HomeMy WebLinkAbout101105153 - 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 #: {O11O5{53
Pin #: 8{y:
Proiect Address: 410 W Bell Avea
Assessor's Parcel:410-1 82-02 Lot: 2
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 7058 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-0602320278J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total
Patio:
T !.Area:
Yards Req'd:
Valuation: $16,000.00
Occupancy:
Constr Type
Code:
Flood Zone'.
# of Stories:
0
Description of Work: lnstatl solar panels. Per checklist. Homeowner letter in folder
Planning Conditions:
Owner: James Dinh
Address: 410 W Bell Ave
Santa Ana, CA 92707
Phone: V14l g3l-gil4
TENA N'' PERI-IIIT CTMC ELL ED
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DATE:t.\\a\a*\
Contractor: Tesla Energy Operations
Address. 2102 Alton 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: American Zurich
Policy #: WC107458503
Expires. 10/31 12021
Engineer:
Address.
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Solar City
Abelardo E. DeVera
3055 Clearview Way
San Mateo, CA 94402
(650) 638-1028
ss18s
Planning Approval By
Plan Checked By.
Permit lssued By:
NPDES Insp. Req'd:
PWA lnsp. Req'd:
Amsden, Julie
Date:
Date:
Date: 1110G12020
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
07776002 57607 Permit Fee
07776002 57770 Microfilm Records
07776002 57672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
Fee Total:
Paid to Date.
Balance Due:
$450 00
$76.95
$1 00
$0.00
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#TotalPlanning !nsp. Req'd:
Landscaping lnsp. Req'd Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 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 51601
01116002 51612
01116002 57770
$4s0 00
$1 .00
$76 95
$527 95
$0.00
$s27.9s
lnspector MID#: 2020-162630
BUILDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcreby aflrnr undcr Fnalty of pcrjury thlt I .m cxer{rl fmm llE Contrrcto6' Licen* [aw for thc following wn (Sec.7031.5
Busincss and Pmfcssion Codc): Any City or Counly which rcquircs r tEmit lo conslruct. olter, ir{rrcve, &mllsh or rcpir my
struture, prior lo its issuilcc, also rcquircs thc applicant for such [rcrmit to filc a $igncd statcrcnl that hc or shc is liensd puEumt
to lhc prcvisions of lhc Contractor's Liccnmd Lrw (Chaplcr 9. Commncing with SNlion 7000 of Division 3 of lhc Busircss md
PrcfcssionsCode)orthathcorsheisexctrptlhcrcfmmondthcb&sisforlhcslhgcdcxcmption. AnyviolstionofSrctbnT03l.5byany
applicanl for a pcrmil subjcts thc applic8nt to a civil pcruIy of not morc thil fivc hurdrcd dolltrs ($500).
C
_1. as owtrcr of the propcrty, or my cmployccs with wagcs as thcir solc compcnsation. willdo thc work and the stnrcture is rnt
intended or offered for sale (Scrc.704a. Busincss and hofcssions Code: Thc Contraclor's Liccnse [:w docs not apply to an owner of
the proprty who builds or improvcs thcrcon. and whcr docs such work himself or hcrself or through his or hcr own employecs,
providcd that such impovcnrcnts arc not intendcd or offcrcd for sale. lf, howcrar. thc buiHing or ir1)roventnt is sold wilhin one )rcar
of complctiorL thc Owner Buildcr will havc thc burdcn of proving that he or she did not build or inrprovc the proprty for thc purprse of
salc).
_1. as owner of thc propcrty. am cxclusively contracting with liccnsed conlraclors lo conslruct thc projcrt (Scc. 7U4, Busiltcss
and Profcsskm Codc: Thc Contractor's License Law docs not apply lo an owncr of propcrty who builds or improves lhcreon,
and who contracts for such gnojcos with a Conlractor(s) liccnsed pursuant to thc Contractor's Liccnse [:w).
_l am cxcnrpt undcr Scttion-, B. & P.C. for thls rcason.
Dale:,Owner:_
WORKERS' COM PF'NSATION
D['CI ARAflON
I hcrcby affirm undcr Jrcnalty of pcrjury onc of thc following dc.clarations:
_l have and will maintain a Ccrtifrcate of Conscnt to Sclf-lnsurc for workcrs' comlrcnsation. as provided for by Scrction 3700 of the
Codc. for the pcrformancc of thc work for which the permit is issucd.
and will maintain workers' comlrcnsation insurance. as rcquircd by Section 3700 of the labor Codc. for the performarrce of
which this issucd. My workcrs' compensation insurancc carricr ard plicy numbcr arc:
Q4PolicyIo
_l certify that in thc pcrformancc of thc work for which this permit is issued. I shall not employ any pcrson in any manner
so as to bcconre subject to the workcrs' compcnsation laws of Califomia, and agrcc that if I should beconrc subjcct to ttp
workcrs' comgrcnsation provisions of Section 3700 of the l-atnr Codc, I shall, forthwith comply with those pmvisions.
WARNING: Failurc to sccurc workcrs' compensation covcrage is unlawful. and shall subject an rmployer to criminal pcnalties and
civil fincs up to onc hundrcd thousand dollars ($100.000). in addition lo thc cost of compcnsation. damages as providcd for the
Scctiorr of I,atnr Codc, intcrcst and attorncy's
l)atc:T0)n Applicant:
t)tict ,\t(,\'l'loN
I hercby affirrn under pcnalty of perjury that I am licenscd undcr provision of Chaptcr 9 (comrrrcncing with Section 7000) of Division 3
of thc Business and Professions Codc, and my licensc is in full lbrce and effect.
Liccnsc Nunrber:t(to{
W
I hcrcby affirm urder lEnalty of Frjury Ihat thm is a onstruction lcnding agcncy for thc JrcrforlMcc of thc work for which this Frmit is
issued (Scc. 309?, Civ. C.).
lrndcr's Nartrc:
lrnder's Address:
APPLICANT DECLARATION
I hcrcby allirnr under pcnalty of pcrjury onc o[ thc following dcclarations:
Dcmolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Title 40. Part6)
_Rcquircd [rtter of Notification
Applicant or Agent
Pernritee nunle
u2o
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenYI nsu latio n
Roof Sheathinq
Shear Wall
Framing
Insulatio nlEnergy
Drvwall
Ext./lnt. Lath
Brown Coat
Nlasonry
Pool Fence
T-Bar (
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL
Certificate of Occupancv
Notes, Remarks, Etc.
Rev. 08'07-201 5
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