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Home My WebLink About102102745 - Permit (4)Proiect Address: 706 N Jackson St Assessor's Parcel 194-171-11 Lot 142 Unrt Bldg: Address Range Suite Range: Zoning: RlTract 554 Hrstoflc No City of Santa Ana 20 Civic center Plaza (M-19), SantaAna, cAg27o2 Building Permit Counter (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit #: 1O21O2745 Pin #: f 8777j Building Use Single Family Dwslling Occupancy: R-3, U 1st FL Area Job Type: Reroof Consk Type: V B 2nd FL Area Nature of Work Reroof/Windows Code: CBC 2019 Other Areas: Existing Bldg & Use: gfp p/66 g3slgg Flood Zone: X-0602320143J Garage Area Proposed Use: # of Stories Total Description of Work: Reroof w/t.o.-Remove and apply comp shingles/sheathing to remairVhandout given Legalize window changeouts/handout given Planning Conditions: Patio T LArea: Yards Req'd Valuation: $6,660.00 r r-lL(n; 'jrice , :{qi i .ii1l \.i iH I / J/'2tt)tl ir urr:i i 4/ ket'+ i I0: (:(:u ..l_Al 1 ol 1 lti2lt-t'il4|l Engineer Address ;i; trr:ir3 /.t.ti _ 'r so,: c ion Iotal lito rfl t9.i i .91 Owner Address Phone Tenant Contractor Address: Owner-BuilderJuan Serrano 706 N Jackson St Santa Ana, CA 927032747 (7141577-s474 lfftilr(i Phone: Stale Lic #: Lic Type: Bus. Lic #l Workers' Compensation lnsurance Cafiter Policy #: Expires: Phone: Lrcense f Phoner License # rRn LJ!Litli,E iPe li I ,J t:ru ilr:I-r - Architect / Desiqner. Address: .-:ll.1r:rlr"rtitr- r tevoiv r rrv" l16l ?tJrl[r'. n i Dor-urerr i.: 51 7 7 t-n)Ut-t- orcir*r*Irrr*2942 i3. 91 Planning Approval Byl Plan Checked By Permit lssued By NPDES lnsp. Req'd: PWA lnsp Req'd Planning lnsp. Req'd Landscaping lnsp Req'd Graham, Jeffery Hernandez, Kalhy Date: 01/03t2020 Date Date: 0l/03/2020 Subject to FieldNo No No No Fire lnsp. Req'd Police lnsp. Req'd No No Account# Misc. Receipt Nlisc. Receipl Misc Receipt 57607 57770 57507 s 7607 576 72 57600 57607 07776002 07776002 0 77 7600 2 0777 6002 o77 7 6002 0777600 2 07776002 $499.59 $3.91 $100.s7 $252.69 $1 00 $22.95 $57.20 Permit Fee l\,licrofilm Records lnvesligation Penalty Bldg. Stds. Revolving General Plan Update lssuance Flood Zone Cert Req'd No Evory pormil tssued sh6ll becomo invalid unless the work on lhe site authonzad by such peftn $ commonced wthn 360 days aftet s issuance.ol tf the work aulhonzed on the sJto by such pefinil E suspended ot abahdonec! lor a pe od o1360 days aftet lho lifie the wo* ts commencod lnspector MID#: 2019-156786 0't 1 16002 5't600 0't116002 51601 01'l '16002 51612 01116002 57770 $22 9s $910 05 $1 00 $3.91 Fee Totat Paid to Date; Balance Oue $937.91 $0 00 $937.91 Block NA Tota I BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.oWNEI AUILDIiR OELC R TION I h.r.by lrtim uLkr lrBlry ol Fr]lry rh{ I s cr.mfl lrDn rlr G,nrrth' Lr.nr Uq litr tlr lolhwr8 rc&'. (S( tull : llu krr .r Pnn.$bn C(rl.) Ary C y or Ci'u y uhrh rcqlB . Ffll lr .$rlMr. rltcr. rWoE. dcBlltrh or EIE! uy {rudu(, tfl, k, s isru,nr., alw, (tur.i rh. rt'plirmr lor skh lrrmi! r, lik , nlkrl dar.mnr rh.t lt r it{ ! lMnsd n!^uel rr rh. 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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 fo[ a building pe rmit has been submatted in your name listing yourself as the builder of the property improvements specified at 2 _l 4 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 lssue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our offlcial 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 ACKNOWLEGMENT AN VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information .jc L l understand a frequent practice of unlicensed persons is to have the property owner obtain an 'Owner-Builder" build- ing 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 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. {5_Z I understand building permits are not required to be signed by property owners unless they are responsible for the coistruction and are not hiring a licensed Contractor to assume this responsibility. .j:_S I understand as an "Owner-Buildel' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. -aiq I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on-permits and contracts. -j .--S. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total val(e of my constructron is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. - : 6. I understand if I am considered an .employer" under state and Federal law, l must register with the state and federal gov'ernment, 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. -:15 l. 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 all 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. . 1 5 -8 I understand as an Owner-Bualder 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 owne(s) that result from any latent construction defects in the workman- ship or materials. :-.!_9 I understand I may obtain more information regarding my obligations as an "employe/ from the lnternal Revenue Ser- vice, 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.oov for more information about lacensed contractors. )3-lO I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and linancially responsible for dress: constru,'i-/ctivit a the followin I ad:4' -...- \ 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. 3il2.l 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 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 lmportant for you to understand that if an unlicensed Contractor or employee of that individual or firm is inJured while working on your prope(y, 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. tion. or other verification acceptable to the adencv is rcauired to be presented when the permit is issued to verifv the prooeftv owner's sionature. Signature of Property owner la <-- E --,<--{ â‚¬ l?lZD -z-..-/) 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 flle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address C Name of Authorized Agent Address of Authorized Agent I declare under penalty of perjury that I am the property owner for the address lasted 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 verification acceptable to the agency is re- quired to be presented when the permit is issued to verify 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, lrote: A copv of the propertv owner's driver's license, form notariza- Date -l ) Phone Number of Authorized Aoent: -D./ ! -s- x\r \ b,.k\ 1.'-\ JOto -E[%9 -x {LG]*LR K{ w--V,/'o \< ) l4u .-1t"":'!!.'IJu'; ,t""too; frtc^,y l, 51,.." ' 1.-vtz o 5rl f^l)crt\ 06>h"( SSVI L <i /r Qq , \ I I ,hL-L lz-o\a