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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 24 Divt c Ce:nfor P/ele <br />PROJECT ADDRESS: S:¥57'* /104 +974/4 Uk/dr SUITE: - <br />-1 <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />14 400.0.1 <br />NATURE OF WORK:NEW ADD C--ALTER DEMO REROOF REPAIR <br />3/2/05:forms/Blda.ADD.Worksheet <br />SAPIN # <br />MASTER ID# <br />SIGN MISC <br />NFW/ADDITION/Al TFRATION· <br />1 ST FL..SF BASEMENT: YES/NO SF NO. OF STORIES: <br />2ND FL.. SF PATIO/ENCL. PATIO:SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS: SF RES. REMODEL:SF PROPOSED USE: <br />GARAGE/CARPORT: SF ALTER/T.I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side Of this applicatfon) : .giv.12Ald€/4/247*7 -10 ied,>,4.-0,#bl #ON€f Und,- cantrdor GOF .ad cab w,te>n/* AM•1 Aer,/s¥•,#k--t>€tectoff JI j <br />140 c k,-,c. to car 9 1„0, ch,A.T . <br />BUILDING OWNER'S NAME:0/iN f SAM+A 63 114.PHONE NO: ,>< g//g <br />ADDRESS. 1,6/ £56> f /0132 A ,> 41 - / /CITY:STATE:ZIP: <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME: 0 -01'f r=*CV'¢priwl c .STATE CONTR. #:902797 0-11 (?M-9279 · €700 <br />LICENSE CLASS:PHONE NO: <br />ADDRESS:/69 0 N. 00146 96 CITY: £:pk17 EL'STATE. g ,ZIP: 9 2,26 7 <br />WORKERS COMP. POLICY#: <br />*KN 1 +44'34 -3 <br />EXP. DATE: <br />4>/1/19- <br />INSURANCE COMPANY: <br />¥rt-f err cel RMflers <br />SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:6 1411 7-Wj AMi (<PHONE NO: 7 414-1 <br />E-MAIL ADDRESS:Sf,Ar 1.Al i o a Srfa - a,a . arl <br />OFFICE USE ONLY: <br />OCC. GROUP: <br />ACC OR SPC (CIRCLE ONE) <br />6 <br />RECEIPT # <br />HRS PER BLDG. FEE $ <br />P/C FEE PD $ <br />TYPE OF CONSTR:11[ b sp?-VALUATION: $SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES/NO FLOODZONE: PROCESSED <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: <br />A