER
APdicen w Apenr. !+� [.�•r ,�.b:L 1 - - _ SANTA ANA,CA, 92701 (714) 647-SHOO
ri ACCOUNT NO. 011-01-5911 --PERMIT VALIDATION CS-605
ffNO3l95 9:MAM -5911 S 93_90
I ED days.III any time after work wI,%-mmenct I In such case a new Permit
%hall fits,be obtained before such work orn be ircorturienceill W,,"I calk C(WY
e, E',
%Adess: Z�4Z Unit/Suite:
BUILDING - INSPECTION RECORD
Site Work Remarks Date Signature I.D. Building Remarks Date Siignatum I.D.
Setbacks Under Pinning MoorJoist)
Forms/Steel I Holdowns Foundation Ventilation
LIFER Ground Roof Sheath
siab floor Insulation I Energy
Dry Wall
Steel Exterior Lath
Pool Fence Brown Coat
Masonry T$ar
Handicap Requfrements
FRAMING
FINAL Shell only)
d
Notes, Remarks, etc.: ;- FINAL Tenant h m n roveent Sl �`� - '"- �. . -