HomeMy WebLinkAbout30138263 - Permit (3)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CAq27O2 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (7141667-2738 lnspector Seclion: (714) 647-5853
Permit #: 30{38263
Pin #: 83513
Project Address: 1317 S Everolade St Unit:
Block; l,lA
Bldg:
Tracl: 3531
Suite Range:
Zoning: Rl
b?
Assesso/sParcel: 107426-11 Lot: 85
Owner:
Address
Blas & Bertha Mota
1317 S Everglade St
Santa Ana, CA 927043'117
(714) 669-9941
01116002 51602
01116002 5'1602
01116002 s1602
01116002 5't602
0r 116002 51600
01116002 51602
Foo Type
Shower
Sewer Alter/Repair
Wtr Htr (Res up to 50 g.
Alter OrainNent
General Plan Update
lssuance
Amount
z'.t.42
42.45
21.42
42.85
21.25
52.98
Qty
1.00
1.00
1.00
1.00
1.00
1 .00
Fee
$21.42
$42.85
s21.42
$42.85
$21.25
$s2.98
Phone:
Tonant Name:
Contractor:
Address:
Owner-Buildor
Phone
Stale Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Poliry f :
Expires:
Slngla Family Dwelling
Alteratlon
Plumblng
R-3, U
VB
cPc 2016
Notes: Plumblng. Oryner-Builder form on file.
Planning Conditions:
Planning Approval By
Plan Checked 8y:
Permil lssued By:
Subjecl to Field:
Building Permit #:
Chavez, Oavety
Dale
Date
Date 071o6t2017
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Ewry pemit issued shall bocgme invalid unless the wo* gn tha site
autllgtized by such pemit is cgmmenccd within 1 80 days aftet its
issuance, ot il the wo* aulhofied on ltl€ site by such pennil is suspended
o( abandoned lor a pedod ol 180 days aftet lhe time the wo* is
comnenced.
$21.25
$181 .s2
$202.77
$0.00
s202.77
lnspector MtD#. 2017-137255
01116002 51600
01116002 51602
Fee Total:
Paid to Date:
Balanco Duo:
Address Range:
Hisloric: No
Building Use:
Job Type:
Nature of Work:
Occupancy:
Constr Type:
Code:
PLUMBING.INSPECTOR RECORD
DATE ID/SIG..COMMENTS owNtt Bulurtr DEL xaTtoir
I hadrr.ffm uldc pa.Iy of Firy Lh. I 6 a.q. to6 rh. Coffi. Li@ t4 6. lb. 6lbwiB !m (sa.?oll.J
&!ijB lrd Fo&3ir Co&)i ,{., Cily q Cold, vtti .Gqunq . FEi lo 6di|(t .ha. nqo(, d@lu' or qt 5,
i!,.irq Fb to ir brE . .ro ,qi- rlE +plid tu rdr Fon lo fir. . ria!.d rroat $r lE or rt ir ltd.d FBr,
lo tt FDviin otlE Codrtd. tid Lw (ClrFa 9, Cdra.iia Eirh SaniD 7m of Dvirb! I of6. A'!iIE trd
Prolt aoB cod.) 6 d!. lE6& i acdi tdd.o -d ti. bi 6r O..lhed q@pliE A!, vi,Lion o(s.dih 70-l1.5 !y t y
.pptoal tu. pcoit s$<t 6c ry9Ud! ro . civilra.ly otel EBth 6E L,qH.b0it (3rm).
8-*4 *r,,.*-r, diy pr,)d whh w.s6dtun $bo,rFE.lbr wiu& rb*nt-d [EinElE. Er
ina.ld 6otu tu .1(Se ?!.a. Aria 6d ?E&-in C.dc lt cdEtd'r Li!. L.* 66 @r .,prt io e ow or
rlEEoF eln bitlt d hrro6 dEr.., id *to &aidr Et ti@dae brlf d lnqd bb d lE 06.4lotc
F!!id.d l[a rst i,F.Erld.GEr i&rd.d do&!d &. -l.. lt lD*€. ti. hiliry d aryn@r a-B wiii!@rc
ofo<prrbo. ln. orG lrrb {i! bE tL hrrh of Fvi$ dri li d d'c dil d hlld, iiqlE 0E FlFry it rt Frpo..of
I ao*G of $. FFry, o act{ivclr-@nodD8 win [.d.d c.rr,-Id!ro <odxl tln Fo]-r (sd 70,14. &rra
!n hDbiod C.&: TL Co rtroir Lt6e Lrv .to6 rr .ggly ro & o* otFlFry eho boildt or irFlE lhaur
.d *t olr.-t. e. erd Foi.st *irh. Con'xrq(r liE d Failn lo rh. con'-rd i Lifr L.s).
I m.t.mp undd s(rFn , A e P (' for rht,6.. ,--..-7-(-rt ^**Rl*S K lLl6l &' tn-aalgxt:g)utEasarlar
D&ClJ8All0!
I lE try i0im !.(k rE lhy orpqury on. orlh. tolkr$ m* dcldllroB
Ih.wrdwillmi, rir. Cdriftd. ofcodr bSdfitu6rwtd @trpalin... F.viLrl for bySetbi l7moirlE
L.bor Co& for rlE FfqMcc of lh. mrt 6r whi.t lt Fml ir iE ..L
-l h.Erd rillrinth rortd orpdrh! iEllftq a Equitld b, Sctrn l70O ot E Lrho. Co&. tu llE pafotu of
rlE wt a* shi.h rhi FEa it io.d My wst6 @tq.!iir iffi 6i, !n polt, @nbq a
8{4,r, * n ,* *t* orrh. won tu f,ti.t rhn Fnn is iu.( I ih.r mr qby &y lEen ia &r lttsE
- lro h@d rud io ti. *dtd'@tpdrin l.6orc.lif.hn.ad {c ll'r ifl.lDuld bcoG $licl rorl!
6rtal ory@li{ ,.@ih6 of S.sbo 37001lh. t &. Coda t $.lL tod,i,ilh or4ly -il lhor FoviriE..
sdrn !(76 otrn l,hor ( o.L, nrdd rnd dhE-'sf6
DEIIEAIIOtr
I tq6r.frtD o& rdryof FirylL I E M & FBi.ba of cl+d 9 {oodrrFrilr eilt scriE ?@0) of Divibr l
of t Oirir d Pt!&d! C.& d rr lic i i f!! 6c d.ft.r.
Cl)lirxu(IrcxlJtDrlli-acEl(a
t Hy.,Im. und( rFlltyof Frjurr rh,r rhd. !..d6lto.tbn Lnd,s isftt for rh. FlolM. of tlE $!d ror slrth rhB fffi ir
ield (Sc lo9r. Civ. C.)
La!&l Ne _
AIIIICAIII.DECI4AAIIq!
I dyCD
'!td6
pa.ly orFic, oE ortlr folh*irt rLbnbql
Daoltb! P.ntl^$.ro raoritrri.b &d lqitldbd (Iirb ,10. Pal6 )
-Lquirld
1116of tJdi6..i,
-l
€tif, rta rlc i&.1 ca!hi,I' nadi,{ &d lqEvd !! @1 +glicrt& lo rhlr FD}r.
.E6"dq - ,
"*,-o
ro rylirb! ndrn.rb 6..toE nbr ih ic6<1 t irerooqtfirt.I cnyrdcoldy
ddnEi€ &d $!r Lls dr4 to loildlr! oiiEu.ib'! !d hdcb, lrlDda ,qErrt€ ofthi. Ci, -d coudy lo ora 'sE rh.
rbor. tldioi.d FlFry 6. Gpclion W/ttSApplicml or Ardl sktrttu..:
}LS
L ffi -*.7- A- n
UNDER GROUND
Waste & Vent ,thJ\4,
Water-Under floor \' \"1 \t I Iru Lr )
Gas-Underfloor
Building Sewer
Area/Slorm Drain
lnterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOUSPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release tl
FINAL
Notes,
APPROVALS
K ltlsfL
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MAYOR
Miguel A. Pulido
MAYOR PBO TEM
Michele l\.4artine2
COUNCILMET\.'IBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinalero
Juan Viliegas
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNINC & BUILDINC ACENCY
20 Crvrc Center Plaza
P.O. Box 1988 . Santa Ana. Calrfornia 92702
wwrr.Santa-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 property
ments s pecified at t)t,3 qC L
We are providing you with an OwnerBuilder Acknowledoment and lnlormalion 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 lorm lo us at our oflicial 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 ACKNOWLEDGMENT AND VERIFICATION OF INFOBMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verity this information.
€-(r. , understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
building permit thal 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 linancial risk for any injuries sustained by an unlicensed
person and his or her employees while working on my property. My homeowneis insurance may nol provide coverage for
those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage lor injuries to
workers on my property.
8-y-" I understand building permits are not required to be signed by property owners unless they are responsibte for
the construction and are nol hiring a licensed Contractor to assume this responsibility.
B Hg. I understand as an "Owner-Buildei' 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.
9-1"\ o. ,understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
6 t4 U. ,understand il I employ or otherwise engage any persons, other than California licensed Contraclors, and the
total value ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
"employei' under state and federal law.
6-{'( U. f understand if I am considered an "employer" under state and Federal law, I musl register with the state and
federal 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 f inancial risk.
B--Wr. I understand under California Contractors' State License Law, an Owner-Builder who builds single-f amily
residential structures cannot legally build them with the intent to offer them for sale, uniess a// work is performed by
SANTA ANA CITY COUNCIL
m,l,do@snla.a., 0.6 Eol!!@ltqi:alirlc
P Davd Bonavdes
db€navdesiAsnla.ana.o,o slrnabro@sanla-ana oro
M'ahele [ran,nez
Mayor Pro Tem, Ward 2
Bronrne2@snra a.a or.
licensed subcontractors and the number ol structures does not exceed lour within any calendar years, or all of the work is
performed under contract with a licensed general building Contractor.
B--LU I understand as an Owner-Builder if I sett the property lor which this permit is issued, I may be held liable lor any
financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the
workmanship or materials.
Bj-r. I understand I may obtain more inlormation regarding my obligations as an "employer" from the lnternal Revenue
Service, the United States Small Business Administration, the Calilornia Department of Benefit Payments, and the
California Division of lndustrial Accidents. I also understand I may contacl the California Contractors' State License Board
(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.
8-1,1 '10. I am aware of and consent lo an OwnerBuilder building permit applied for in my name, and understand that I am
[", ligF "i5'l Y ^gw E"J"['i# faUp*&? "VE\IH" Hn f^' "t*' 2 * q t, t o,t
6-nd 11. 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 OwnerBuilders as well as employers.
O-A" I agree to notily the issuer of this form immediately of any additions, deletions, or changes lo any of the
information I have provided on this Iorm.
Licensed contractors are regulated by laws designed to protect the public. ll 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 ol 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 lirm is injured while working on your
property, you may be held liable for damages. ll 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 lhe status ol 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 lor issuing the permit. /Vole.' A copv ol the orcoertv owner's driver's license,
form notarization. or other verilication ecceDte ble to the aoencv s reouired to be senled when the Derm s
issued to verily the owner's sionature.
Signature of Property Own I )ts {4/oT4 Date 03-ot
prinrnameor o*^",,P,8/ AS lt/ oTV
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, lhe execulion ol which lunderstand is my personal responsibility. I hereby authorize the
following person(s) lo act as my agent(s) to apply lor. sign, and,ile the documents necessary to obtain an Owner-Builder Permit for my
project.
Scope of Construction Project (or Description of Work)
Project Location or Address
Name ol Authorized Agenl
Phone Number of Aulhorized Agent
ldeclare under penalty of perjury thal I am the property owner for the address listed above and I personally filled out the above
information and certily its accuracy.
Property Owner's Signature Date
Print Name ol Owner
Note: A copy ot the owner's driver's license,lorm nota zation, ot other verilication acceptable to the agency is required to
be presented when the permit is issued to verity the propetty ownet's slgnature.
SANTA ANA CITY COUNCIL
nel'.io@Fnla-ana.oro
Mayor P.o Tem, Wad 2
mtunn€r@snra ana cro slono@sanla.ana.oro
P Oavd Benavd€s
t!e!rsd9@raqr:a!r,sc ,, eoas@sa1ra .' a o'o sr ld'e o(asdnra a.a o'.
Address ol Authonzed Agent: