HomeMy WebLinkAbout10294904 - Permit (2)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 #: 1o2949o4
Pin #: 542lJ1
Proiect Address: 2025 S Greenville St Bldg: Address Range:Suite Range:
Zoning: R'l
ft
Lot: 37 Block NA f.ad 2929 Historic No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Alteration
Window Changeout
SFD w/att garage
R.3, U
VB
cBc 2016
x-0602320257J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $1,500.00
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories
Oescription of Work: Legalize window change out ldron &t *ul/Lt
Owner:
Address:
Danny Tran
12132 Movius Dr
Garden Grove, CA 92840
(714) 398-3840
Contractor
Address:
Owner-Builder
Engineer
Address
Phone:
License #
Architect /
Desrqner:
Address:
Phone:
License #
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'dl
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
t ar, Escartet Oale: '1112712017
Date:
Hernandez, Kathy Oale: 1112712017
Subject to Field:
Frre lnsp. Req'd No
Police lnsp. Req'd: No Accoun
Flood Zone Cert. Req'd: No
07776002
077760 0 2
0777600 2
077760 0 2
0177500 2
077760 0 2
$154.26
$93.17
$234.08
$1.00
$21.25
$52.98
Misc. Receipt
Misc Receipl
Misc. Receipt
5760 7
s7607
57 607
576 72
57600
57 607
Permit Fee
lnvestigat,on
Penalty
Bldg Stds. Revolving
General Plan Update
lssuance
r#
No
No
No
t#Total
01 1 16002 51600
01116002 51601
01 1 16002 516't 2
$21 25
$534.49
$1 00Every pemit issu'd shall become invalid unloss the wolk or, lha slle authotizod by
such permit is cofimenced wthin 180 days after ils tssuanco ot il lho wo* aulhotized
on the site by such pemit is suspanded ot abandoned lot a poriod of180 days attet
lhe time the wo* is commenced.
lnspector MtD#. 2017-140126
Fee Total
Paid to Date:
Balance Due
$556 74
$0 00
$556.74
Assessor'sParcel: 408-393-13
Unit
Planning Conditions:
Phone:
Tenant:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensataon lnsurance:
Carrier:
Policy #:
Expires;
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Set Backs
Forms/Steel/Holdowns
Erection Pads
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathing
Shear Wall
Framino
lnsulationi Energy
Drywall
Ext./lnt. Lath
Brown Coat
l\rlason ry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Ce(if
//\
FINAL 2-t -lr v-vl,to
Certif icate ol Occupancy u -\J
Notes, Remarks, Etc
BUILDING- INSPECTOR BECORD
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Y
MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILMEMBERS
P. David Benavides
Vacente Sarmiento
Jose Solorio
SalTinajero
Juan Vlllegas
lNTERlt\,4 CITY MANAGER
Cynthia J. Kurtz
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria O. Huizar
CITY OF SANTA ANA
PLANNING & BUILDING ACENCY
20 Civic Center Plaza
P.O. Box I988 . Santa Ana, California 92702
www.santa-ana.oro' oba
NOTICE TO PROPERW OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
imBruemtnts"v"'.tt"oEo*^rf\, gl. %-'J^ a.".A^ cA qz+aT
WeareprovidingyouwithantomakeyoUawareof
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 offacial 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
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
Lr. , understand a frequent practice of unlicensed persons is to have the property owner obtain an "OwnerBuilder- 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 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 property.
U1 , , 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.
Fa , understand as an 'Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself
frolJgtential financial risk by hiring a licensed Contractor and having the permit flled in his or her name instead of my own.
DA o ,understand Contractors are required by law to be licensed and bonded in Califomia andto list their license numberson
permits and contracts.
^f-V\ S. ,understand rf I employ or otherwise engage any persons, other than Califomia licensed Contractors, and the total valueof
my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an'employer" under state
and federal law.
P\ U. f 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 disabilily insurance, and contribute to unemployment
compensation ofeach "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
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 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.
h t , understand as an Owner-Builder if I sell the property forwhich this permit is issued, I may be held liable for any financial or
personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
mou do@sanl8 a.a oro
Mayor Plo Tem. Ward 2
m marlrnezasanta ana oro vsamrentoasa.la.ana oro sdono@sama.ena.o.o dbenavrcesosa.6-a.a oro !vj!e9ri@r@r2:a@_q!9 slr.a€ro@sanla'ana o.o
m-9. I understand lmay obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service. the
United States Small Business Administration, the Califomia Department of Beneft Payments, and the Califomia Division of lndustrial
Accidents. I also understand I may conlact the Califomia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or
www.cslb.ca.oov for more information about licensed contractors.
ffi- ,lO , am aware of and consent to an owner-Builder building permit applied for in my name. and understand that I am the party
l?ffi,"sB*:er,?:"',ff*:,x"Jlf?""-"{?n,:,,ulx5{,,"H;"4, A rz ?o+
N1 , agree that, as the party legally ano financiatty res/onsible for this proposed construction activity, I witt abide by att
apP|lr,able laws and requirements that govem Owner-Builders as well as employers.
-[r 2. , ,gr"" ,o notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have
provided on this form.
Licensed contractors are regulated by laws designed to protect the public. lfyou contract with someone who does not havea license,
the Contractors' State License Board may be unable to assist 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 or firm is injured while working on your property, you may be held liable for damag es. lf you
obtain a permit as Owner-Builder and wish to hire Contacto6, you will be responsible for verifying 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. Not€A coov of lhe Drooertv owner's license, form notarization, or other
verification acce table to the ,s re uired to be he d
sionature,
Signature of Property Own Date: t I /-,+It+
Print name of Owner fR-4,.\n
aurxontlArtoN oF AGENT To Acr oN pRopERTy owNER's BEHALF
Scope of Construction Project (or Description of Work)V,"*4* tl, n&urs
Project Location or Address 1-oLd S. G-y<tt:V,"- ) ea.^jn fu^G 4 zl,t0
1r'1
Name of Authorized Agent
Address of Authorized Agent
I declare under penalty of perjury that I
information and certify its accuracy.
the prope owner for the address listed above and I personally fllled out the above
Property Ownels Signature
Print Name of Owner:\ YAzwt
Note: A copy of the owner's driver's licen form notarization, or other verification acceptable to lhe agency is required to
be presented when the permit is issued to rify the property owner's signature
PLink:WP51/CounterActivity/AssemblyBills/Notice to Property Form
SANTA ANA CITY COUNClL
Mayor Pro Tem. Ward 2
moulrdo@santa-ana qo sl naero@sanl.a ..a do
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.
Phone Number of Authorized Agent:
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