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Home My WebLink About102102208 - Permit (2)City 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 #:1O21O22O4 Pin #: 31?t \ Proiect Addresst 1117 W Seventeenth St Unit Btdg TTact: BATES Address Range: 1109-1117* Historic: No Suite Range: Zoning: ClAssessor's Parcel:399-071 -1 6 Lot: POR 1 Block: NA Building Use: Job Type: Nature of Work: Existing Bldg. & Use: Proposed Use: Commercial Alteration Window C/O Commercial/Offices Occupancy: Constr Type: Code: Flood Zone: # of Stories: B VB cBc 2016 x-0602320144J 1st FL Area 2nd FL Area Other Areas. Garage Area: Totat Patio: T.l.Area: Yards Req'd Valuation:$1,000.00 Description of Work: Legalize window changeouts-same size, same style/auth on file Planning Conditions: Bstch * : 52991t 0f I ice: (:TYH Owner: Address: Phone: Tenant Jose F Casillas 2740 Waverly Dr Los Angeles, CA 90039 12131304-7226 Owner-Builder Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: Engineer: Address: Phone: License #: Architect / Desiqner: Address: Phone: License #: Tronsoct i on TotcrI Jose F Casillqs llicrol i 1r rJ1116rJ02. ICI Checl BuildingIt I16(102- 5l611l[il]0 Generol Plqn Updnt lJl I 16002- 5l6tJllt.illtl BIdg Stds Revolvin 0l I 16utr2- 5161?rlurr Planning Approval By: Plan Checked By: Permit lssued By: NPDES lnsp. Req'd: No PWA lnsp. Req'd: No Planning lnsp. Req'd: No Landscaping lnsp. Req'd: No Fire lnsp. Req'd: No Police lnsp. Req'd: No Flood Zone Cert. Req'd: No Guevara, Jerry Hernandez, Kathy Dale: 1111212019 Date: Dale 1111212019 Subject to Field: Misc. Receipt: Misc. Receipt: Misc. Receipt: 07776002 011L6002 07776002 07776002 07776002 07776002 07776002 Permit Fee Microfilm Records lnvestigation Penalty Bldg. Stds. Revolving General Plan Update lssuanceAccount#Total 57601 5777 0 57601 57607 57612 57600 57607 Fee Total Paid to Date: Balance Due: $166.53 $3.91 $100.57 $252.69 $1.00 $22.e5 $57.20 $604.85 $0.00 $604.8s Every permit issued shall become invalid unless lhe work on the site authorized by such permit is commenced within 360 days after its issuance,or if the work authorized on the site by such permit ls suspended or abandoned for a period of 360 days after the time the work is commenced. 01 1 16002 51600 01116002 51601 01 1 16002 51612 01116002 57770 $22.95 $576.99 $1.00 $3.91 lnspector MID#: 2019-155790 Contractor: Address: E BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DEL('ARAI'ION I hercby allirm uncler pmalty ofpsiury thal I on exeinpt from lhe Conlracto6' License [,aw for thc follorving reson (Sec.70]1.5 Businss and Profmion Codc): Any Cily or (bunty rvhich requira a ponit 10 construcl. alte. irnprove dmolish or reprir m1 stnrchrre. pdor lo its issumcc. also reqtrirG thc applicant for such fEmil lo file a signed statoncnt thal he or she is licenscd pusuant to the provisions ofthc Contrdclor's l,icensed [,arv (Chapls 9. Commencing rvilh Section 7000 of Division 3 ofthe l]usiness and Profcssions('ode)orthatheorsheiscxetnptthscfromandlhebasisfortheallegederonption. AnyviolalionofSationT0.rl.5byani applicantforapennitsubj(tsthe applicanttoacivilpenaltyofnolrnorelhanllvchundreddollds($500). y' I.6 o\ursofth(propefly.ormyenrplo;muith$agsmtheirmlecornpersalion.\rilldolhe \\orkandthestrudueisnol intcndcd oroflsedforsale(Sa.T044.RusinessMdProfcssionsCode: fheCoillraclor'sLicmseLawdosnotapplytooownqof lheprcpdty whobuildsorirnprov6thtr@n,mdwhodo6suchwolkhimselforhoselforthroughhisorherownernployc6. provided thal such irnprovmots ae nol inlodql oroflqcd for sle. lf. ho$'qo, the hrilding or improlanml is $ld within one )@ ofcornpldion. the 0\vner Buildq rvill havc the burdm ofprovirrg tha he or she did not build or ilnfrove the prcpqty for the purpse of salc). l. o orvno oflhc propmy. am exclusively conlr acting wilh licensed conlraclore k) construcl the proiecl (Sec. 7(X4. Busincss and llofesstn Codc: 'l he Contractor's l,icense l,arv docs not apllly lo an owner ofp[rperly rvho builds or improves thereon. and rvho contracts for such projets rvilh a Corilracto(s) Iicensed pursuant b lhe ('onlraclor's l-icose [-a$'). I arn cxcrnl)l undcr:iection . lt & P (. tirrthis rc,rr,rrrl! Y'.*,,*"?,*,,*}J,.- ) i-l)alr itlrzlrqX-()N ner: DECLAR,{TION I hereby affirrn under lmalty of grjury one of thc follo$ irtg delnrations: . lhaveandrvillmaintainaCetificalcofConscnlloSelf-lnsureforworkes compmsation.&s providcdforbySetion3T00ofthe Latrr Code. for the pofomance of the u,ork for $hich lhe pflnit is issued. Ihavcandw'illnraintainNorkers-conrpcnsalioninsurancc.as rcquiredbl. lieclionlT00oflhcl-abor(-ode.forlhepo'forilranceoI tht'rorkforshichthispcnnilisissuctl.Myuukss cortpcnsalioniosurancccanierandgrlicyrrunrberoc: ('arrier: 11:licy Nuntber:[]rpires: I certif)'lhal in thc pcrforillance oflhc $'ork for \r'hich this pcrnrit is issucd. I shall not cnrploy an:. prson in any manncr so as to becoilre subjcct to thc workos'cornpensilion la\\'s ofcaliftrnria. and agre that il l shotrld tEornc subjftt to the workq-s' conrpensalhn provisions ofSeclion 3700 ofthe t,atbr Codc. I shall. foflhrvith comply rvith thos provisions. WARNINC: Faihrre h sue N'orkers'compelsation co\trage is unla$ful. and shall subj(t an onployr b oirninal fmaltia and ci|il finauptoonchundredthousand<lollars($100.U)()).inadditiontolhecostofconrJrnsation.danagescprovidedforthe Seclion 3076 ^"*. I t i'E[):]x.and allorney s DECLARATION I hoeby aflirm undo Jvralty of pcrjury that I m licmed undo provision of ('hapto 9 (commcncing with Sdion 7000) of l)ivision -1 of the Business and Prcfssions Codc, md tny liccnsc is in full force md effect. l,iccrse Class: Dntc: _ Liccnsc Nunrl*r: ( oillrtctor: CONSTRUCTION LENDIN(; AGENCY I hoeby affirm under ;rnally of pqjury lhat lhfle is a constnrction lmding agmcy for the psftrnnance ofthe rvork for $hich this permit is issued (Sec. 3097, ('iv. C.). Lendo s Narnc: Lcndcr's Addrcss: APPLI('ANl' DT]('LAR,\1'ION I hda{\ allinr under pcnalty ofpcrjutr onc oflhc ftrllo$ ing dcclaralions: t)cnrolition I'crnrils Asbestos Notification Fedcral Regulations ( I itle.l0. l'ar16) Requir c(l t-cllcr oI Ndil]calion I celili that thc ltdcral rcgulations rcgo{irtg asbstrs rcmor al ar c nol ilp|licahlc lo lhis p,oiecl I cenif)-, lhal I har c rcad this applicalion md sl.le lhal lhc atFle infonnalion is con ccl. I agr(- lo comply \\'ith all ('ily and ('ount] ordinancs anrl State l.a\vs relaling to building conslnrction, and hereby author izc represorlali!6 ofthis City and Counly lo mts upon the abovc nrenlitNed prope(y for inspection DUmSeS- )L/\pplic{trt or Agetrt Signature: Perrrifeenanre(print): l x b,:ril,e-4 L \z- t^^rtM-I)ater r \Irz 1zot"1 Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/VenUl nsu lation Roof Sheathinq Shear Wall Framinq lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif I FINAL Certificate of Occu Notes, Remarks Etc. 3 //{/2,)/r-&li I Planning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 (714) 647-5800 www.santa-ana.org APP-13 CBC 2016 NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a build specified at ing permit has been submitted in your name listing yourself asW \eslâ‚¬,fi'\ eeY*V Elt S.cxn*o, r'<na the builder of the property improvements ilt-1 CA C|ZIOL We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder. Wewillnot issue a building permit untilyou have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS; Read and initial each statement below to signify you understand or verify this information. 441 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builde/' build- //g permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prop- erty. @ I understand building permits are not required to be signed by property owners unless they are responsible for the - 6nstruction and are not hiring a licensed Contractor to assume this responsibility. /) ?+l understand as an "Owner-Builde/' I am the responsible party of record on the permit. I understand that I may protect r/self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. %* I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers fl permits and contracts. ,f?i I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total SAlue ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe/' under state and federal law. -N=6 I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal gUvernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. -M I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential s#uctures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- tors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed generalbuilding Contractor. kâ‚¬. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- C{al or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. -kj* I understand I may obtain more information regarding my'obligations as an "employe/'from the lnternal Revenue Ser- Wce, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi- sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800- 321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. W I am aware of and consent to an Owner-Builder building permit /arty legally and financiaily responsible for proposed construction activity or"is' - i t t-J \r.J' St-,.."evare4^t1,1 S+ Sa.nl a( applied for in my name, and understand that at the followino ad- Awtx . CA q'2:10 G I am the Signature of Property Owner Print name of owner 5 O -ry\ I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all {fplicable laws and requirements that govern Owner-Builders as well as employers. 4Z*l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I fbve provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civilcourt. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copv of the propertv owner's driver's license. form notariza- tion. or other verification acceptable to the aoencv is reouired to be presented when the permit is issued to verifv the propeftv owner's siqnatu re. Ar'.-------'Date: lo''+ - ZPLq7Se? . ce\sil\c,.s AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personalresponsibility, lhereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work)tMinclo tN Cha"nqL Project Location or Address:Irt-l W Se ue n*e <-r*h st Sanla Ay-,- c*%10L Name of Authorized Agent:bc^b ri e \ct e, . Linv,tne ; lo b 3 F- fto l,.f A1,â‚¬,Orv\O tN CA nt Address of Authorized Age Phone Number of Authorized Agent.131-.) 424 -\bz1 I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date lo q. 2-o Print Name of owner: 5O se F . Ccr.si \\r,tS Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re- quired fo be presented when the permit is issued to verify the propefi owner's signature.