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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 2 300l 14 ·Lyon Sk ·SUITE: <br />USE OF BUILDING: 4-RESIDENTIAL) COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.Aoo.Worksheet <br />SAPIN # 10 1 90 8/ 9 <br />2614-1/30 77 <br />MASTER ID# <br />NATURE OF WORK: NEW ADD CLTERE.1.-3 DEMO REROOF REPAIR SIGN MISC <br />NEW/ADDITION/ALTERATION· <br />1ST 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 USEL <br />GARAGE/CARPORT:SF ALTER/T.I.: SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : New Roof Mounted Solar Panels <br />BUILDING OWNER'S NAME:PHONE NO: <br />Shelley Stan f)hin 114-35U - 52-0 l.9 <br />AeDRESS:CITY:STATE:ZIP: <br />S ar,UL <br />UNANT'S NAME (Comm/Ind)PHONE NO: <br />CONTRACTOR'S NAME: <br />SolarCity <br />STATE CONTR. # <br />888104 <br />LICENSE CLASS: <br />C10, C46, B <br />PHONE NO: <br />714-514-5830 <br />ADDRESS:CITY:STATE:ZIP: <br />2165 S. Grand Ave.Santa Ana CA 92705 <br />WORKERS COMP. POLICY#EXP. DATE: <br />7661066265033 9-1-14 <br />ARCHITECT/ENGINEER: <br />ADDRESS: <br />CONTACT NAME: Kristina Persaud <br />INSURANCE COMPANY:SANTAANA BUS. LlC. #: <br />Liberty <br />STATE LICENSE #PHONE NO: <br />CITY:STATE:ZIP: <br />PHONE NO:! 714-514-5830 <br />E-MAIL ADDRESS: kpersal-Id@solarcity.com <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: $SUBM\Tr AL DATE·. « /t p <br />1 <br />FIRE SPKR: YES /NO A/C: YES / NO FLOOD ZONE:PROCESSED <br />RES. DEV. FEE: YES / NO PRIOR; OWELLING UNIT : YES/ NO COMMENTS: J <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS. <br />imliilt-