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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:lo Il N . ki48 jt 1 5444 40, CA SUITE:SAPIN #101*38·14 <br />USE OF BUILDING:RESIDENTL COMMERCIAL INDUSTRIAL OTHER . <br />MASTERID# <br />NATURE OF WORK: NEW AD ALTER/T.1.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION <br />1ST FL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGE/CARPORT: <br />JOB DESCRIPTION (n I . <br />124} dolt. id C <br />SF BASEMENT: YES/NO SF NO. OF STORIES: <br />SF PATIO/ENCL. PATIO:SF BLDG. HEIGHT: <br />SF RES. REMODEL: SF PROPOSED USE: <br />SF ALTER/T.I.SF <br />3 reverse side of this application) :on-resiaeptial projects se, <br />Pho-Itivottdic 595+601 <br />BUILDING OWNER'S NAME <br />Roga)40 * A(va¥62 <br />ADDRESS' <br />to \ 1 N . Icl st , Sail• A., CA CITY: <br />W.k 01,7 4 <br />PHONE NO: <br />1lct -S41- %16 <br />STATE:ZIP: <br />cA 923 <br />TENANT'S NAME (Comm/Ind): . PHONE NO: <br />CONTRACTOR'S NAME: i STATE CONTR. #:LICENSE CLASS:PHONE NO <br />10,1 Au r 10(cIr (3. C 46) 120111 (g. 6 46)1,»-67£ 2892 8 <br />ADDRESS:CITY:STATE: <br />4,1 W La .'be, U Suite pl BWA el ziP) 4 >/ <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />3 4 Ilkl <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO <br />®,0 Autr 50 lap , CA c .93-019 1 34-69-4·4#2 9 <br />ADDRESS:CITY STATE: 6 <br />cal (U lawbeft /20( , fuite 1-1 1 8}24 04 <br />CONTACT NAME:Jok l.i,PHONE NO:323-603-9396 <br />E-MAIL ADDRESS:N.I U @ *MALPOWEFS 0(RE. COWL <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: $024 f /L»SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES/NO FLOOD ZONE: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 />f <br />/ 7 <br />101+