HomeMy WebLinkAbout101102883 - Permit (4)Proiect Address: 1418 W Elder Ave
Assessor's Parcel '109-276-08 Lot 74
Unrt Bldg: Address Range Surte Range.
Zoning: RlBlock NA Tract 1574 Hrstoflc No
t city nf Santa Ana 20 civrc center Plaza (M-19), santa Ana cAg27O2 Building
Permrt Counter: (714) 647-5800 lnspection Requests (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1O11O2EE3
Pin #: 568(1
Building Use
Job Type
Nature of Work
Existing Bldg & Use
Proposed Use:
Single Family Dwelling
Alteration
Pool demo
Sfd w/att garage
Occupancy:
Constr Type
Code
Flood Zone
# of Stories:
R-3, U 1st FL Area: Patro:
V B 2nd FL Area: T.l.Area:
cBc 2019 other Areas Yards Req'd:
x-o602320257 J carage Area: Valuation: S3,000.00
Total:
,,"PERMIT SHALL NOT BE FINALED UNTIL ALL N/V PERMITS HAVE BEENOescription of Work: Demo pool & backfill. Pool demo handout given
FINALED-"
Planning Conditions:Bot(h+:55r5? 1 2r:l?r:t I0: (:(:uELLAt
u
IOwner
Address
Phone
Tenant
Andy Dang
57'12 Ocean Vista
Huntington Beach, CA 92648
(714\ 724-0256
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Contractor
Address
Engineer
Address:
Phone
License #
Architect /
Desiqner
Address.
Phone
License #
Rel+: 1L]l I r:r
l/ 17 /1(t2lt 1il9 I
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I i12e67121,
fr(lns(r,:L ion I otaI
And! oone
l,5r.rlr-rur:l
;€rrerol PIsn UPdote l-ee
:r1 I l6t-rU2- I16l-Ilrjr:|l.| -
luildine
$?:
t t l6[n:l
t l,5r-rr
. r'o{
Planning Approval By
Plan Checked By
Permit lssued By
NPDES lnsp Req'd
PWA lnsp. Req'd:
Plannrng lnsp Req'd:
Landscaping lnsp Req'd
Orozco. lvan
Amsden Julre
Date t0/25/2019
Dale
Dale O'll17l2O2O
Subject to Field
Misc. Recerpt
Misc. Recerpt
Misc. Recerpl
ot776oo2lit66lYAlnilF'e:c. +'1i,:
07776002 57770 Microfilm Records
07776002 51612 Bld?. Stds Revolving
07776002 57600 Genetal Plan Update
07176002 51501 lssuance
L',$id6:s:
$1 00
$22.95
$57.20No
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert Req'd: No 01 't 16002 51600
01 1 16002 51601
01 1 't6002 51612
01116002 57770
$22.95
$223.73
$1 .00
$3.91
Account#Total
Every perml Bsued shall become nvaltd unless lhe work on the stte authonzec! by
such peml6 commehced wlhh360 clays after ls tssuance or il lhe work aulhorized
on the sito by such permil 6 suspended or abandoned for a period of360 days after
the tme lhe work B commenced
lnspector MrD# 20'19-155420
$251.59
$0 00
$251.59
Fee Totalr
Paid to Date:
Balance Due:
BUILDING. INSPECTOR HECORD
SITE.WORK tD/stG COMMENTS
Set Backs
UFER Ground
SLAB Floor
Subf loor/VenVlnsulation
Roof Sheathing
Shear Wall
Framing
lnsulation/Ene rgy
Drywall
Ext./lnt. Lath
Brown Coal
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
u2.1\'u \2n YV vv 6-l
Cerliticate of Occu pancy rl I
Notes Rem rks, Etc
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Planning & Building Agency
Building Safety Division
20 civic center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
www.santa-ana.org
aPP-13 CBC 2016
NOTICE TO PROPERW OWNER
Dear Property Owner:
We are providing you with an Owner-Builder Acknowledoment and lnformation Veriflcation 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 owne r,
obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT AN VERIFICATION OF INFORMATON
DTRECITOIVS.' Read and initial each statement below to signify you understand or veify this information.
lyl . t understand a frequent practice of unlicensed persons is to have the property owner obtain an 'Owner-Buildel' build-
in! 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 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 prop-
erty.
\
l,)V Z. t 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.
dC-S. f understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potentral financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
o permits and contracts
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
my construction is at least five hundred dollars ($500), including labor and materials, I may be considered anvalue of
S
'employe/ under state and federal law.
FLS I understand if I am considered an 'employer" under state and Federal law, I must register with the state and federal
g6Vernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com-
pensation of each "employee.' I also understand my failure to abide by these laws may subject me to serious financial risk.
I understand under California Contractors' State License Law, an Owner-Builder who builds single-tamily residential
ructures cannot legally build them with the intent to offer them for sale, unless a// 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.
I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
I
An application for a building permit has been submifted in your name listing yourself as the builder of the property improvements
soecified at lltl0^ t.r. E-/ 7',i A
'\ ^
_ I
Wg I understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser-
vic6, the United States Small Business Administration, the California Department of Beneflt 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.oov for more information about licensed contractors.
di<'tl.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
pdrty legally and flnancially responsible for proposed construction activity at the following ad-
dress
lJlL'tl.l 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.
h ave
12. I agtee to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
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 flnancial 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.
to the agency responsible for issuing the permit.of owner's driver's license form notariza-e
ented when the ermit is issued to the
propefty owner's siqnature.
Sagnature of Property Owner Date
Print 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
Print Name of Owner
Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is rc-
quired to be presented when the permit is issued to verify tha propefty owner's signaturc.
/ltrC, t^t ,/-/.^t.7
Before a building permit can be issued, this form must b.€ completed and signed by the property owner and returned
co
pre:
/, z/rn,uI
Date: