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Home My WebLink About20157244 - Permit (2)city of santa Ana 20 civic center Plaza (M-19), Santa Ana, cA 92702 Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Electrical Permit #:2tJ157244 Pin #: 73643 Project Address: 902 S Garnsey St Assessor's Parcel: 010-251 -13 Lot: POR 17 Unit: Block:19 Bldg: Address Range: Tract: POLYTECHNIC VlLlHistoric: No Suite Range: Zoning: SD40 Owner: Address: Phone: Cristina Corea 16542 Bellflower Blvd., #200 Bellflower, CA 90706 (310) 869-s810 Fee Type 01116002 51603 Serv Meter 01116002 51600 General Plan Update 01116002 51603 lssuance Amount 48.1 0 19.93 49.68 Qty 1.00 1.00 1.00 Fee $48.1 0 $19.93 $49.68 Tenant Name: Contractor: Address: Owner-Builder Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: Building Use: Job Type: Nature of Work: Planning Conditions: Planning Approval By Plan Checked By: Permit lssued By: Subject to Field: Building Permit #. Single Family Dwelling Miscellaneous Serv Meter Occupancy: Constr Type: Code: Date: Date: Date: R-3, U VB cEc 2013 Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Notes: Upgrade/handoutgiven. Fee Total: Paid to Date: Balance Due: 07121t2015 Account# 01116002 51600 01116002 51603 $19.93 $97.78 $117.71 $0.00 $117.71 Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 180 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 180 days after the time the work is commenced. lnspector MID#: 2015-122752 I ELECTRICAL.INSPECTOR RECORD DATE ID/SIG COMMENTSAPPROVALS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release Rough Service Meter FINAL -,arCl tr-D Notes, Remarks, Etc.| --.r 667 ^r'MCBr43'zv"' - ' Owncr-Buildcr Dcclaration I herehy alTirm under penalty ofPerlury that I am exempt forn lhe Contraclors Lrcense bw for lhe following reason (sec.7O3L5 tjusincss and Profcssion ('odc): Any Cily or Counly which requircs a pcrrnit to conslruct, alter. improvc. dcrnolish or rcpair any struclurc. prior to its issuancc,alsorequirctheapplicanlforsuchpermiltofilcasigncdslalcment lhalheorshcisliccnsed puBlanltolhcprovisionsofthc Con(ractor's Licensed l,aw (Chapter g, ('omnrencing with S*tron 7000 ofDivision I ofthe Rusiness and Professions Code) or lhat he or shc is cxempt lhcrefronr and lhc hasis for lhc slleged cxemplion .Any violalion ofSection 703 I .5 by Any 6pplicanl for a pcmit subjccls lhc applicant tr a civil penalty ofnot morc lhan fivc hundred doll0rs ($500). _1. as os'ner of thc propen),. or my cmployees with rvsgcs as lhcir solc compensalion. will do thc rvork and the slructure is nol intcnded or offerad for sale ( Sec 7044. Business and Professrons Code The Contractor's l-rcense L6w does not apply to an owner ofthe propcrty who builds or irnptovB thcrcon. tnd who docs such work himselfor hcrsclfor through his or hcr own cmploycca. providcd that such improvcmcnts arc not intendcd or offcrcd for salc. lf, howcvcr. lhc building or improvcmcnt is sold within onc ycar ofcomplction. thc Owncr-Buildcr will havc thc burdcn ofprovinS thal hc or shc not build or purposc ofsalc). __ l. as o*'ncr of thc propeily. arr exclusivcly conlracling wilh licanscd lhc proicct ( Scc. 7044. Busin6s and Profession Code: _l-hc Conlractor's Licensc lrw does not apply to an of whq burlds or improve thcreon, and who conlracls for such pr()iecls wilh s Conlraclo(s) licensed !he l,aw ) _l am cxcmpt undcr Section .8. & l)ale: I hereby 6fl'irm under penalty ofperjury onc ofthe following dcclarations: I havc and will mainlain a Cerlificalc ofCoNent lo Self-lnsure for workers' conrgrcnution. as provided for by Setion 370o ofthe libor Codc. for th. pcrfonnaf,cc of lhe work for which lhe pcrmit is issrcd. Ihaveandwrllnrainlainworlers conrpensalioninsurance.as requiredbySection3T00ofthel,aborCode,forlheperfornranccofthe work for which lhis pcrrnit is issued My workers conrpenslon insurance carrier and policy nunrher are ('aricr: Policy Number:_ l lhis scction neid not bc complctcd lf rfrc pmlr rs fr,, ft*dollars l$1001 I cerlili lhal in lhc performancr ofthe work for which lhis I shall cnrploy anv person in anv nrf,nner so as to hecame suhject lo lhe workers' conrpensalion laws of('ahfornia.rfl td to lhe worlers' compcnsal ion pror isioils ol-sccl ion l7(x) oI the I)nte: WARNINC l'ailure to secure workers'l. and shall suhjcct an ernployer to criminal pcnallics and civil fines up to onc huf,drcd thousand dollars ($l lhe labor Code. inl(est and attorney s fe addilion lo lh. cosl ofconrpensation. dailrages as provided for lhc Seclion 11076 of LICENSED CON'I'RACTORS DECLARATION I hereby amrm undcr penahy ofperjury lhat I am licensed under provision ofChapter t) (commencing \vilh Seclion 7000) ofDiyisi(ln I of lhe Business and Professions Code. and rnv license is in full force and cffect. License ('lass:[-icense Numbcr I)ale: I herehy aflim undcr penahy ofperjury lhrl issucd (Sec. 3097. Civ. C.). l-ender's Name agency the pcrfomance ofthc work for Nhich lhis perniil is l.ender's Address APPLICANl'S DECI,ARATION I)emoliti<rn Pernrils'Asbestos Nolification federal Rcgulatiof,s ('fille 40. Parl 6) Rcquired Lcttcr oI Nolifi cal ion I cerlilv that lhc lideral rcgulations regarding asbcslos nol applicablc lo lhis n()icct. is coftcct. I altrce to comlly wilh all City and County atrthorize reprcsenlali\es ofthis ( ily and CoInly to enler upof, lhe l)ale:- S'*'-t.u h tr{@- orf>rfs M:\WP5 1 \Permit-lnspeclion For lnspection 31 06 uN-7 I 1 Jr'o! MAYOR Miguel A. Pulido MAYOR PRO TEM Sal Tinajero COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Vincent F. Sarmiento Dear Property Owner An application for a CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE GOUNCIL Maria D. Huizar CITY OF SANTA ANA PTANNING & BUILDINC AGENCY 20 Civic Center Plaza P.O. Box .l988 o Santa Ana, California 92702 www. santa-ana.org / pba NOTICE TO PROPERTY OWNER it SU the buil the property improvements We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you of your responsibilities and possible risk you may incur by having this permit issued in your names as the Owne 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. OWNER'S ACKNOWLEGMENT AND VER!FICATION OF INFORMATON DIRECTIONS; Read and initial each statement below to signify you understand or verify this information. .., I. ' ! 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" Uuif Orng 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 property. ." [ 2. l understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. \ rrLi ! 3 I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potentialfinancial risk by hiring a licensed Contractor and having the permitfiled in his or her name instead of my own. -!j!_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ,'4 7i. ' L 5. I understand if I employ or othenrvise engage any persons, other than California licensed Contractors, and the t,otat vatue of my construction is at least five hundied'dollirs ($5001, including labor and materials, I may be considered an "employer" under state and federal law. h,iI L 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and feOerat government, withhold payroll taxes, provide workers' compensation 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. 0 L I 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 allwork 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. lis\s /\ t1t ' L 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financiat or personal injuries sustained by any subsequent'owne(s) that resulifrom any latent construction defects in the workmanship or materials. il ,r .t ' L 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Servrce, the United States Small Business Administration, the-Cafiforni- Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-32'1-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. i l ,tL' L- 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am tne party legally and financially responsible for proposed construCtion activiiy at the following od d.oo o . ,i,,\ ' L' 'l'1. 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. it .;!_:12. 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 any financial 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 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 be completed and signed by the property owner and returned to the agency responsible for rmit. IVofe; A copv of the propeftv owner's driver's license. form be when the ,s Date: A ?')*/7oSignature of Property Owner Print name of Owner ft- c:*, AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property 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. ScopeofConstructionProject(orDescriptionofWork): Project Location or Address Address of Authorized Agent: Phone Number of Authorized Agent: 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 Owneis Signature: Print Name of Owner: Date: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is rssued to verify the property owner's signature. PLink:WPS1/Counter Activity/Assembly Bills/Notice to Property Form 03-13-2014 SANTA ANA CITY COUNCIL Mrguel A. Puhdo i Sal Tinapro I Vrncent F. Samrento I Micnete Mart,nez i Angelca Amezcua i p. oavio Benaudes I Roman Reyna Mayor I MayorProTem,Ward6 | wardl I wardz i ward3 | w"roo I wards Name of Authorized Agent: