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OC PUBLIC WORKS/ OC PLANNING |300 N. Flower Street, Santa Ana, CA 92703 | PERMIT APPLICATION | PAGE 1
PPeerrmmiitt AApppplliiccaattiioonn
County of Orange
300 N. Flower Street
Santa Ana, CA 92703
714.667.8888
714.667.8885
Today’s Date: Permit #:
TYPE OF PERMIT
RESIDENTIAL (RS)
NON‐RESIDENTIAL (NR)
GRADING (Preliminary) (GA)
GRADING (Precise) (GB)
LANDSCAPING (LS)
RESIDENTIAL TRACT (RT) *
FENCE, WALL, RETAINING WALL (RW) *
*(Separate attachment required for multiple submittal)
PLUMBING (PB)
MECHANICAL (ME)
ELECTRICAL (EL)
SWIMMING POOL/SPA (SW)
SOLAR (SL)
DEMOLITION (DM)
SIGN (SB)
OTHER ___________________________________________________
PROJECT INFORMATION
Addre
ss of Project:
Address City Zip
Legal
Description:
ocation of Site (Decimal Degrees):
Assess
/
or Parcel Number (APN):
L Example: 3 / 3.687 117.786
Latitude Longitude Latitude Longitude
Project Description:
STRUCTURE SIZE: / ///
Total Basement 1st floor 2nd floor 3rd floor
GARAGE SIZE SQUARE FE
Current Related Permits:
E : T
SITE ACREAGE:
CONTACT INFORMATION
Owner Name:
Owner Address:
Phone Number:
Address City Zip
Contracto
Address:
r: License #:
Phon
e Number:
Agent/Contact Person: Affiliat on:i
Phone Number: Fa : x Email:
ARCH TECT: I / ///
Name License # Street # City Phone #
Permit Application (10/2011)
COUNTY OF ORANGE | OC PUBLIC WORKS | OC PLANNING
OC PUBLIC WORKS/OC PLANNING |300 N. Flower Street, Santa Ana, CA 92703 | PERMIT APPLICATION | PAGE 2
ENGINEER: / ///
Name License # Street # City Phone #
SOILS ENGINEER: / /
License #
//
Name Street # City Phone #
App le to Gradin Permits ONLY licab g
ENGINEERING
GEOLOGIST: ////
City
/
Name License # Street # Phone #
CUBIC YARDAGE: CUT: FILL:EXP
WATER DISCH
O
RT:
PROJECT ACREAGE: ARGE I.D. NUMBER (WDID):
TOTAL SITE ACREAGE: DISTURBED SITE ACREAGE:
This se d by County Property Permit ons ction must be complete s (CPP) staff for grading & landscape applicati
CPP PERMIT NOT REQUIRED
CPP PERMIT FOR ENCROACHMENT PERMIT IS REQUIRED
CPP APPLICATION HAS BEEN SUBMITTED
PERMIT NUMBER _______________________________________________
NO DECISION – ADDITIONAL INFORMATION NEEDS TO BE
S BMIU TTED
CPP STAFF NAME _________________________________________________
DATE AND INITIAL _______________________________________________
I CERTIFY NO WORK SHALL OCCUR IN COUNTY RIGHT OF WAY AND/OR EASEMENTS.
Signature
Date
Applicable to Sign Permits ONLY:
TENANT/BUSINESS NAME:
CY PERMIT NUMBER:
OCCUPAN
SIGNAGE
: DETAIL Wall Sign Freestanding Single Face Double Face Illuminated Non‐Il
Ground Clearance:
luminated
Height: Lengt
ADDITIONAL INFORMATION (i.e. Sign Copy) :
h: Sq Ft:
DECLARATION:
DECLARATION:
I declare to the best of my knowledge that the information I have presented on this form and attached materials is true and correct.
I also understand that additional data and information may be required prior to final approval of this application and that insufficient
information / documents may delay the plan review process.
Print Name Signature Date
STAFF USE ONLY:
OTC PLAN CHECK PLANNING APPLICATION PCRA CE SETBACKS
ZONING: Coastal ACTUAL: REQUIRED:
APN#: Flood Plain FRONT
LEGAL: SIDE (R)
PA/CP: Required SIDE (L)
PLANNER’S NAME: REAR
APPLICATION COMPLETE/
CUSTOMER CARE STAFF NAME
(per related checklist) INITIAL DATE
Permit Application (10/2011)
OC PUBLIC WORKS/OC PLANNING |300 N. Flower Street, Santa Ana, CA 92703 | FINANCIALLY RESPONSIBLE PARTY| PAGE 3
DDeessiiggnnaattiioonn ooff FFiinnaanncciiaallllyy
RReessppoonnssiibbllee PPaarrttyy
County of Orange
As stated in the Board‐approved Ordinance, the County’s Planning Department operates by recording actual
costs against a deposit for grading and planning services. Thus, it is required that each permit or record
maintained by Planning have a Financially Responsible Party (FRP) identified.
Per the County Ordinance, the FRP and the owner will receive all official communications regarding fiscal
matters, including notices of low balances and additional requests for deposits and copies of permits. The FRP
will also receive any refunds, if applicable. Once the FRP is identified, a confirmation notice will be sent in which
the named FRP will have 10 days to notify the County of any errors. If the designation is contested, all work on
the permit(s) may be stopped until this issue is resolved.
Permit / Record # (s)
Planned Communities Reimbursement Agreement (PCRA): Y N
Trust Account Name/Number: (Associated for reference)*
*Automatic Trust Account Replenishment requires a separate form.
As the Applicant Owner Contractor Other (specify) _________________________, I designate
the Financially Responsible Party to be:
Contact Person/Agent o this application to be: f
Applicant* Owner Contractor Other* ____________________
Name:
Company/Business Name
Address:
City, State, Zip
Phone #:
Email Address:
PRINT NAME SIGNATURE DATE
County Use Only New Applicati on Revision tion to Current Applica
Received by: Date: Role Updated in APPS:
* Any FRP other than the owner or a licensed contractor must have notarized authorization to complete any form
on behalf of the owner or licensed contractor.
Permit Application (10/2011)