HomeMy WebLinkAbout10195754 - Permit (2)ryProject Address: 541 W Santa Clara Ave
Assessor's Parcel oo2-123-12 Lotr POR 3
Bldg: Address Range:
Tract pOTTS, BORDEN & STDWELL Historic: Y6E
Unrt Suite Range:
Zoning: RlBlock NA
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 #: {O{95754
Pin #: 3OBl4
Bullding Use: Single Family Dwelling Occupancyr R-3 1st FL Area:
Job Type: Rovision Constr Type: V B 2nd FL Area:
Nature of Work. Revision Code: CBC 2016 other Areas:
Existing Bldg. & Use: SFO Wdst garage Flood Zoner X-0602320163J Garage Areal
Proposed Use: # of Stories: , ,o,",, O
Oescription of Work: Revision to 10193617. Sheer wall transfer (roof to sheer wall) on the inside. Updated the 4 x 10 boam.
Planning Conditions: lnterior revision only.
Patiol
T.l.Area:
Yards Req'd:
Valuation: $0.00
Owner:
Address
Phone
Tenant:
Contraclor
Address:
Owner-Builder
Engineer
Address
Matthew White
541 w Santa Clara Ave
Santa Ana, CA 927062548
(406) 570-8852
Apollo Structural Partners
Andy Yang
4968 Arrow Highway, #F
Montclair, CA 91763
c75895
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Pollcy #:
Expires:
Phone:
License #
Architecl /
Desiqner:
Address:
Phone:
License #
Planning Approval By.
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req
PWA lnsp. Req'd:
Pianning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd:
Police lnsp. Req'd
,tv
Hei Fred
ki, Teri
Date: 03105/2018 Misc. Receipt:
Oale O4102J2018 Misc. Receipt:
Dater 04103/2018 Misc. Receipl:
Subject to Fieldl
No
No Account#
07776002 53500 Revision
07776002 57672 Bldg. Stds. Revolving
01776002 51600 General Plan Update
'1067 4
Total
$213.86
$0.00
$0 00
No
No
No Flood Zone Cerl. Req'd: No N/A - No Balance
Every permit issued shall becone invalid unless lhe wo* on the sile authorizod by
such pemit is comnenced wilhin 180 days after its issuahce.or ifthe wo* authonzed
on lhe site by such peinit is susponded ot abandoned fot a potiod of180 days 1ftet
the lime the work is cofimenced.
lnspector
Fee Tolal
Paid to Date:
Balance Due
$213 86
$213 86
$0.00
MtD# 2017-137802
BUILDING. INSPECTOR RECORD lCOMMENTSSITE-WORK DATE ID/SIG.
Set Backs
Forms/Steel/Holdowns
UFER Ground
SLAB Floor
Subf loor/VenVl nsulation
Roof Sheathing
Shear Wall
Framinq
lnsu lation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
lvlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL vL(/tx >877
Certilicale ot Occupancv
Notes, Remarks, Etc
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Erection Pads
I hnrc rld rhtr {' .arn
MAYOR
Miguel A. Pulido
MAYOR PRO TEI,I
Michele Martinez
COUNCILMEMBERS
P. David Benavades
Vicente Sarmrento
Jose Solorio
SalTinajero
Juan Villegas CITY OF SANTA ANA
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
improvements specified at
\(A"t a-^l E '.- 4z t>L
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
DIRFCTIONS: Read and initial each statement below to signify you understand or verify this information.
/Zk ,understand a frequent practice of unlicensed persons is to have the property owner obtain an "OwnerBuilder' building/ pdrmil 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 subjecl 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 9n Owner-Builder and am aware of the limits oI my insurance coverage for injuries to workers on my property.
/l-4 I understand building permits are not required to be signed by property owners unless they are responsible for the
PConstruction and are not hiring a licensed Contractor to assume this responsibility.
l/ 11_-, I understand as an 'OwnerBuilder" I am the responsible party oI record on the permit. I understand that I may protect myself
UltrVrl polential ftnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
///-U-q. , understand Contractors are required by law to be licensed and bonded in Califomia and to list their license numbers on
/-PeJmits and contracts./// --
11 ys. I understand if I employ or otheMise engage any persons, other than California licensed Contractors, and the total value of
/"rhy construction is at least five hundred dollars ($500). including labor and materials, I may be considered an "employer' under state
and federal law.
ill/ --.-///// U'6. I understand if I am considered an -employer" under state and Federal law, I must register with the state and federal
/'d-ouernment, withhold payroll taxes. provide workeri' compensation disability insurance, and contribute to unemployment
c7pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
/l/t U7. lunderstand under California Conlractors' State License Law, an Owner-Builder who builds single-family residential' struclures 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
gereral building Contractor.
l/ il--* , 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-r'dersonal injuries sustained by any subsequent owne(s) that result fiom any latent constluction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
m0ul/doIos6nta-an. o.o
Mayor Pro Tem Ward 2
6,nan,ne:6'sanl, ana orc
v,ce.t6 Samrenro
6amrenloasanta-a4a o.a lsdMoAsante-ana do
P DrMd B€naedes
dbenav desOsEnra ana.oro Mleas@sa.t6-a.a do slrnae.oasanh ana o.o
INTERIM CITY MANAGER
Cynthia J. KurE
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
lvlaria D. Huizar
PI.ANNING & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box I988 . Santa Ana, California 92702
www.santa ana.orq,/gba
///2" I understand I may obtain more information regarding my obligations as an "employer'from the lnternal Revenue Service, the
'u,/United States Small Business Administration, the Califomia Deoartrnenl of Benefit Pavments, and the Califomia Division of lndustrial
Accidents. I also understand I may contact the California Contractoristate Lrcense Board (CSLB) al 1-8OO-321-CSLB (2752) or
www.cslb.ca.qov for more information about licensed contractors.
I am aware of and consent to an Owner-Builder building pe rmit applied for in my name, and understand that I am the party
llv d nancially responsible for proposed construction activity at the foll ng
add ress -l-4 C
_'1 1. 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 Owner-Builders as well as employers.
_12. I agree to 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. lf you contract with someone who does not have a license,
the Contraclors' 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 als o 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 damag es. 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 Iicensed and the status of their workers' compensalion insurance coverage.
Befor€ a building permit can bo issued, lhis form must be completed and signed by the prop€rty owner and returned to the
agency responsible for issuing the permit. ,Vore.' A cooy of the property owner's driver's license, form notarization. or other
,s dtobe senled when the I is ,ssued lo ve the e owner's
siqnature.
Signature of Property Owne Date -z ZL.
Print name of Owner ./t *L.,u LJq, [r
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property O\,,/ner, the execution of which I understand is my peBonal 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)
Name of Authorized Agent:
Phone Number of Authorized Agent
! declare under penalty of pe4ury that I am the property owner for the address listed above and I personally filled out the above
informatjon and certify its accuracy.
Property Owneas Sagnature Date
Print Name of Owner
Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to lhe agency is required to
be presented when the permit is issued to verify tha propefty owner's signature.
PL nk.,i'P51 C!)r.i.rrAclr\ rly Assom5 yBrl s N(,irre li) Pr-a,i)aii!, Forri
SANTA ANA CITY COUNCIL
mpur,.loiosanla ana.o.o
Mayor Pro Tem Ward 2
n,mn'nez6sa.la-a.a do
Mcste $m'ento
rmronroosanta-ana @ Edqr@$!l&a4e-ql9
P D.v'd e€n6vd6s
dbenaud6@sanra-ana oro Mlleoas@sant3-ena ryo shnaEo@sa.la am do
7
Project Location or Address:
Address ot Authorized Agent'