HomeMy WebLinkAbout20170572 - Permit (4)city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA,27O2 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 2017fJ572
Pin #: 5682S1
ProiectAddress: 5151/2 W Cubbon St
Assessor'sParcel 010-244-09 Lot POR 7, POR 8
Unit:
Block: 18
Bldg: Address Range:
Tract. POLYTECHNIC VIL l..biisto ric: No
Suite Range:
Zoning: SDlo
Owner:
Address:
Phone:
Tenant Name:
Conlractor
Address:
Gustavo Caldera
606 W CURIE AVE
Sanla Ana, CA 927073920
{949) 981-6368
Owner-Builder
Feo Type
Serv Meler
0-1 HP KW or KVA
General Plan Updale
lssuance
Microfilm Records
Amount
55.37
3.70
22.95
57 .20
3.91
Fee
$55.37
$3.70
$22.95
$57.20
s3.91
01 116002
01 116002
01 1 16002
01 1 16002
01 1 16002
5160:
5160:
5160C
5160:
5777C
Qty
1.00
1.00
1.00
1.00
1.00
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
I0: omorolesl91Gf I
2iL t{1172
1l:r:r2 An
t1{J.13
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VB
cEc 2019 Noles Hand ort'dlven. Auth on file--.,-.. i*ir. irrrrrr i.)o=
renerO.l rlOn u!uuLe rcc
i i i.iOnr- iiouOtlttltl-
iectr ii oi
i i io'r'ir- i i{idl00n-
Licnoi iir ( irur-urerrLs
i l iduuT- i777'-'ur.ril-
t22.91
1116.27
13.91
rl43.l3
Authi: 150026
Building Usei
Job Type:
Nature of Work
Planning Approval Byr
Plan Checked By.
Permit lssued 8y:
Subject to Field:
Building Permit #.
Accessory DwellingUnit-D Occupancy.
Miscellaneous Constr TyPe:
Service Meter Code:
Date
Date
DateZuniga, Alliss
Every pemit issued shall become invalid unless the wo* on lho sito
authonzed by such permit is cofifienced wtthin360 days aftet ils
/ssuance. or if lhe wo* authofied on the stte by such perfitt ts susponded
ot abancloned lor a penod of360 days altet tha ltua the wod< ts
commenced
$ 143.1 3
$0.00
i143.13
lnspector ltAlD#: 2020-157O26
01 1 16002 51600
01 1 16002 51603
01116002 57770
$22.95
$116.27
$3 91
Planning Conditions:
01113t2020
Account#
Misc. Receipl:
Misc. Receipt:
Misc Receipt:
Total
Fee Total
Paid to Date:
Balance Due:
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS O\,YNET BUI LDf,T DI:II'A RA T('N
I hd.! .llm !"& Fmht of FiuD- rnt I d dmF fitrn rh. C.drr16' L(.e t$' to. rlE nilorins l@r (5(.7011 5
tt6ilB .d P.ofdbn Cod.): Ary ( n)_ or (ouny *hah rqur6 . Fmi ro mdrucr. dt6. mFoq &rmlah o, EFtr F!
3truduc Fs to ilr isslftc. illo.cquc rlE +plid Lr$d IF to6L.litndtdsEn Ot lEo,tlEi! li..NGd FEd
h rh. tmv|'i.c ofr,E Conr*tor'! Lt6rd l,w (clEBg 9. Com.tu'.s \hh Sdion ?000 oa Dili3ior I oflh. &!nB dd
PmldbN Cod.) or fial tE tr st! i! .rdfl rhd.froo ed rhr t ri! lor th. llkEq, .rdFi6r. ary viold ion of s..rio. 7011 5 1r_ D,
{,phc. rn!p6m $bJdrrh. rtph..rro s<trrlp@hycr fr md.rhM li. hund.d dolls ( t50u r
'f r, - "**.t,r'.p.1.n), ormr.mflorc slh \ 6g6 s lh.tr r'1. L nn6{n,n, wlld. rhc s.'l .rd rrE dME 6 ml
'r lrdrdGl or ofr6.d lor s!. tS6.7Or4. BuIB &d PnlBi.6 Cod. 't hG ( .dr*ror'r Li.* t * &6 nol !p,ly l. an o"c of
rh. F.Fry tr lb bikh or inDr.!6 rlERrc dd sh. d,6 kh *!rl hiro.lt or hdlror thmush hn d lE om mpl.}!6
Foriilcd rh't $ch imFo\dGa e mr -!!i.i c olIt .d ftr sL lf. ns6{.llE tlilding ff ing$Bcr k 5ld *ith w }r
ofotrpLri(a rtE O$E hild6 \nl hlr iE h,nd! 6fForr* 0d lt or dE dn d lliu m dF!r.lrE FoFy tu E F,FEof
l. sorEof rh.FoFt,, h.rdctr.lr .odrxrine sih lkdE dN r&6rosldrud rlr FsF (Sa ro{{, AGtrB
lrl hr*..ihcod.: Th. co rxM! I-icGE kw do6 mt.r'el!. ro 6 o*c olpropdy *ho ttuild..r intrcrs lhqor
lnd *ho Nnrrrl.fd 3uchFoi61!*nh t codMorl3) lkolal p!6d lorh. Codrrls r ljc@ le)
I Jtr,.\.n,tr unJ.' Srtrrr'
r,.r. ,.-) ?' --r- tlr,6
Il A r'('lLtrihtr'.Nn'
l r *r. r ii' i ir+pi',lir rx x==ffi*
,q\U=D=
! h6.t ) .mflo ufutr Ftsn! .aFjur_ oE oa rh. f{nh$ in8 d(lJltioB
I h.rt id *iU tuid.in ! Cdiardc ol( o@ to Sdr.IoE f Nt6 odFliiot! ! Ftrvilcd 60r by Sdhn !?00 of th.
l,h, Co<k fc rlE psf(fu olrlE qrr f6 {tad th. Ff,n i! isucd
I h!\. lnd s,ll maim.in $or[d comFG.rion iBur.mc, s r.qui6j ht Sal n'n 171x) oflh. l*or Cod., for
'hc
pcfollMc. ol
rh. $ort id $hrhrhi!lnmn t isuo.l Myqork6 compadion ituur (. (di6 &d rFlicy nuf,t d &.
I cdr$ ihd n rh. Frolmft. df rh. ror\ lor $hkh thB Fnn E u$.d. I !t ll tul on@lor ml F$n in oy lMF
$ s h tEom sqd b rh. snta'otr{rBrhn ltu! of Cdiromi. dr.gr thl if I nsuB b(oE st dt ro tlE
*slt6 onDoE lhn proviioN ors.(xn lTm ot dE tlEx ('.<L. l th.ll, fonhe nfi o,Dl! whh tlF- Fnvitid
lt RNlNc: tliluE ro KN sorts' comn<slaro N\d!*. t unl,*fur. md sh.ll subiar u dplo!6 lo o'nintl Frhi.. md
.nil fina up ro on. hu.dr.d thoMd &llB (1100.000). i. oddn'on i{' rh..or oaconp.Mlion. drn,3d B Fo\idd lor rfi.
sdir 107a.frh. r+nr( odc inr
4
DECIAIAIIO!
I E.riy .llm uld6 Frtt of Fjur, fii I d li.qE d uDda Fovirio! of Cll4rq 9 (.omi,g vnh Sciio! 7000) of Divi3ioo l
of rlE Blll!6 ad Prol6.i,6 Codc ..1mr lEqg ir i. tull foc d.,Ia:r.
(.ONSTRIJC-TION I r{trlNC AGENCY
I hdby .Ifm und( paElry of pcrjlry rhd rha. i r coilfudhn kndinr !8dr fu Oc Flolr1e. of (h. wL for ehich lhis Fri a
Nu.d (sn 109?, civ. c.)
I o<16'r Nd.
AITLICANIDE(JJAAUA!
I h6.tr ilfm und6 Fnahr olpdjury oft ofrh. follosin+ d(ld.rions
ocDolirbn l'6nne,{sb.sros NotificFr io. l.dol R4ulalions frnk {0. I'an6)
Rattrn.d l-drd of No'incition
^ I (dra) lhd lh. lcd.r.l rsubrod hl8r$iS 6b6rd lmrd e mt .r9lr!bk lo lhi! p'oF
F.-,r,,a ,*. *,r. oml.rb. d rd.thr E.tor inroldir i'conBr IrsErootply*ih cny.d (-o'!n)
-ord!ffi6 od Sr.. t s a!4 io hu,ldsr!.fo#udiotr id lE.br+lbir.,q6.dnnB of rhi. Cil!, Ed Cowr,v lo dd '4ontlt.tr!\( D( !,tr(Ll t,1$1\ nr nst{ri1,
Appllo orAt6l Shn.rur(frsqftlCltz 3.2
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 lr
Bonding / Grounding / UFER ,1-'1t t \ ).l1ol
Transformers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rouqh
Ceilings (T-Bar Rough)/,'.,\
Meter Release l-2a-20 LYJ\AI
Rough \
Service Meter t,-21-?4 k"\,-{ffi\
FINAL l-/1-a YN*]O
Notes, Remarks Etc
-LL.-7.o)D - o
^Jf)
+*,<.o
reS' o(J .9-zJrrt- -5 !.Ctrb dD
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Planning & Building Agency
Building Safety Oivision
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-s800
www.santa-ana.org
APP-13 CBC 2016
NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a b,uilding permit has been submitted in your name listing yourself as the builder of the property improvements
specified at ').llt )_,4 _t_) , t:L_- **z:r t --, L ,<: t: o 9:Dl
We are providing you with an Owner-Builder Acknowledqment and lnformation Veriflcation Form to make you aware of your
responsibilities and possible rask 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,
obtaln the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this intormation.
tc'-12 I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildei' build-
iig permit that erroneously 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 flnancial fisk 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 for those injuries. I
am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for in.iuries to workers on my prop-
erty.
, 1,,i, 2 I understand burldrng permits are not required to be signed by property owners unless they are responsible for the
e6nstruction and are not hinng a licensed Contractor to assume this responsibility.
t1f,-t. t understand as an "owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
fiysclf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
<.J._4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
(1,
',, ' 5 | understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
/y'alue of my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an
'employe/ under state and federal law.
'-::--6. I understand if I am considered an "employer' under state and Federal law, I must register with the state and federal
liiEinment, withhold payroll taxes, provide workeri' compensation disability insurance, and c6ntribute to unemployment com-
pensation of each .employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
Ll-1. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
st- Ii-ures cannot legally build them with the intent to offer them for sale, unless a/l work is performed by licensed subcontrac-
tors 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.
' _, , 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 fanan-
cial or pergonal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
1l
"9. I understand I may obtain more information regarding my oqligations as an "employef'from the lnternal Revenue Ser-
.,!ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi-
sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-
321-CSLB (2752)or www.cslb.ca.qov for more information about licensed contractors
' t, n.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
fgl"n''Hry TlYt^H'Toffi:,Yr qTposed construction activitv at the rorlowins ad-
__.1,:11 I agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all
a/p[cable laws and requirements that govern Owner-Builders as well as employers.
[]Atl'Z. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
hSve 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 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 for you to understand
that if an unlicensed Contractor or employee of that individual or firm is in.iured while working on your property, you may be held
liable for damages. lf you obtain a permit as Owner-Bualder 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.
tion, or other verification acceptable to the adencv is req uired to be presented when the permit is issued to verifv the
propetty owner's siqnature
Signature of Property Owner Date:
Print name of Owner t/'.-k z>z=-*4
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 filled 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 notari2ation, or other verification acceptable to the agency is re-
quired to be prcsented when the permit is issued fo verity the property owner's signature.
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. /Vote.' A copv of the propertv owner's driver's license. form notariza-