HomeMy WebLinkAbout101105014 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714\647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O11O5O14
Pin #: 46583
Project Address: 2857 N Augusta Way
Assessor's Parcel: 232-101-26 Lot. 52
Unit:Btdg:
Tract: 15648
Address Range:Suite Range:
Zoning: RlBlock: NA Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Solar
Solar
Sfd w/att garage
R-3, U
VB
cBc 2019
x-0602320144J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $1 5,000.00
Occupancy.
Constr Type
Code:
Flood Zone'.
# of Stories:
0
Description of Work: lnstall roof mounted solar panels. Per checklist.
Planning Conditions:
Engineer
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
PZSE lnc
Paul Kenneth Zacher, SE
8137 Sunset Avenue, #120
FAIR OAKS, CA 95628
(e16) s61-3s60
s3878
Owner. Peter Nguyen
Address: 2857 N Augusta Way
Santa Ana, CA 92706
Phone: (619) 5654482
Tenant:
Contractor: Tesla Energy Operations
Address: 210zAlton Parkway
lrvine, CA 92606
Phone: (7021 785-2998
State Lic #: 888104
Lic Type: B, A, C-10, C-20, C46
Bus. Lic #: 324801
Workers' Compensation I nsurance.
Carrier: America n Zurich
Policy #: WC107458302
Expires: 10/31 12020
Btd
] t6Ll
cr'of
.r1 l. 16tt
1n st er
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd
Julie
Date:
Date:
Date: 1012312020
Subject to Field:
Misc. Receipt.
Misc. Receipt:
Misc. Receipt.
07776002 57607 Permit Fee
07776002 57770 Microfilm Records
07776002 s7672 Bldg. Stds. Revolving
07776002 57600 Genera! Plan Update
Fee Total:
Paid to Date:
Balance Due:
$450.00
$64.80
$1.00
$0 00
No
No
No
No
Fire lnsp. Req'd.
Police lnsp. Req'd Account#
No
No Total
Landscaping lnsp. Req'd Flood Zone Cert. Req'd. No O1 1 16002 51601
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
01116002 51612
01 1 16002 57770
$450 0c
$1.00
$64 80
$st 5 80
$0 00
$515.80
lnspector MID#: 2020-162280
L
BUILDING. INSPECTOR RECORD
SITE-WORK DATE !D/SIG,COMMENTS OWNER BUILDER DELCARATION ' .
I hcreby affirm undcr Jrcnalty of perjury that I am exempt from the Contractors' Licensc [:w for the followrng reason (Sec.7031.5
Busincss and Profcssion Codc): Any City or County which requircs a pcrmit lo construct. altcr. improve. dcmolish or rcJrair any
structurc, prior to its issuancc, also rcquires the applicant for such pcrmit to fih a signcd stalemcnt that he or she ls licenscd pursuant
to lhe provisions of thc Contractor's Licensed [:w (Chapler 9, Commencing with Section 7000 of Division 3 of the Busirress and
Professions Codc) or that hc or she is exempt thcrefrom and the basis for thc allcgcd excmption. Any violation of Section 7031.5 by any
applicant for a 1rcrmit subjccts thc applicant to a civil penalty of not morc than five hundred dollars ($500;.
_1. as owncr of thc F,roF,crty. or my employecs with wagcs as their solc compensation. will do the work and the stnrcttne is rnt
intcndcd or offcrcd for salc (Sc.c.7044. Busincss and Professions Codc: The Contraclor's License [-aw does not apply to an owner of
thc proprty who builds or improvcs thereon. and who dcrcs such work hinrsclf or hcrsclf or through his or her own employees,
provided that such improvcmcnts are not intenclcd oroffercd for sale. If. howcrar, the building or inqtrovenrcnt is sold within onc 1tar
of complction, thc Owrrcr Buildcr will have the burden of proving that hc or shc did not buikl or improve the propctty for the pur;nse of
salc).
_1. asowncrof thc pnrpcrly, amcxclusivclycontracting with liccnscd conlractors to construct thc prcrjcct (Sec. 7(X4, Busincss
and Profbssion Codc: 'l'hc Contractor's Liccnsc Law does not apply lo an owncr of propcrty who builds or improvcs there<ln.
and who contracls for such projccts with a Contractor(s) licenscd pursuanl lo the Contraclor's Liccnsc Law).
_l am cxcmpt undcr Section-. B. & P.C. for this rcason.
Date:
WORKERS' COMPENSATION
DECLARATION
I hcreby aflirnr undcr pcnalty of perjury onc of thc following dcclarations:
_l have and will maintain a Ccrtilicate of Consent to Sclf-lnsurc for workers' comlrcnsalion. as povided for by Section 3700 of thc
Codc. for the pcrfornunce of thc work for which the pcrmit Ls issucd.
and will maintain workcrs' conrpensation insurance. as rcquircd by Scction 37fi) of the Labor Code. for the performancc of
which is My insurancc carricr ard policy number arc:
rt74Policy
_l ccflify that in thc Jrcrtbrmancc of the work for which this pernrit is issucd. I shall not employ any person in any manncr
so as to beconrc subjcct to thc workcrs' compcnsation laws of Grlittrrnia. aurd agrcc that if I should bcconrc subject to thc
workcrs' compcnsation provisions of Scction 3700 of the l-atnr Codc, I shall. forthwith conrply with those provisions.
WARNTNG: Failurc to liccurc workcrs' compcnsation coveragc is unlawful. and shall subjccl an employer to crfuninal pcnaltics and
civil fincs up lo onc hundred thousand dollars ($100,000). in addition to thc cost damages as providcd for thc
Scction Corlc.altorncy's
I hcreby allirnr undcr pcnalty of pcrjury that I arn liccnscd under provision 9 (comrrncing with Scrction 7000) of Division 3
of the Business and Profcssions Codc, and my license is in full force and cffcct.
Liccnse
D
C()NSI'RUC'I'ION I,I'Nt)ING A(; I'NCY
I lrcrcby sffim undcr FntrltyofFrjury thar thcrc is a construction lcnding agcrcy for lhc JErformurcc ofthe work for which this frcrmit is
issucd (Scc. 3097, Civ. C.).
Lrndcr's Narnc:
lrndcr's Addrcss:
APPLICANT DECLARATION
I hcrcby allirm undcr penalty of Jrcrjury onc of thc following declarations:
Dcrnolition Pcrmits-Asbcstos Notification Federal Rcgulations (Title 40. Part6)
-Rcquircd
lrttcr of Notificalion
atxrve nrcntioncd propcrty for
Applicant or Agent
Pcrnrilee nanre
)D
lhc
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/Ve nVl nsu I atio n
Roof Sheathing
Shear Wall
Framing
lnsulatio nlEnerqy
Drywall
Ext./lnt. Lath
Brown Coat
lVlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
L/ ?-'2-/-P /Lc zi
F!NAL /2. l. Ld fLC eSt t4a1 2f7
Certificate of Occupancy
Notes, Remarks, Etc.
L
Rev. 08-07-201 5
Date:_
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