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Home My WebLink About30135684 - Permit (2)a city of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702 PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647 Plumbing _586t\ Permit #: 3O{35684 Pin #: 30365 Proiect Addressi 117 W Fourth Sta - Assessor's Parcel: 398-258-03 Lot: POR 2, POR 3 unit:300 Block: 14 Bldg: Address Range: Tract: TOWN OF SANTA Aflistoric: Yes Suite Range: Zoning:SD84 Owner: Address: Phone: Tenant Name: Contractor: Address: Phone: State Lic #: Lic Type: Bus. Lic #: Workers Compensation lnsurance: Carrier: Policy #: Expires: Fainbarg V 129 W Wilson St #100 Costa Mesa, CA 92627 194e1722-7400 Specialty Coffee Assoc of America Owner-Builder Fee Type 01116002 51602 Sink 01116002 51602 Min Fee Adj 01116002 51600 General Plan Update 01116002 51602 lssuance Amount 11.47 31.82 19.93 49.68 Qty 3.00 1.00 1.00 1.00 Fee $34.41 $31.82 $19.93 $49.68 Building Use: Job Type: Nature of Work Planning Conditions: Planning Approval By: Plan Checked By: Permit lssued By: Subject to Field: Building Permit #: \)In",n"no*1010712015 Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Notes: auth on file Fee Total: Paid to Date: Balance Due: Commercial Alteration T! Occupancy: Constr Type: Code: Date: Date: Date: B iltB cPc 2013 Kathy 011'16002 51600 01 1 16002 51602 $19.93 $1 15.91 $135.84 $0.00 $135.84 Every permit issued shall become invalid unless the work on ff,e site authoized by such permit is commenced within 180 days after its rssuance, or if the work authoized on the site by such pemit is suspended or abandoned for a period of 180 days after the time the work is commenced. lnspector MID#: 2015-124335 PLUM BING.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS 0wner-lluildcr Declaration I hcrcby sffirm undcr pcElty of p.rjury lhat I am cxempt fornr thc Contradors' License kw for the following rcon (se.7ol !.5 BsitrGs md Profcssion Codc): Any City or Couty which rcquirB a [Emit to coNtrucl. altcr. improvc. dcmolish or rcpair rny structuc. prtrr to iti issuatrcc. also rcquir6 thc spplicant for 3uch pmit to filc I signcd statflcnt that hc or shc is liccBcd puBuilt to thc prcvisiotrrf thc Comractor's Liccrocd Llw (Chlpter 9, Commcncing with Setion 7000 ofDivision 3 ofthe Busines snd Prof6cio6 code) or that hc or shc is cxcmpt rhgcfrom 8nd thc b8k for thc sllc8cd cxcmption .Any violarion ofsccrion 70-l l.J by sny applicanr for a pemil lubjccts thc applicsnt lo r civil pcnllIy ofnot morc th.n fivc hudrcd dollm ($500). _1.8 owo6ofthcprcpcny.ormycmploycBwithwl86aithcirsolccompcmtion.willdothcworkedthcrtruci[cisnotintqdcd or offcrcd for sle ( S{ 7044, Busin6s snd Profcssions Codc: Thc Contractor's Lic.mc Law docr not apply to an owncr ofthc prcpcdy who builds or improvG thscotr. ud sho do6 srch wort hirelf or hmclf orrhrcugh his orhrown cmploye, prcvidcd that such improvcmcnts arc not intcndcd or offscd for srlc. If, howcvs, thc building or improvcmcnt h sold within onc ycar ofcomplction. thc OwB-Builds will havc thc burdo ofprcvin8 thst hc or 3h. not build or improvc for thc purpolc ofsalc). _1. s own6 of thc propcny, m cxclulivcly contncling with liccorcd contEctoG to costruct thr projcct ( Se. 7O44. Buinos ud Profcsrion Codc: Thc Contraclor'3 Lic.nsc law doe not apply to an ownor ofproperty who builds or inprovca th?r@n . ond who cont.lds fo. ruch proj*ts wih a Cont.actor(s) liccnscd puBu6nt to Contradoa s Liccns. kw ) I n & P.C.tcason. Dalc: I hcrcby affirm undq pcnalty ofperjury onc ofthc _ I havc and will mainlain. Ccnificslc ofConsent lo Sclf-lnsure for worliers' conrpensation. as provided for by seclion l7o0 ofthe l,abor Code. for thc performance ofthe work for lvhich thc pennit is issued. . l have and wrll nlarnlarn workers conpensatron insurance, as requrred by Sectron lT00 of lhe l.abor ('odc. lbr lhe perlbrnrancc oflhe work for whrch thrs perntil is rssued My workers compensation insurance canier and policy nurnbcr arc: Cmicr:_ Policy Number: Expires: (This scclion nced not be complcted if rt* po.ir i, fo. On" tr,rn*"a Oottm | $ t OO) or tess) thc hbo, Code. interGt .nd lttomcy's f6 LICENS}:D CONTRACTORS DE('LARATION I hcreby amrm uodcr penahy of perjury lhst I am liccnscd undcr provision ofChepter 9 (comrncncing wilh Scction 7000) of frivision -1 of thc Busincss and Prof6sions ('odc. and my liccnse is in full forcc and cffect. Liccnsc Class: l"iccnse Numbcr Dstc:Contractorl CONSTRUCTION LENDING AGENCY I hcreby amm undcr peuhy of pcrjury thal lhcre is a construction lcnding rgcncy for thc pcrfomncc of thc work for which this pqrnit is issucd (Scc. 1097. Civ. ('.). Lender's Namc: Lends s Addrcss. APPLICANl'S DT]CI,ARA'I'TON I)cnNlilion Pcrmils-Asbcslos Notification ledcral Rcsulati()ns ( I itle 40. Pan 6) Re(luired l.ettcr of Notifi cati(Jn _l c.rtify that thc fcdcrsl regulatioN rcSrding sbGlos rcmoval arc not applicsblc to this projat. _ I ccniry that I havc rcad lhis application and state thal thc abovc infomation is corecl. I agrcc to cornply rvith all City and County ordiuncG af,d Strlc Lrws rclrling to ahovc mcntioncd propc(y for coNtruclion. and hercby suthorir rcprGentalivcs ofthis City and Counly to cnlff upoo thc UNDER GROUND Waste & Vent Water-Underfloor Gas-Underfloor Building Sewer Area/Storm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Piping Fill Line/Back Flow Pool Heater/Gas Line Misc Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Rough Plumbing Final Gas Test Meter Release n/^)/ FINAL L//J / /fl r *, aa Notes, Remarks, Etc.u nlanner so as lo Dalc: WARNINC Failure lo Applicant or agent sig.: Permillee namc (prinl): _Datcl_t ltf r; MAYOR Miguel A. Pulido MAYOR PRO TEM Vincent F. Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Eenavides Michele Martinez Roman Reyna Sal Tinajero CIry OF SANTA ANA PLANNING & BUILDING ACENCY 20 Crvic Center Plaza P.O. Box 1968 o Santa Ana, California 92702 ww!1,.sanIa-ana.org pba NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the pro perty S atrl We are providing you with an Owner-Builder Acknowledqment 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. We will not issue a building permit until you 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. GMENT AND INFORM DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. -&-understand a frequent practice of unlicensed persons is to have the property owner obtain an "owner-Builder' building 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 injuiies to workers on my property. 4@ I understand building permits are not reguired to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. @lunderstandasan"owner.Builder',lamtheresponsiblepartyofrecordonthepermit.lunderstandthatlmay protect myself from potentialfinancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ?o I understand Contractors are required by law to be licensed and bonded in California and to list therr ticense numbers on permits and contracts. * I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materrals, I may be considered an"employer" under state and federal law. -% I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers'compensalion disability insurance, and contribute to unemployment compensation of each "employee ' I also understand my failure to abide by these laws may subject me to serious financial risk. 4r. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontractors 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 general building Contractor. CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Mrguel A Pulroo Mayor MPulrdo@s6nta-ana.oro Vrn6t F Samâ‚¬nto Mavor Pro Tem Ward 1 VSamrento@sanla-ana.oro P Dnd Bâ‚¬.Euds Ward 4 Rman Reyna Wa.d 5 RRemaaOsanta-ana orc Ward 6 STrnaero@saota-ana oro SANTA ANA CITY COUNCIL Mchele t\,(aitrne; Ange[â‚¬ ArnezoJa Ward 2 Ward 3 Sai TrnsFrc MMartrnez(Asanta-ana.o.o AAmezcuarosanla-ana oro OBenavrdes@sanla-ana.orc A- aA I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(s) that result from any latent consiruction defects in the workmanship or materials. ?n I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration. the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-321 -CSLB (27 52)or www.cslb.ca.qov for more information about licensed contractors 63-- tne pa, 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am ly and frnanci responsible for proposed construction activity at the following Nt Ar1- I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. Q-r2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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 anyfinancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. 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 veriflng 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 copy of the propertv owner's driver's license, verification to be when the ,s a, f Ufzrl< I 6-r\C^r^,6-q.A AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF Excluding the Notice to Prope(y Owner, the execution of which I understand is my personal responsibility, I hereby 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):( nrt,^t|Q l:Gttrhr' tt<27.fte{uke E\ 5rur-5 Project Location or Address:Itl W, Ytth, r-l{L@f Name of Authonzed Agent:da+ Zâ‚¬Doc,a/ Address of Authorized Age 2 [rnon" Number of Authorized Agent: I declare under penalty of pequry that information and certify its accuracy. 5iE.Ct- lam property owner for the address listed above and I personally filled out the above Propefty Olvner's Srgnature Print Name of Owner:F-.<\an C-l"tc,-'*- tr*A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when lhe permit rs lssued to verify the propefty owner's signaturc. Mrguel A Puhdo Mayo. MPulrdo@santa-ana.orr Vrncst F SafiEnlc Mayor Pro Tem, Ward : Vsarm6to@santa:ana org SANTA ANA CITY COUNCIL Mchele li,tanrne; AngelrG Arnma Ward 2 Ward 3 Sal Trna,erc ward 6 MManrneziosanta-ana.qo AAmezcua(asanta-ana.ore DBâ‚¬navrdesrAsanta-ana crc RRevna@santa-ana.orc STrnaarcfAsanta-ana.om P Davd Bfrauds Ward a R@n Reyna Ward 5 Signature of Property Print name of Date