HomeMy WebLinkAbout20164398 - Permit (2)City of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical Permit #: 2O164394
Pin #: 25727lnspection Requests: (714) 667-2738 lnspector Seclion: (714) 647-5853
Project Address: 519 E Pine St Unit:
Block; B
Bldg: Address Range:
Tracl: P S & BLEE ADD Historic: No
Suite Range:
Zoning: R3
q
Assessor'sParcel: 404-081-09 Lot: t2
Owner:
Address
Maria Valenzuela
519 E- Pine St.
Santa Ana, CA 927016027
(714) 326-8485
Fee Typo
01116002 51603 Serv Meter
011 16002 51600 General Plan Updale
01'116002 51603 lssuance
Qty
1.00
1.00
1.00
Fee
$51.29
$21 .25
$52.98Phone:
Tenant Name;
Contraclor
Address:
Owner-Builder
Bot,ch+:405{3 - [D/16/2n17 I0: CCUELToffice: CTYH Tronsi: 213 1 ofAccti: Refi: 2r:r16{J?[]
Fcpti:Q2030994 - Ll/16/2tt17 3214 Pt1
TnonsocL ion Totol 1f21.32
rii'.
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
l'1or in V(rlenzuel n
Upgrade/handout glven.
$
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Miscellaneous
Service Meter
Occupancy:
Constr Type
Code:
R-3, U
VB
cEc 2016
Notes:
Planning Conditions
Planning Approval By Misc. Receipl:
Misc. Receipt:
Misc. Receipl:
Total
Plan Checked By
Permit lssued By
Subject to Field:
Building Permit #
ki
Date
Date 1U16nO17
Account#
Every pemil issued sha becofie invalid onless the wo* on lhe silo
duthonzed by such pennit is commonced wilhin 180 days aftet its
issuance, ot if the wo* aulhonzed on the site by such pemit is suspanded
ot abandonod lor a pedod ot180 days aflet lhe time the wo* is
commenced.
$125.52
$0.00
$125.52
lnspector MID#: 20'17-139371
011'16002 51600
01 1 16002 51603
$21.25
$104.27
Fee Total:
Paid to Date:
Balance Oue:
Amount
51 .29
21 .25
52.98
Phone:
I
I
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Faclory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffil Rough
Ceilings (T-Bar Rouqh)
Meter Release
Rough
Service Meter
FINAL q/2c//E tM,tr
Notes, Remarks, Etc.n 7:1V
OWNE-R DUILDER DELCARA-NON
I hcby.{Im und6 F[ny of Fjn,,_ lht I m.r.n{i tom tlr Coirrllod l.i.de lrw for lhc follouiia i.un lscroll5
BBii6 &d PiofBion ( odc): An, ('ny .r Codt shkh r.qui6 r rEnr tn tu.rtud, i!6, !r$.!c damlirt.r ,gnt m)
Jrucrdc. Ftr x' tu is!e., .l!o Eq!i6 rh. .IFtLrr frn such Fhn lo fi|. . lrgi.d ndcMl thn lE or rt it licds.d Po6'.d
ro rtu Fo\tioN otdE Conr.*roir l,ic6!dt lr* {Ch.rla 9, CommminS wilt S6lion 7000 of Oivisiot I of 'h. BuinN &d
PrDl{bN Co&) or 0!r lE o. JE i .rsIpr llE 600 sld rlE h-! lor lh r&s.d aoFi,n Any ri.ldion of S<dio;7ol l t b, sy
!pr,!ic! for.FnnDbjc6rIE.p?li@rro.olrlFflhrofmrmElh&fiu.hund.ddoll6(!5m,
t. s ow of llr proFrl. or ny mplord *irh $.s6 s rlEir FL onFGdirn, *iU rh tlr r od tn tlE rME i ml
rrdd.d dofii.d adr&(s< 7o{.l, Asi6-d PrDtabB Cod.]lE Conlrnl( 3 Lite t vib6d+l}to-orFot
rh. r.DDary $lb hilt o. i"sm\s tlEq4 d'd u lD d6 sn x,i hif,*lf or haxlf ot rlmurt hi! q hd o*n mpr,rc.
proviJed rhar ruch inF*qmc e ml i dd.d o. otusl tor sle l[ now6s. rlE blildinB ot im!.orml i! Fld wirhin .n. d
ofslFlrb(lh. O*c ttui!:lr wiu h.n dE hlnar oaFii,r fir lE or tE dil ml hill s itrFtE t FbFty 6r rlEPllFEoa
l. s own< ofrn. Fnr6ry. m .rclsiv.ly conrrmrins with licds.d conr&$6 o atrntud lh. pmjdt (S( 7044, UB s
srn hski ( od.r 'I'h. Conrrr|oir Lr.e l-!$ do6 mr rp?ly ro x ogE of ForEly sn t'lildt or inprord rtson,
dd "lb odn<r! t{ *h FoF wnh . (ttrdnl, li.aed FlBEr b dE Coffioir tj.(c l- I
I m.r.mfl undd s<rn1n t /l .B &P.c ro,lhur*on
X - ls.Al,*l#n Lt Pzu c Lt'
i,/ \ Dr(llf,AltoN,frorrh.}\"ns d(h'rnEI hd.t ) lmrmund.r lmlr, of Fjor) (
I h.r. nii s'll Mrhin . Cdi,ic.t. ol Consr lo Sclt lBurc for $vr6 omFndion, s F.vidcd for bt Sel6.l7tl(l.frh.
lrtor ('odc. tr rh. FfoiiM.. of rh. wort for *hich lh. po il b isu.d
Ih!\cr.d\!llmi'.hrorl6 corirpcdnFn 'llilluc 6 Equtql t', Sdnn 1700 of llE llbor (n&.lo.rE Ffollle. oa
ltc mrt for thich thi p6Fir is isrd My wo,t6 @oD.nraio. iEor4. cdic md policy nunb.r t.
I cdiry$d 'n rtE Ftorn@. ofrh. *.rL tu trhi.h rhi! Fmn ir is.d I rh.u ml dplol &y Fkn in r) nmF
s 6hb.tom$tin'olh.qo 6'onFE onL$or(difond &d+ftrh. rll nhoE lE om utic.l lorri
"o 6'comFBrionprnvnioNors(1ioolTftolrl'cllhrCodalilEll.fonhwnhcompbwnnlhosprovaion.
n m\og. a unh*tu|- s'd lru tubel m adoF ro ainin.lFEIE ud
cMl linB uD ro on. hun&.n rhousnd dolld l()O.o(x)). i. lddirrn lo lh..oir of .onFurioi. drn46 a ltoyiir.il fo' rlE
Serii{ 1076 ofrh.lrhtr( c. int(d and
/.\ht? I l tNz Jr-1_l
I fidrb' !ftd u'tt6 Fd, of Fru r: $r I m [.6!.d ur& Foviion of Cn ri6 I {offii.s *nh sdi.f, 7fi)) ot Oirnion :r
of rlr Bciffid Pmt6io6 Co{t. id ny l(.@ a m tutl 6E id .116r
(olirBr&flo!.rElltlc.AIitBla
I hftby .Itm untl6 FuXy oa pqjury thn $q. n . odtudion laxl'u rstry fo, lhc Ffo,M. of rh. m* fot *nrn lhis p.rni ir
turu.tj {56. :1097. Civ C )
aftLlcANlDlllJSrrla!
I H'y lrm unds pariy or FJu, r- om ol rh. ftllowin! .l<ltntio.3
Dohlnion Ps' iAtb6r6. Uorifi..ihn F.da.l R.sul,l6N ( rnt a0, P!^6)
A.qurqt ln16ottLirfr<dir
I !d'6 ihadh. f.d.6l r.suhrnN Es.rd'n* 6tErG roor!1,. R,r appl'(rhkrnrhq!m(d
, . - n\/, *.,J* SJ"*,ft*,-v*A,(RalR(k?*," -.n, q h., ( i! n, cun,r
or.l'nin(B rd\d. t,B dr{ 'ns
ro burld'n8 coffid 'oI\ od h6.by .!!hori[ r.p.6an ivB ol Uft cir, dd counry ro drd trIn. rh.
"h"* .E76.dlEp-ry r., ,..F(-" p,.B'B
Appror or At6r Silfnrn Drl.
"*,*"..--D,/u-r.-rfl,!.\A r VALE0t UZ L^
I
I
I
I
I
I
I
I
MAYOR
MiguelA. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmienlo
Jose Solorio
Sal Tinajero
Juan \4llegas
Dear Property Owner
INTERIM CITY MANAGER
Cynthia J. KurE
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PI.ANNING & BUILDING AGENCY
20 Crvr( Center Plaza
P.O. Box 1988 . Santa Ana, Calrfornia 92702
Www.5anta-ana.orq,/pba
NOTICE TO PROPERTY OWNER
An application for a building bmitted an ur name listing oft property
improvements specified al
We are providing you with an Owner-Builder Acknowledoment 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON
DIREC/IONS: Read and initial each statement below to signify you understand or verify this information.
ALY , understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building
permit that enoneously implies that the property owner is providing his or her o\ryn labor and material personally. l, as an Owner-
Builder, may be held liable and subject to serious flnancial 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 O),
ALJ
permitsia
4N
constru
'ner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand building permits are not required to be signed by property owners unless they are responsible for the
ion and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand thal I may protect myself
from potential financral risk by hiring a licensed Contractor and having the permit flled in his or her name instead of my own.
ild,understandContractorsarerequiredbylawtobelicensedandbondedinCalifomiaandtolisttheirlicensenumberson
nd contracts
I understand if I employ or otherwise engage any persons, other than Califomia licensed Contractors, and the total value of
my construction is at least five hundred dollars ($500), including Iabor and materials, I may be considered an "employe/ und er state
and federal law.
AIJO f understand if I am consrdered an "employer' under state and Federal law, I must register with the state and federal
governmenl, wilhhold payroll taxes, provide workers' compensation disability insurance. and contribute lo unemployment
compey'sation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
IJrV/ 'L7. 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 ail work 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
genera/building Contractor.
LI)r/I Y-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 flnancial or
personal in;uries sustained by any subsequent owne(s)that result from any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
l ayor fto Tem, Ward 2
m.!lidoasanta-a.a m
.1-'
./
f\LV , understand lmay obtarn more information regarding my obligations as an "employer" from the lnternal Revenue Service, the
United States Small Business Administration, the Califomia Department of Benefit Payments, and the California Division of lndustrial
Accidqnts. lalso understand lmaycontact the California Contractors' State License Board (CSLB) al 1 -800-321-CSLB (2752 ) or
www.cslb.ca.qov for more information about Iicensed contractors.
l\', O , am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party
legally and financially responsible for proposed construction activity at the following
addresy
iluY,. I agree that, as the party legally and financially responsible for this proposed mnstruction activity. I will abide by all
e laws and requirements that govem Owner-Builders as well as employers.applicall
at_v
frovided
I agree to notify the issuer of this form immediately of any additions, deletions. or changes to any of the information I have
on this form.
Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does nothavea license,
the Contractors' State License Board may be unable to assisl you with any financial loss you may sustain as a result of a com plaint.
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 ofthat individual orfirm is injured while working on your property, you may be held liable for damages. lfyou
obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verii/ing whether or not those Contractors are
propedy 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 copy of the property owner's driver's license, form notarization, or other
verification acceptable to the asency is required to be presented when the permit is issued to verify the property owner's
sionatute-
Signature of Property Owner AfitilA LvALr trTrv t-fl Date
h VA M
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 peBon(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
Name of Authorized Agent
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 certiry its accuracy.
Property Owner's Signature Date
Print Name of Owner:
Note: A copy ot the owner's driver's license, form notarization, or other verification acceptable to the agency is required to
be presented when the permit is issued fo verify the property owner's signature.
SANTA ANA CITY COUNCIL
mouldoi@$nt -ana do 6arh'enb@sanla-ana oro 6or@o,Asanra -ana .*o dbenav'des@sanla-ana oro rM easasanta a.a oro shnasolAsanta r.a.oro
Print name of Owner -tI
M'cher. Ma.lle2
Mayor Pio Tem Ward 2
mrronrnez6santa-ana o.d