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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 16 2-U w . Man \y <br />USE OF BUILDING: ('RESIDENTIA COMMERCIAL <br />SUITE: <br />INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN # jo Igge,*:.2.4 <br />A:>tq _ 11*SO? 6 <br />MASTERID# <br />NATURE OF WORK:NEW ADD CALTER/T.I.DEMO REROOF REPAIR SIGN MISC <br />NFW/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 USE: <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 />Er i ck son Durna (14 1 Ill .34%-01 62 <br />ADDRESS CITY:STATE:ZIP: <br />-i <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />SolarCity 888104 Cl 0, C46, B 714-514-5830 <br />ADDRESS:CITY:STATE:ZIP: <br />2165 S. Grand Ave.Santa Ana CA 92705 <br />WORKERS COMP. POLICY#: <br />7661·066265033 <br />EXP. DATE: <br />9-1-14 <br />INSURANCE COMPANY: <br />Liberty <br />SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME: Kristina Persaud PHONE NO: 714-514-5830 <br />E-MAIL ADDRESS: kpersaud@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: $SUBMITTAL DATE:-S((O/1 Li <br />FIRE SPKR: YES / NO A/C: YES/NO FLOOD ZONE:PROCESSED b g <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: