HomeMy WebLinkAbout10193423 - Permit (3)Project Address: 4626 W Hollyline Ave
Assessor's Parcel 100444-22 Lot: 5
Unat Bldg: Address Range:Suite Range:
Zoning: Rl \t-
Block: NA Tract: 2464 Historic No
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1fJ153423
Pin #: 57946
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Alteration
Windows
SFD
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories:
R.3, U
VB
cBc 2016
A-0602320143J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation:$5,000.00
0
Description of Work: Legalize (10) vinyl sliding window change outs. Like for like. Auth on file
Planning Conditions: Existing wood trim not to be removed or alteras part of this Project.
Ownerl
Address:
Phone:
Tenant:
Contractor
Address:
Owner-Builder
Engineer
Address:
Architect /
Desiqner:
Address:
Phonel
License #
The Do Family Living Trust
19132 FESTTVAL CtR
Huntington Beach, CA 926486609
(714) 316-9s09 Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'dr No
Mar. Escarlet
Zuniga, Allissa
Oale 0710312017
Date:
Dale: O7lO3l2O17
Subject to Field:
l\,lisc. Receipt
Misc. Receipt
Misc. Receipt
07776002 5150I Permit Fee
07776002 51672 Bldg. Slds. Revolving
07776002 51600 General Plan Update
07776002 5150, lssuance
$154.26
$1.00
$21 .25
$52.98
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#Total
Flood Zone Cert. Req'd: No
Every permit issued shall becorne invahd unless the work on the site authonzed by
such pemit is cofimenced wilhin 180 days aftat its issuahce,ot if the wor* authoized
on tho site by such pennit is suspended or abandoned for a penod ofl80 days aftet
the lhne the ,,vod< is commenced .
lnspector MtD#. 2017-137194
01 1 16002 51600
01 116002 51601
01 116002 51612
$21.25
$207.24
$1 00
Fee Total:
Paid to Date:
Balance Due
$229.49
$0.00
1229.49
Phonei
License #
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNf,R AUILDEN DEI.(AIAIION
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ATIIIIAIiLDECIJXATTOX
I hddr .trm u.d< !.!uh!_ orp<,u.} oE olllE lollo*ins d.(l&dirN
Domlnion Pmtu-Asberor Notili..t ion F.ddrl R.luldio.r{In1.40, Pan6)
R.luncd I dra of Ndrtual$n
, .diry rhil rhc f.dral rcgulato6 ,qrerjlig NtEslos rmr ,. not 4lplrahL ro rhB pflrF
ed (otrilio otd un,n (lE
2/5/b(7
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsulation
Roof Sheathing
Shear Wall
Framing
lns u lation/Energ y
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL */f
'/t?
,Y Rrr-nr 8[
Certificate of Occupancy '
Notes, Remarks, Etc
".'., 'tfj f at1
lcd16 rhI I ll1\.r.id rhir
t1rtr,(\D
I
T-Bar
I\,(AYOR
Miguel A. Pulido
MAYOR PRO TEM
Michele Marlinez
COUNCILMEMBERS
P. David Benavides
Vicenle Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
tm provements ecif led at L/t ,N Nit Z D3
We are providing you with an Owner-Builder Acknowledoment and lnformatlon 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 permlt 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 ACKNOWLEDGMENT AND VEBIFICATION OF INFORMATON
DIRECTIONS: Bead and initial each statement below to signify you understand or verity this information.
O- 't. ,understand a frequent practice ol unlicensed persons is to have lhe property owner obtain an "Owner-Buildei'
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I,
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 prope(y. My homeowner's insurance may not provide coverage lor
those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to
worr(ers on my property.
O Z. f 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.
V g. t understand as an "Owner-Builder" I am the responsible party of record on the permil. 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.
6- o. I understand Contraclors are required by law to be licensed and bonded in Calilornia and to llst their license
numbers on permils and contracls.
O S. f understand il I employ or otherwise engage any persons, other than California licensed Contractors, 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.
fif O. t understand il 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 compensation of each "employee." I also understand my lailure to abide by these laws may subject me to
seflo s financial risk
7. I understand under Calilornia Contractors' State License Law, an Owner-Builder who builds singleJamily
residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLEBK OF THE COUNCIL
iraria D Huizar
nDurido@san!a-ana orc
Mayor P.o I€m, Ward 2
hmartner@san|a ana.o.o
Vrcsnre Samenlo
vs{menlo@sanla-ana-orc 60lono@sanra-an, qo
P Davrd Benavdc!
dbenavides@.anta ana o,o ivillsasraenta'ana oro slrnaso@santa.ana.o.o
CITY OF SANTA ANA
PLANNING & BUILDING ACENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, Californra 92702
ww\r'v.5anta ana,org, pba
NOTICE TO PROPERTY OWNER
licensed subcontractors and the number of structures does not exceed four within any calendar years. or all ol the work is
performed under contract with a licensed general building Contractor.
V A. 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 lrom any latent conslruction delects in the
workmanship or materials.
-U-g. f 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 lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board
(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.
10. I am aware ol and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the part gall and f inancially responsible for sed construction activi at the loll rnro
addres
I 11 I agree lhat. as the party legally and financially responsible lor this proposed construction activity, I will abide by
allapplicable laws and requirements that govern Owner-Builders as well as employers.
X t 2. I aoree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
inJ-ormation'i have provrded on this lorm.
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 ror
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 Conlactors, you will
be responslble for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Belore 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 coDv of the Dropertv ownet's driver's license,
form notarization, ot othet verification acceptable to the aoencv is reouired to be presented when the Dermit is
to the wner s nature.
Signature of Property Owne Dale 7 ,20 1
Print name of Owner
,\lt hau +11\v\ l) o le,l\<\ec-
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice lo Property Owner, lhe execution ol which lunderstand is my personal responsibility, I hereby authorize the
,ollowing person(s) to act as my agent(s) to apply lor, sign. and file the documents necessary to obtain an Owner-Builder Permit for my
project.
Scope of Construclion Projecl (or Descriplion ol Work)
Name ol Authorized Agent
Address of Authorized Agenl
Phone Number of Authorized Agent
I declare under penalty of perjury lhat I am the property owner for lhe address listed above and I personally filled out the above
information and certify its accuracy.
Properly Owner's Signature Date
Note: A copy ol the owner's driver's license, fom notarlzation, ot other verillcation acceptable to the agency is required to
be prcsenled when the pemit is issued to verily the propeiy owner's signature.
SANTA ANA CITY COUNCIL
mo!hdolasanla-an: o.o
Mayor P.o Tem. Wa,d 2
fltun'nez@snl..a.a.ord vsarm,e.ro@sanra.anaoro'sclono@sanra-anaoro dbenavLdes@sanra.a.aoro lrlegar@sadr:ala,q9
)
Project Location or Address:_
Print Name ol Owner:
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Liv ng Room
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Bedroom
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KITCHEN WINDOW ELEVATION
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