HomeMy WebLinkAbout10194524 - Permit (2)E
Project Address: 1030 W West Orange Rd
Assessor's Parcel 002-311-3r Lot: 10
Unit Bldg: Address Range Suite Range:
Zoning: RlBlock NA Tract: 7'170 Hrstoric 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 #: 1()194524
Pin #: 42924
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Single Family Dwelling
Reroof
Reroof
SFD w/att garage
R-3, U
VB
cBc 2016
x-0602320144J
1st FL Areal
2nd FL Area
Other Areas:
Garage Area
Patio:
T.l.Area:
Yards Req'd:
Valuation: $6,792.00
Occupancy:
Constr Type
Coder
Flood Zone.
Proposed Use: # of Stories:
Total
Description of Work: Reroof w/t.o.-Remove and install comp shingles/replace sheathing/handout given
Planning conditions:
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Phone;
Tenant
Suzan Rudolph
1030 W West Orange Rd
Santa Ana, CA 92706
(714) 673-3379
Owner-Builder
Engineer
Address
!iu:cln Rrrdolph
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires;
Generol PIon Upd.rte F
0l I I6r-nl2- 51 6r:fl:lr:l r:rtt -
Bu ild ins
rJl l I S|]i2- _.; l.Jr-r | '-ir:r0-Plds StC: EE',.1..,ins
r11 I 1 3it1?- 51.1 I 2urr:r-
l./iso
(:C+ : *ri**r*rilII.7:?7
Phone:
Lacense #:
Architect /
Desiqner
Address:
Phone:
License #:
Planning Approval By
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Orozco, lvan
Hernandez, KathyV}
Oalet 'l0l19l2017 Nlisc. Receipt
Date: Misc. Receipt
Date: 1O/i9/2017 L,lisc. Receipt
Subject to Field:
No
No Account#
O7775OO2 515O1 Permit Fee
07776002 51672 Bldg. Stds. Revolving
07776002 57600 Geneal Plan Update
07776002 51501 lssuance
$308.52
$1 .00
$21.25
$52.98
Fire lnsp. Req'd:
Police lnsp. Req'd
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every permil issuad shall become invalid unless lhe wo* on the slte authotized by
such pernlt ts cofimenced wilhin 180 days after s tssuance.ot if lhe wo* authoized
on the site by such perml is suspenclod ot abandoned lor a ponod o!,180 days aftet
lhe time the wotk iscofimenced
lnspector MID#: 2017-139435
Fee Total:
Paid to Date:
Balance Due
$383 75
$0.00
$383.75
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
$21.25
$361 .50
$1.00
Owner:
Address
Contractor:
Addressl
Total
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILT'ER DEL('AR.'TION
I hd.t, arrn onds Fuhy ,.f Fiury rht I m .raF nln th. Codrtdoi l.i.re l,s for th. tolbui* ds,i (st 701 1 , r
Bu!i.6! aal Prof$on Cod.) Any ( ity or ( ounry *h'.h r.qui6 a ,6hit lo co.$tud, ah6. imtror.. &nolnh or EIrtr my
srtudue r.ior h ns isuu.- rbo r.qu6 th. 4tlr,! Lt $(i Fni lo 6lc t riS..d ntlmt lhd rE or lrE n li..E d noBd
lo rh. F,yki6nr of th. Conteror's Licos.d l,r' (Chrfld 9, ('.mnftr.a qnh S(t'on 70m of Di\kio. 1 of lhc BBin md'
Pmldlions Cod.) or lhll lE or rh. it .rofl lhd.nom sd rh. b.rn tor lhc lll.sqt dopr ion Any ! iol.l io. ol stri.n 701 I J hy an) \
rpph..r ,or . Fnn qhJd! rh. a'pl'crn! ro . cn il p.Mh y of Fr mr. ih6 6r. hlndr.d &rlls ( t5(D)
l. s oqF of lhc Fopdty. or my onplot6 wnh *.*6 s lh.n sE comPcd io.. sill d' rhc \ot tod rh. nMR ir m!
n drLd tr oll(.d aor nk lS< 70u. AutiB ud ProfdFB (ii. Ih. ('odrxro.t La.G I^ &E mr 4r[ lo o.\E of
rh. rnrxny Elr hlil(h or imFov6ltEq,h, srl *h. d(E .u.h ss.l hihs.lf or nell d. ihoolh hi! m h( oun dthr 6
Foviddt rhr! rud inFollmE m N hldn d ororlslil for 5k lL ho*6d. ttE tuiuing or itrprorffi i. r'ld qihin on. )@
or@tr9Lrir( tlE (xffi Loilda Lill IEE rlE hrkn or lro$r ih, ri d sh. dn d rlnd or i'rrct! tl|c FoF!) nr. tlr F,IIE of
l. d o$G of !h. Fot'd). o qclNir.lr.odrdirts r h lrdtd co.lr6o6 r. rotulI rlE FoFl (Sc ?orl. &Bffi
d Pbfishn(\d.: lh.Conrxlor'r I (orc I 'v dod nol tptlyro o$ nG of prop6l) $ ho bur ld! or inpror6 lhsFn.
d.d $h. co,{6crr ror $.h thld3 snh r (ttudo(r) licd<i pudd tu
'h.(
ontlclois l.icdr.lrr}
^,|.-'7'ifri/17 -l,rhZlt-'
, DECI,/IIIATION
I hd.r, rmm und.r Frlty. ol Fjury .E ofrE r.lhs'ns ddh. $E
I h6vc d * nl mid.in r ( dific.r. ol const to S.lt lNur. n r $.rtd:' olnrnt lion. G prn id.d tu hy s(lion :t?01r oih.
litu ( odc tq lh. F r'.M. of
'h.
s. fo. trhahrh.Fnn 6 rtu.d
I h^. md will m.inl,in uorl6 .oDt Mr io. iNUr@., s r.!un.d hy Sd ion 70o of rh.Ijhor cod., fo. th. pqaof]M.. of
th. sut fr shth lht Fhn ! isFd My trqt6' sn4.Mirn iMltr. c.ro id Flk! .umb6 e:
I cdit rhd in llrFfodtcolrh. $or( frtr chkh rhir Ddnr it itu.d. I rull m' dPlo) rny F$n 'n
m) msffi
$ d ro h<oe 3ub<r ro rh. sorl6' comFrd'on b*r or Calilomr el .*c th.l if I Jnuld b..om. tubd' ro lhc
u orld' 6mFE tion FDvitn)N of S.nior 1700 of rh. lrb.r cod., I slEU. tonh*ill 6opl, tr irh ihoE Pro\ irioN
\tAiNtNC Frtut ro -tft mrld mnpd ion o16rs. s unLstuL di ih.llsbicl o drrl4ld ro simi l FEIE.nd
civil fin6 up k' onc hu(nci rf.usrd &lls (llo0.Oo0), in 3dd'lF. ro !h..on olcomF@l'on. dm.8d a Fo\il.d tu lh.
Scrrcn 11076 orrh.lit r Coda inr66l sd .llo'Ey s fs
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DECIISATIO!
I h.r.by rilm unds p.uhy olFjury rhd I m ftds.d und- pr!\sion.r( i4!d q l.ommdcrn! *'lh Sc.rsn 70fir) ofDnrh. !
Df rh. Achd ed Pmfsiotrr Cod.. &l n!" li.re ir h full forc. dd.ral
CAIiIBUCIIANI,ENDItrG.6GII.(T
I horl,r arm und6 Fuhy o t paiury rhnl lhq. i,t r conrruclio. l6ldin8 +ocy fo. th. psr(md.. .f rh. aorl 6r which lhB Fnr i!
is!.d {sa. 1007. ci! c).
APPLI(' NT DI('LTR TIO
I hdttl .Fih o.ds porfty of o.rjur) oe of th. forlo$rn8 {k l[.l6ns
D.mohion Pd6is-Aln<ros NorificarNn Id6!l Rcsulahd8 (1 irl. ltr, PM6)
R.,-tuiral l.drd of fiixi6cnnn
I cdii! rhi rb. ftn r.l rlsuhioB Essdiry 6!610r t@r.l o. mr .rfiiclbk lo lhB 9rnjd
I.6riayrhdIh.v.rodlhnqrplicrrmnand3rri.rhdrh.!b.v.irlomalioniscorFrlaSr(tocomtly*ithrllCirt.6dConrr
odilffic rd shi. t $. E]nru lo buiuins .odtu.ri.tr &n lEct! llnho.n! rqendn 6 of rhi! ( iry!d Counryro dd uF)n rlE
,tnt. nhrhndt mdv fo. B6ioll!,.4
^-#;ffi":*"ffi.'t,r 4*4 :- .y'rs/u
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathing ltj nLitt'l+ t4'
Shear Wall
Framing
ln s u lation/Ene rgy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Frnal Report
Enqineer Final Report
Flood Zone Certif
lr
FINAL C1t-t?)kn&la-
Certificate of Occupancy
Notes, Remarks, Etc.
(c,{,rs
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t!4AYOR
Miguel A. Pulido
i,{AYOR PRO TEM
Michele Martinez
COUNCILMEMBERS
P. David Benavides
Mcente Sarmiento
Jose Solorio
SalTinajero
Juan Mllegas
INTERIM CITY MANAGER
Cynthia J. KurE
CITY ATTORNEY
Sonia R- Carvalho
CLERK OF THE COUNCIL
l,4aria D. Huizar
CITY OF SANTA ANA
PLANNINC & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box I 988 . Santa Ana. California 92702
www.santa ana.orq oba
NOTICE TO PROPERTY OWNER
An application for a bullding permit has been submitted in your name listing yourself as the builder of the property
improvements specified at le
We are providing you with an wner-Build k m n n rm F tm 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 VER IFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
W\]. I understand a frequenl 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 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 nol 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 property.
-gOAa t understand building permits are not required to be signed by property owners unless they are responsible for the
gonstruction and are not hiring a licensed Contractor to assume this responsibility.
9M t undersland as an "Owner-Builde/' l am the responsible party of record on the permit. lunderstand that lmayprotect myself
{iom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
kil-4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
'p-ermits and contracts.
-KAS , understand if I employ or otherwise engage any persons, other than Califomia licensed Contractors, and the total value of
rhy construction is al least llve hundred dollars ($500), including labor and materials, I may be considered an "employer' under state
and federal law.
WU ,understand if I am considered an 'employer" under state and Federal law, I must register with the state and federal
dbvernment, wrlhhold payroll laxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation ofeach "employee." lalso undersland my failure to abide by these laws may subject me to serious financial risk.
I
W L t undersland under California Contractors' State License Law, an owner-Builder who builds single-family residential
dructures 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
general building Contractor.
W[ze. t understand as an Owner-Builder il I sell the property for which this permit is issued, I may be held liable for any financial or
p-drsonal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
npu do@ssnt8 ana.do
Mayo. Pro Tem. Ward 2
mraan'nez@santa'ana oro vsam enlo@ sanla.ana oro soono@sanh-ana oro db€.avrdesiasanla€na oro v'rleoas.Asanla aoa oo sl nareroasanla ana oro
Dear Property Owner:
r{lL 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 California Contraclors' State License Board (CSLB) at 1-800-32'l-CSLB (2752) or
www.cslb.ca.qov for more information about licensed contractors.
-h4:[,le!ally an
address;
-UN,t , asree that, as rhe
a{plicable laws and requirem
I&2. t agree to notrry tne i
plbvided on this form.
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
d flnancially responsible for proposed on activity at t llowie
am the party
f>7bL
party legally and financially responsible for this proposed construction activity, I will abide by all
ents that govem Owner-Builders as well as employers.
ssuer of this form immediately of any additions, deletions, or changes to any of the information I have
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 assisl 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, /Vole; A coov of the properlv owner's driver's license. form notarization. or other
verification acceDtable to the aaencv is reouired to be ted when the Dermil is issued to verifv the oroDertv owner's
sionature.
Signature of Property Owner Date: /['?7
IPrint 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)
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 fllled out the above
information and certify its accuracy.
Property Owner's Signature Date
Print Name of Owner
Note: A copy of the owner's driver's license, form notarization, or other veritication acceptable to lhe agency is required to
be presented when the permit is issued to verify the propefty owner's signature-
PL Lnk:r:,'P51 Cirr.rn:irAcilrilr Assanllll./3iiis flc,irce 1o Pr!i)cr:), Form
SANTA ANA CITY COUNCIL
mo![do@sa.ta'6na do
Mayor Pro Tem. Wad 2
m,rurt n.!6 sanr.'ana o.o
Vce.le Samienlo
6ame.lo@sanl3 ana orc Edp!@$!.1a:!!!-e!9 dbenav,desosanla ana oro rM eoasasanla-ana oro sl nareroosa.la ana o.o