HomeMy WebLinkAbout101102760 - Permit (3)Project Address: 1923 W Jan Way
Assessor's Parcel 109-523-08 Lot: 49
Bldg: Address Range Suite Range:
Zoning: RlBlock: NA Tract.3355 Hastoric: No
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspectaon Requestsr (,714\ 667 -2738 Inspector Section: (714) 647-5853
Permit#: {O{{02760
Pin #: ?{2i2V
Building Use: Single Family Owelling Occupancy: R-3, U 1st FL Arear Patio:
Job Type: Reroof Constr Type: V B 2nd FL Area: T.l.Area:
Natureof Work: Reroof Code: cBc 2019 other Areas: yards Req,d;
Existing Bldg. & Use: Sfd Watt garage Flood Zone: X-0602320257 J Garage Area: Valuation: $4,000.00
Proposed Use: # of Stories:
Totat:
Description of Work: Reroof house & attached garage - remove comp, replace any damaged sheathing, install new 3o-year shingles. Handouts given.
Owner authorization on file.
Planning Conditions: Replace any damaged wood m€mbers, fascia, eaves, rafters, etc prior to final approval.
Owner:
Address
Phone:
Tenant:
Contractor
Address:
Engineer
Address:
JUAN JOSE LOPEZ ALVAREZ
'1923 W Jan way
Santa Ana, CA 92704
(7141 737 -037 4
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
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$41S.17
Phone.
License #:
Architect /
Designer:
Address:
Phone:
Lrcense #:
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i:illl.qlng.ii.i6Lriri.. i;.i d t, i iit ii -
. !:narqi ,Linn ilpdote Fee
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r,iarc,i, iifi i uocufien t s
$39tr. 2$
$22.?1
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Planning Approval By: Orozco, lvan
Plan Checked By:
Permit lssued By: Chavez, Dave Z-
NPDES lnsp. Req'd: No 'x
PWA lnsp. Req'd: No Fire lnsp. Req'd:
Planning lnsp. Req'dr No Police lnsp. Req'd
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every pemit issued shall become invalid unless the work on the site aulhonzed by
such permit is cofimenced within 360 days aftet ils issuance.or if the work authorized
on lhe site by such pormit is suspended or abandoned fot a peiod ol 360 days aftet
the time the wo* is cofimenced.
lnspector MID#: 2020-156905
Fee Tolal
Paid to Date:
Balance Due:
$41 8.1 2
$0.00
s418.12
Date: 0'l/06/2020
Date:
Date:01lO7l2O2O
Subject to Field:
lvlisc. Receipt
lvlisc. Receipt
NIisc. Receipt
o77751dw) 51601
o ttt-ooo'StiEFtzo
07116002 57672
o7776002 57600
07776002 57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$35Crtlb r.rt-
$l3r.9iri::
)
$1 .00
$22.95
$57.20
No
No Account#Total
01 1 16002 51600
01 1 16002 51601
01 1 16002 5'1612
01116002 57770
$22.95
$390.26
$1.00
$3.91
U nit:
BUILDING. INSPECTOR RECORD
COMMESITE-WORK
Set Backs
Forms/Steel/Holdowns
Ereclion Pads
SLAB Floor
Subf loor/Vent/lnsulation
Roof Sheathin t
Shear Wall
Framin
lnsulation/Ene
allD
Ext./lnt. Lath
Brown Coat
[/]ason
T-Bar
Handica Re
utD Final Re ort
En ineer Final R ort
FINAL
Certificate of Occu n
N emarks EtcES
,\,/n'
d
OIVNER BUII,D}:R|)EL('ARAT(
I lErcby ariri und.r p.mlry or rrjury rlrll I m .rcmfl ltum rhc O,nrr.k t I-
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.acnsc ljw aor rhc follovi,s r.aern (Se 70.]1.1
Burinci\ fui Proli$ion Cotl.): Any Ciry or Cou.ry whrh rcqund d lEmil ro con{ru.t. sllcr. inpfuvc dcmolish or rclair tv t
dd.ruc, llri,k, ils is\xmc. rko rcqlirc\ rh. lPtlia ntrskhFm lo ilc a $sncd sllcmnr rhar tr or shc n !dn{J punu'nr
n, rlrc l)!*aioni ol lh. Conr.acd's Li.cnrc't trw lcluflcr 9, Conmcnuin! wirh Secrnrn ?0(l) of Divtitn ] ot rhc Businc$ dl
Pnnc*tuns Oic) or rhar h. Dt she t crcnq,r (hc.chm !d lhc b trorrhc.llcscJctchNnn. Anvvnrhhdnolsarion70rl'5bvonv
aprlica nr r p.mil subic.k thc rlfliuMl ro a dril t)cnllr y ol flor morc I hrn rivc hundrcd dollds (S5d)).
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n ctr,tc,i or olf.rd lm slc (Se.?044, Busincs rn,l Proftshns C*te: Thc Conx !ulr\ l-ic.nk tis des not 'ptlv b u owkr df
rhc Fmncny whrbu ls or inDn,ks rhcdr. ail wh) das s(h wo* himscl, or h.r\clf or thoulh hn ot h'r owtr cmpktyccs
poviJ.J (h!r $ch impoffinh * mr nrcnled oroffcNd Ibr sL. li hN.rd, rhc huiLlhs or ii{n,Em n $U wnhin om vta
;l d,nr'hr$n. dr Ow;r Bufird w,ll havc rhc hurJ.. or tNviry rhd hc or sh. dil
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nnill or rqnv hc PNpcn, lor rh' |dtlxtt ol
l.asowncrorrhcpmr.ny.an.rclusivclyconka.!i!3wirhltcnscdconiracn,Flo.onsrtuctihcpofd(Sc'7041.Bu\incs
ili Ptur6srn 6dc: ih. Conk.uln\ l,iccnsc Law der not apply b rn .wnct or p!,lcdv who buiUs 'r m{tuvcs lhcE n,
and *ho conrr.k lo, surh rojccts wirh d On'r,(ktn, li.cnscd Purumr b rhc Conrr((x s Licn* Law)
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I hcrchy al rim unJfi pcnrlly oI Friury oft ol th. inlbwine .t&laratbns
Ihavc!dwillmrint|raCcrlircarcotconscnllosclllnsur.ntrwo*c6'conwnsarion,rspl)vidciti'rhvSccrttn\?ol)olrhc
lr$r Grlc. lbr rhc lErfornEre ot rh€ wotk lot whiuh rhe Fm s isucd
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haw and will mlinr,in *otk.s comncnsaiion nEurrn.c. rs .cqxidl hv Sc.l ioo .l7(n of rhc L.hor Codc. fd thc p'rrdmn" ol
ttc worklorwtu h rhisFrmn L\ isnd. My woik.s' om['cn$rn'n in afrc..mcr ar rntvnumbcroc:
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worlcs u.mpctr\rroh pRJvkhns ol Sfrrn)n l?OO.llhc lihtr Ciiic.l shiL tunhwrh co.ulv wirh rh$ PDYirnrn\
WARNTNG i lurc r" *.,'. w,trkcs'.oDp.trsdio. covcn8c rs unlxwtul. .tuIshrll {hjcct an cnpl'vq b cn'biDl l8nahtr rtul
.'vrl lincs up b orc hundrcd rhouu.i dolls (!10{.(xl(,). ; rJ,l n b rhc rod uf compcnsrrb' d'nDScs as lm!trt&l l'r ric
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!Er! x{DQ!
I hcEt y aflnm unJlr Fmlryorp.rjury rh{r I am licniJ;d.r pNvnboorchaPler 9 (dnmfrin8 wilh SmriJn ?lno) otDiviihn l
of lh. auiim$ ,nd P(ntsioor Codc, anl my liccnsc is in fu ntM d}] ctLcr
CONSTRUCIION LENDTNG AGENCY
lh.rb1/aftrnlUndcrEnrllyofpc'jurylh,lllteLsaconslru.li0nlcfu]in!.ccnuytfilh.lcrfomunccdflh.qolk{d*hi.hllispcrmilir
issucn (So. .r{}9?, Civ. C.).
LnJ.r's N"mc
A}fUSABLOSCLAEAIION
I h.'rhy'trmu lcrlcaahyorPcrjuryonc oirhc rtnlowins dccldarknr:
Dcmlili,n Pcmils-AstF(oi Norirr.at{n Fcncral Rclulal,ons (f ilL40 Pin6)
_R.qumd r/llcr ot Norirr,tion
I.cnilyrhdr rhc ialcri| resuht(,ns regdnins ast {o. 'tnNv irc nor aprlkdtlc lo drh l()jct
rl$v. ftnroncd F pcny,,tr insP..r0n
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,*," . / />126
UFER Ground
Pool Fence
Flood Zone Certif.
Lc crsAd,iftsl
foare I rD/src.
lElzo )
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
Dear Property Owner:
has been submitted in your me li rng yours lf as the bu er of the pro improvementsAn applicati
specified at
on bu ild in s ermr
c\
We are providing you with an Owner-Builder Acknowle ment and ln 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 wlll not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this
form to us at our oftlcial 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.
=J
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.
-==2 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.
=ts
I understand as an "owner-Builde/' 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 an his or her name instead of my
own.
-5L_1. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
=!J
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
value of my conslruction is at least five hundred dollars ($500), including labor and materials, I may be considered an
"employe/ under state and federal law.
:=i--6. 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.
=S.-7.
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.
NOTICE TO PROPERTY OWNER
-€=-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 finan-
cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
--t-S. I understand I may obtain more information regarding my obligations as an "employel'from the lnternal Revenue Ser-
vic6, 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.oov for more information about licensed contractors.
=LtO
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
party I
dress:
nd flnan onsible for pro tructio activity at the foll ng ad-d cons(.2?az-r
SJ-f f I agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner-Builders as well as employers.
--:J.-
have
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
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 cou(. 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 prope(y, 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. /Vote: A copv of the propertv owner's driver's license. form notariza-
tion. or other verification acceDtable to the aoencv is reduired to be presented when the permit is rssued to verifv the
propeftv owner's sidnature.
Signature of Property Owner o^r", , f 4f 1' ;r,
Print name of Owner
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.
Scope of Construction Project (or Description of Work)?"lc<ce- 31","e <(fr ( tLl
Project Location or Address
R
I I L3 W Soc^- U,.^.r S^ ,^\A^.U.'iL-l(!
I
Name of Authorized Agent :
Address of Authorized Agent:
Property Owner's Signature
Print Name of Owner:
ct ,\Ct 'I at Q z-zttu
Phone Number of Authorized Agentl
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
Date ,lrl.r,
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 verw the property owner's signature.
l-lt\
Planning & Building Agency Smoke & CO
Alarm Affidavit
20 Civic Center Plaza Ross Annex
P.O. Box'1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
na.orq
INSP.O2 2013 CRC
This document moy be found at...htto:/iwww.sa nta-an a.orql obal
(Please use a black or blue ink ball-point pen)
Project Address:
t o //o77aOPermit Number:
Property Owner:LY
Contractor:License #:
State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential
b u ild ings.
California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R31.4.3 and R314.3.3 define
the requ ired locations.
6\eoti, boxes below must be checked:
E Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired
appliances (i.e, hot water heater, cooktop, furnace) or a fireplace.
E smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed Combination Smoke/CO alarms must comply with all applicable standards and be approved
by the State Fire Marshall (SFM). Battery life must be 10 years.
I hereby certify that I am the contractor or the property owner of the above project. I further certify
that smoke alarms and carbon monoxide alarms have been installed in compliance with the governtng
Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the
ma nufactu rer's instructions.
(check onel tr Pro erty Owner
NOTE: rhrs sef-c ertiJication is only used fot projects thot dffect the ExTERtoR of the structure. This
process is applicoble ONLY to projects where access to the interior ol the dwetting by o Sdnta Ana
lnspector is not required.
Signoture:a Ddte:lqt 70
Have this completed form and the job-card readily available on final inspection!
*,,SANTA
NA/}ffi
Licensed Contractor