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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 909 S Toland Street <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL <br />SUITE: <br />INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN # <br />MASTERID# <br />NATURE OF WORK:NEW ADD ALTER/T.I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION· <br />1 ST 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 USE: <br />GARAGE/CARPORT:SF ALTER/T.I.:SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : 4. 6 k-N ROX- -YACI ¥1·1-rd <br />93\A(L, 10 Pan.#1\.L 1.0 mic/¢10-\Y\(,2 F.HIES) \-6:09) Ang.\, I (A\Cran-Un <br />29 0, on A 4,14- <br />BUILDING OWNER'S NAME:Teresa Mitsueda PHONE NO:714-775-1705 <br />ADDRESS'CITY STATE:CA ZIP:909 S Toland Street 'Santa Ana 92707 <br />TENANT'S NAME (Comm/Ind)PHONE NO: <br />CONTRACTOR'S NAME: <br />Vivint Solar STATE CONTR. #: <br />973756 <br />LICENSE CLASS:PHONE NO: <br />C-46 657-600-8252 <br />ADDRESS:CITY:STATE:ZIP* <br />1529 E McFadden Ave Suite A Santa Ana CA *92705 <br />WORKERS COMP. POLICY#: <br />WC 029342335 <br />EXP. DATE: <br />11-1-2014 <br />INSURANCE COMPANY: <br />AIG Claims, Inc. <br />SANTA ANA BUS. LIC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:Amber Steinbeck PHONE NO: 657-600-8252 / 714-815-5772 <br />E-MAIL ADDRESS; amber.steinbeck@vivintsolar.corn / OranqeCountySolar@vivint.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: $'2610(8.60 SUBMITTAL,OATE/22114 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCES <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br /> tr-\ \C. <br />..e