HomeMy WebLinkAbout101107084 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O11O7O8,4
Pin #: Or?r;
Project Address: 2841 N Augusta Way Unit Bldg
Tract 15648
Address Range:Suite Range:
Zoning: RlAssessor's Parcel. 232-111-25 Lot: 1 Block: NA Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use.
Single Family Dwelling
Solar
Solar
Sfd w/att garage
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories.
R.3, U
VB
cBc 2019
x-0602320144J
1st FL Area
2nd FL Area
Other Areas:
Garage Area.
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation: $24,000.00
D
Description of Work: lnstall roof mounted solar panels, per checklist.
0
Botcht:5?729 6/2?/2rl2l0ffice: CTYH Tr0ns*: 1?Acc[*: Refi:
Rcpt*: tt333t-t33tt 6/?q /?tr21
Transoct i on Totsl
lrJ1It:t7LtB4
Planning Conditions:
1u:41 i
1751.LI9
Engineer.SOlarCityf e:,Icr f ner.s!.f 0per 1t iiirii,.
James ChildsOwner:
Address:
HUY NGO
2841 N AUGUSTA WAY
Santa Ana, CA 927061 134
(7141 604-8873
Contractor: Tesla Energy Operations
Address: 2,,102 Alton Parkway
lrvine, CA 92606
Phone: (7141 496-0688
State Lic #: 888104
Lic Type: B, A, C-10, C-20, C46
Bus. Lic #: 324801
Workers' Compensation I nsurance:
Carrier'. Zurich American
Policy #: WC107458303
Expires'. 10/31 12021
Address.3055 Clearuiew Way
San Mateo, CA 94402
(650) 638-1028
50775
$450. t:t[
$l . t-ttt
36tt .'71
$7El . r_rg
Auth*: tr943g9
Phone:
Tenant
Phone:
License #:
Architect /
Desiqner.
Address:
Phone.
License #:
Planning Approval By:Date:
Date:
Date: 0612912021
Subject to Field.
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
0!776002 57607 Permit Fee
01776002 57770 Microfilm Records
07776002 s7672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
$4s0 00
$60 75
$1 00
$0 00
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd
Amsden, Julie
t
No
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Total
Landscaping lnsp. Req'd 01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$450 00
$1 00
$60 7sEvery permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterits 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.
Fee Total
Paid to Date:
Balance Due:
$st 1 7s
$0 00
$st 1.75
lnspector MID#: 2021-167 145
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNERBUILDERDELCARATION .
I hcrcby omrm under pmlty of prjury thd I m cxcmpl from thc Contmctom' Licens liw for thc following rercn (Src.7031.5
Busincss and Profcssion Codc): Any City or County which rcquircs s fErmit to construct, altc]. improve, dcmlish or rclEir any
structurc, prior to its issuucc, rlso rcquircs the applicant for such Frmit to lilc a signcd statercnt that he or she is lienrcd pmuaht
to thc Fovisions of thc ContEcror's Liccn$d hw (ChrpIcr 9. Commcrcing with Scction 70OO of Division 3 of thc Busircss ond
PmlcssionsCodc)orlhathcorshciscxcmptthcrcfromondthcbssisforthcallcgcdcxcmption. AnyviolationofscctionT03l.5byany
applicant for a lErmjt subjets thc applicant to a civil pcnalty of not mrc than five hundrcd dolltrs ($500).
-1.
as owncr of thc property. or my employccs with wagcs as thcir solc compcnsation. willdo thc work and thc stnrture is nol
intendcd or offcrcd for salc (Scc.7(X4. Busincss and hofcssions Codc: Thc Contraclor's Liccnse Law docs not apply to an owncr of
thc prcpcrly who builds or improvcs thcrcon. and who docs such work himsclf or hcrrclf or through his or hcr own cmployccs,
providcd lhat such improvcnrcnts arc not intcndcd oroffcrcd for sale. lf. howcvcr, thc building or improvcrrcnt is sold within one ycar
of complction. thc Owncr Buildcr will havc thc burdcn of proving lhal hc or shc did not build or irprove thc propcrty fur the purposc of
salc).
-1.
as owncr of the property. am cxclusively contracting with liccnsed contractors to construct thc project (Sec. 7W, Busincss
and Profession Code: The Contractor's Licensc Law docs not apply to an owner of propcrty who builds or improvcs thcreon,
and who contracls tbr such projccts with a Conlractor(s) liccnscd pursuant to thc Contraclor's Liccnsc [aw).
-IamexcmptundcrSection-'B.&P.C.forthisrcason.Il.rr,..1t.--^-.
WORKERS' COIVT PENSATION
DECI {RATION
I hcrcby affirm under ;rcnalty of perjury one of the fbllowing dcclarations:
-l
havc and will maintain a Certificale of Consent to Self-lnsurc for workers' compcnsation. as provided for by Scction 3700 of thc
work lbr which thc pcrrrrit is issued.
Scction 3700 of thc Labor Code. for the pcrfornrance of
,carrier and Jnlicy numhr are:
6 2 P.^Policy
_l ccnify that in thc lrrformns of thc work for which this lrcrmit is issucd. I shall not cmploy any JErson in any mrnncr
s as to bc@m subFct to Ihc workcrs' compcnstion laws of Califomia, and agrcc that if I should bccom subjcct to the
workcrs'compcnsationprcvisionsofSction3T00oflhctiborCodc, lslull.forthwithcomplyvilhlhosprcvisions,
WARNING: Failure to surc worke6'@mIEnsalion covcragc is unlawful. and shall subjct an cmploler to aimiml Fmltics and
civil lines up to onc hundrcd thousand dollaB ($100.000), in addition lo thc cost of comlrcnsalion, damges as provided for thc
Scctiorr intcrcst and allorrcy's fccs.b
I)llCl.r\lt,\'l'l( )N
I hereby atf irm undcr pcnalty of pcrjury that I am liccnsed undcr provision of Chaplcr 9 (comnrcncing with Section 7000) of Division 3
of thc Busincss and Profcssions Code. and nry license is in full forcc and cffect.7('fffio
W
I hcrcby affirm undcr trcmlty of pcrjury thd thcrc is a constructk n bnding agency for thc pcrformncc of thc work for whkh this fsmit is
issucd (Scc. 3097. Civ. C.).
Lcndcr's Namc:
Lrndcr's Address:t
APPLICANT NECI ARATION
I hercby affrnn undcr penalty of perjury one of the following dcclarations:
Dcmolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6)
_Rcquircd Lctter of Notification
County
abovc nrcntioned propcrty for
Applicant or Agent
I'ernritee nanre
pur[x)scs.
up,on thc
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenUI ns u Iation
Floof Sheathinq
Shear Wall
F[aming
lnsulatio nlEnerqy
Drywall
Ext./lnt. Lath
Brown Coat
[Vlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
/9m L l/ +- at l1 I ., ,ln -d-e fu)a
FINAL ,/7U O. 7t 7v/2',Vtc.* //./
Certificate of Occupancy
Notes, Remarks, Etc.
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Exnires:
_ Contraclor:_
l'cdcralrcgululions regarding ashcstos rcnxrvalarc not applicablc to lhis projcct.
and hcrcby authorize rcprcscntatives
rcad this
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