The URL can be used to link to this page

Home My WebLink About40134946 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Mechanical PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853 Permit #:4O134946 Pin #: 69{57 Proiect Address: 2606 N Flower St Assessor'sParcel: 001-244-25 Lot: POR 10 Unit: Block: NA Bldg: Address Range: Tract POTTS, BORDEN &lllistoric: Yes Suite Range: g Zoning: Rl Owner: Address: Carol Cossaboom 2606 N Flower St Santa Ana, CA 92706'1547 (71413834454 01 1 16002 51604 01 1 16002 5160C 0'r116002 5'r604 01116002 5777C Fee Type Compressor General Plan Update lssuance Microfllm Records Amount 97.17 23.79 59.30 4.05 Qty 1.00 1.00 1.00 1.00 Fee $97.17 $23.79 $59.30 $4.05 Phone Tenant Name: Contractor: Address: Owner-Builder Phone. State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: Botchi:56673 - 9/29/2O2A I0: srorqIeElSOftice: CTYH Trsnsi: 18 3 of 3Accti: Refi: 40134?46 Rcpt+:03074610 - 9/29/2020 10:54 AH TronEoction Totsl t486.96 (:onoI Cossoboor Generol Plon Updqte Fee r11lt6rt02- 51600000- llechon icol 01116U02- 51604r-100- 11 icrof i Ir & Doculents 01116002- 5777('000- Iloster Cord CC+: rr**r*rrr***1574 _ r23.79 _ t156.47 _ t4.05 $486.96 Authi:226?45Building 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 Comp Arabe, Jill Hernandez, Kathy 09t29t2020 09t29t2020 Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Notes: Fee Totat Paid to Date: Balance Due: Occupancy: Constr Type: Code: Date: Date: Date: R-3 VB cMc 2019 Every permit issued shall become invalid unless the work on the site authoized by such permit is commenced within 360 days after its lssuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 360 days after the time the work is commenced. 01 1 16002 51600 01 I 16002 51604 01116002 57770 $23.79 $156.47 $4.05 $184.31 $0.00 $184.31 lnspector MID#: 2020-161798 M ECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS ()lvNt:R nult,r)uR IrEl-cARA'n()N rPI)lictiltli,rtl)rJtrlil\uhiccl\lhc ilpl)licrrlkrrcivilpcnrlly(,lnr)lnx)rclhxnli\chun(lrcd(lolllrs(35(X)). \:rlc ). tn(l $h0 c()ntrilcls liI such pr).icels siltl r (l)rilrilcl()(\) liccilsc(l pur\lrrnl (, lhe (inilrir(lor'\ l.iccnsc l-rN ). -l am cxcmpt under B, [)olci ?120 ()rrnar: I hcrchy atfirm undcr pcnally oI pcrjury onc of thc following dccldralions: _l huvc and will nuintain a Ccnificatc of Conscnt to SelFlnsurc lirr workers cornpcnsillt)n. as providcd frrr by Scction 3700 of thc Lrthr C(xlc. for lhc pcrformancc of lhc work for which thc pcrmil is issuccl. _l havc und will nuintain workcrs conrlrcnsution insurrncc. as requircd hy Scclion 37U) oflhc l,abor Codc. for lhc lErfonnance of the work for which lhis pctrnit is issud. My workcrs' comJrcnsali(ilI irrsurilncc caricr and policy numbcr arc: ?-*i^.. PolicY Numhcr: Exnir"t' - _l ccrlily lhflt in thc pcrfornuncc of thc work for which lhir pcrmit is issucd. I shall not cmpk)y any pcrson in any manner $ as k) hccotrrc suhFct to thc workcrs' compcnsat ion lnws of Cdlifornia. and agrN I hnl if I should hccorc subFct to thc workcrs'contpcnsdtionpmvisionsoISslion.3?U]ofthctJh)r(ixlc.lshall.forthwilhcomplywilhlhorcprovisions.. I{ARNING: Failurc to wurc workcm'compcnsalkrn covcragc is urlawful. and shall suhject an cmplolcr lo oiminsl FElties and civil fines up to orc hundrcd thoussnd dolltrs ($100.000). in sEtion 3076 of thc t*nr Codc. intercst ed attomy's fccs. lo thc cosl of comlEnsalion. damges &s providcd fo] tlrc u,u",Q-7Q-ZOU IICENII|LCQNIIA.CIQB DECI ARA'TION I hcBby allirm undcr pcnalty of p.rjury thlt I an liccnsctl under provision ol Chaf,tcr 9 (connrEncing wilh Sccthn 7ff)0) of l)ivision 3 o[ thc Busirrcss and l'rolcssirns Codc. ad nty liccnsc is i[ Iull lorcc and cflccl. Liccnsc Class:-Liccnsc Numhcr: l)nlr W I hcrcby xflirm ufdcr Ircnulty of tErjury that thcrc is il conslruclion hnding agcncy fo, lhc lrcrfornuncc oflhc work for which lhis fErmil is irsucd (Scc..l(,97. Civ. C.). hndcr's Nanrc: lrndcr's Addrcss: APPLICAN'I' I)DCI,ARAl'ION I lf,ltbr allirrn urdcr l)cnxhy ol'pcr iury (rrc (rf thc lirlkru ing rlcclarat ions l)cnx)lilion I'ernrit(-A\lr\lo\ N({ili(rlion I:c(lcrnl Rcgulnliors ( l illc.lO. l'ilr16) _Rcquilc(l l-ctlcr ('l Nrilili( rliur -l ccrlily lhrl lhc lltlcrrl rcgulalions rcgar(linE r\h+slos rcrilr,1illilrc n({ nl)f licilhlc lo lhi\ projccl. -l crrlil.v lhrl I hnve rci(l lhis rppli(nlion nn(l slrlc lhrl lhc irh)!. inl()fltlrlion is c(irrccl. I ilgrcc lo crrnrply : rcl)rc\cnlnlivcs 0l this City with all Cily rnd County and Counly to cntcr upon thcordinnnccs and Stalc lrws rclating to building ud hcrchy aulhorizc rho\c nlcrlirnN(l l)r()pcrly litr i nppliexill (tr ABcnl Signrlurc: Pcrnlilcc narrc (prirl):Cossa ,r,,r.,?-13-:?!4 Appliances liletal Fire Place Evaporative Cooler Furnace Compressor lvlisc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rouqh Ductwork Vents Toilet Room / Clothes Dryer Residential Ranqe Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openinos lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech FinalTest Meter Release FINAL lo 4-@ l-Ltr,)21t4c. n Notes, Remarks, Etc sa,t rI'os. 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 PROPERW OWNER Dear Property Owner: An application for a buildin g it has been submitted in r name listing yo urself as the builder of the property improvements specified at Z6oa q)eY 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. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS; Read and initial each statement below to signify you understand or verify this information. nll-I 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build- - ing 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 construction and are not hiring a licensed Contractor to assume this responsibility L, A,I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. -L O I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Ut I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vilue of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. U, 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' 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. U, 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 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 general building Contractor. Z, 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- -cia) or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workman- ship or materials. L, I understand I may obtain more information regarding my obligations as an "employer'' from the lnternal Revenue Ser- Vce, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divr- 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. to an Owner-Builder building permit applied for in my name, and understand that I am the le for proposed constru -Sh..zz-[. Saurta. ction activity at the following ad- 2|. I agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all ffilicable laws and requirements that govern Owner-Builders as well as employers. -Lrr l 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 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 aqencv is required to be presented when the permit is issued to verifv the p ropertv owner's si o n atu re. Signature of Property Owner Date:?-zq-Hu Print name of Owner AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personalresponsibility, 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) Project Location or Address: A\.,a.f A QZPS Name of Authorized Agent: Address of Authorized Agent: Phone Number of Authorized Agent: I declare under penalty of perjury that I the property owner for the address listed above and I personally filled out the above information and certify its accuracy Print Name of Owner:rol Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re- quired to be presented when the permit is issued to verify the propefi owner's signature. Property Owner's Signature:o^r", Q-2q- u)t Co=s,boon