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Home My WebLink About10196540 - Permit (2)q Project Address: 830 E Fourth St Assessor's Parcel:398483-07 Lot: 8& PORT Block: A Address Range: 826-834 ' Historic: No Suite Range: Zoning: SD84 Unil: City of Santa Ana Permit Counter: (714) 647-5800 20 civic center Plaza (M-19), santa iia, CASZZOZ l n spection Req uests: (7 1 4) 667 -27 3 6 l nspector Section: (7 1 41 647 -5853 Bu ild ing Permit #: {O{96540 Pin #: 96442 Building Use: Commercial Occupancy: M 'l st FL Area Job Type: Tenant lmprovcment Constr Type: V B 2nd FL Area Nature of Work: Tl Code: CBC 20,16 Other Areas: Existing Bldg. & Use: Commercial/Retail FIood Zone: X-0602320276J carage Area Proposed Use: # of Stories: Totat Description of Work: Tl-lnstall demising wall to create separate area/Partition walls to create bathroom Planning Conditions: Patio: T.l.Arear s4 Yards Req'd Valuation: $2,000.00 0 Owner: Address; Contractor Address: Engineer Address Salvador Jimenez 16551 Ridgefield Dr RiveBide, CA 92503 (7',t41913-7647 Architect / Desiqner: Address: Phone: License # Owner-Builder Planning Approval By: Plan Checked By: Permil lssued By: NPDES lnsp. Req'd: PWA lnsp Req'd: No Planning lnsp. Req'd: No Flores, lvan So Anson $o '"'n"no"'' *"n' 077760 0 2 077760 02 07776002 07776002 0777600 2 017760 02 Dale: OSl24l2O18 Date: 07/20/2018 Dale: O7l2Ol2O18 Subject to Field: l\4isc. Receipt NIisc. Receipt lvlisc. Receipt 57607 53600 5 7607 57672 57600 5760 7 $149.25 $100.27 $243.16 $1 .00 $22.08 $55.04 710'1 8 Total Permit Fee Plan Check Fee Penalty Bldg. Stds. Revolving General Plan Update Fire lnsp. Req'd: Police lnsp. Req'd No No Account# Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No Every permit issued shall become invalid unless tha wo* on the site authorized by such pemit is commenced within180 daD aftet its issuance,ot if the wotk authorized on lhe site by such pemit is suspended or abandoned fot a period ot180 days after the time the wg* is commenced . lnspector MID#: 2018-143546 011 16002 51600 011 16002 s1601 01116002 sl612 $22.08 $447.45 $1.00 Fee Total Paid to Date: Balance Oue: $570 80 $100.27 $470.53 Bldg: Tract HALL'S ADD Phonel Tenant Phone: License #: Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires; i / ,lt-t I tt J( rlr t-u lssuance BUILDING- INSPECTOR RECORD SITE.WORK DATE rD/srG..COIHTIIENTS OWNER Bt]ILDI]R DEt,CARATIoN I hcrchy illnm uklcr Fmlry.f Frury rhai I anr cxenrpi fo,n rlrc (i)nrMtrr Li.ctr\c Lru l rhc lolk,siig rcas (Sc.7o.ll5 Brsi',.r\ rnd Prolc$ion Codc) An! airy or Counry uhi.h rcqlircs r rErmir rn mtrslrucr. rllcr. imnnve. &mnish or rcpan .trr \lnrcturc, lriMlo ir\ i\suh..c.rl$ rcquircs rhc lpplicrnt lir qrh |tnnn r) liLasiStrcd nnr.'tunr rhnr h.or shc illi..h\.d pur\urnr to rrf, lr.!i\n s ollhc Cotrtr0crors Liccnscd ljw lchrprcr 9. Conmcncirg wirh Scdion 70(x) of Divhiotr 3 ol'rh. Businc$ rtrd. Px,rcssnns (irdc) or rh r hc or shc i\ crcflrpt rhcrcliun iM rhc h is rff rhc allc8cd crcn,nrion Any !iolarior o{Sccrion 70.11.5 hy rny rnpli.anr for al.nnir *rhj(h rhc (p0lic!trtto rcivillEn(lry.l nor m.Erhrn fiv. hrndi.d dollah($5m) l. * o*n rolrhc I,ropcrry, or r]y cnrl'lo)Nr sirh srscs !s rhcir slc cotr,pctrsarion. *illdo thc w.rk an,l rhc sltrhtrc is En i cidci or.ficrcd for srlc (5(.701.1. Btrsin.ss md l,rofcsions Codc] Th. Co rr.roas t.iccnsc htr docsn.r.polyturnow.er f rhc mrn ny who bu ild\ or nqmks rhcren. !(l stu dNs such x,* hin\cll o. hcFclf or rhiir3h his nr hcr own c.rrloyccs. pmvidcd rhar \uch imororcmnhEmt inrcndcd d off.nd inrek lLh.wc!.r.ihcili ing or itrltrmvcrnr t sokl *irhinnrc r! olconqrblbn.llf Owncr auiu.r wiu halc rhc b[rdco ofpovil8 rhll hc or shc did mt buiu or iryruvc rh. pmtrny lor rh. ru{x,*ot L a\osncr oirhc fl.I)cny. rrcrclusiv.lycuftrcrinE wirI licen\s] conrrcron h con(rucnlE pmjcct (Ss. ?(84- Bu\incs rnd hfssirn Codc: Thc Conkrtr\ l-iccn{e l.xw docs trot rIJrly ro trfl owncr olnropcny slro buildr or nnprovcs rhcrcon. rid *ho co ri.h to. su.h tm]c.r sirh r(,drncttr(\)liccns&!purshtrr L/llllc\cnrfl un cr lclr -J- "r 11 .Dd"1 ry 2o**, I hcrcby !fltflunds Dcnah y of Dcrjury onc ofrhc f{nb{inS dechlrtions: I h"ecud siilnui ain! Cc iti.ntcofcotr{nr t) scll lnsurc fi,r worLcn coml.trvrion- !\ pmridql Ior hyScclion.lTO(ror rhc I]fitr (()d .lor rhc a.nnnun.. orrhc wo* ror which thc Fnnil h nslcn I hrvr rnd wllln,ri0ltrir *orkc.i.onrFn!rri( r\urrrk.,r\rcqutcJhySccriotrlTlx)olrhc,.rhorC.d..rarrhcprnrHmcol rlr sork tu shich rhht.nnir i\ i$trcd Myworkcr{ co rtr \ rion i'NUr ncr catricr .dpli.tnunrh.r rr.: P,ni.1 Nu'nb(r.-l^nircs _l ccnirytnar irrhcltrr.rnrn corrh worr lar *hich rhi\ p.imir is issucd. t shrlln.r cntl.y nny r.Non in lnynrM,cr$ * t, h(rotu $h]ccl lo lhc *r*cr conrDcnsntiotr laws of Cnlitrnir. rnd agrcc rh ifl shoui h.(mk sohjcd ht)f, qork$J corpcnsrr ion proririon\ ol Sccr ion l TOO oi rhc Ll|r)r Cdl.. l shrll. l.nhw .onlllly wirh rli,$ pn,vtinr WARNINC: r.ifurc b ku. workcrJ.onf.hsario!..rcrosc h unhwlir ycr lo ainrinilpemlrt\ rtrd .ivll liri nf ni oN htrndrcd rhou{ d d.llr\ lsl(x).olDr. i'r nir i(xr. drnrScs rs pr.vid.d Lr rh. Sc.riotr l07a ol'hc btxtr Cudc. mrLrc{ M'l ,,",",7 -*tt-- (U^C DI':( I,,\R |I loN I h.rht aflirn trndc. rcnallyoi0crjury lhlr I .m licn*d undcr I,ovi\bn ofChaprcr or 'hc Busircsstrnd Pmics\iorN Codc.0nd nry li..nr. i\ tu ftrlltirr( xl cr'lc.t 'ntrf,mi'rg rih Sccri(in 70(X)).lOn ni,in.l SIINSIBUEII!}NI,ENDINC.&GDNCT I hcrcby iffi n unJur Fnalry or pcrlury rhd rhm is ! onsrruction bnding trs.ncy for thc I'.'ndrmrcc of ihc wor* fo! which thh lcanit is issucd ls.c.:rO9?, Civ C ) AIIUSAIiLIECI,AAdIION ItEEh!nrtlnnu*idr |*Mlry or p.rjur! onc orrhc t0ll,,$ltrsncchDrn \: Octrblni( Pcnnns Ashcdos Norific,rion l:cdcrul Rceuldir r ('rirb4t), Pin6) Rcquncd krrcr of Norifi crri0n -lccnilyrhrrrhcrcdcrdlrcguLrn,s rlrdingr\h((o\ rcnmvilrrc n.l aptli.rhlc to rhn tnjc.r lccnifyrhar I havc r. rhi\ inth.dionml{atc irc.r I rsic ro.oDdy wirh allCirv rnd C,nn v orliMtr.cs Md Sr rc l, w!rclaritrgr.6uitnr8.on(rilc rrt)rc\.trrdnc\ ofrhis Cirv,'nd Courry (, cnr$ unotr rhr xhovr nrnriorcd prorcdy |or st$lrotr NrB$c *;'- -rf-,Appli.lnl o. Aa.trl SiAtr.lurr lvwa i%_ Set Backs Forms/Sleel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVlnsulalion Roof Sheathing Shear Wall I Framing w o//e 4q D lnsulation/Ener r/*,Jv ;) Ext./lnt. Lath Brown Coat lvlasonry Pool Fence Deputy Final Report Engineer Final Report Flood Zone Certif FINAL ///7il/ .&4o Certiticate ol Occupan Notes Remarks, Etc ('rrrr - Drywall 9/z T-Bar Handicap Req. MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILI\4EMBERS P. Davad Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa ana.org/pba 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 lm vem ents specifi We are providing you with an Owner-Builder Acknowledqment 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 DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. <at{t I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" b0ilding 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 property. <{h I understand building permits are not required to be signed by property owners unless they are responsible for 'lhetonstruction and are not hiring a licensed Contractor to assume this responsibility. pro ctm I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may yself from potential financial rask by hiring a licensed Contractor and having the permit filed in his or her name instead of my own num bers I understand Contractors are required by law to be licensed and bonded in California and to list their license on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the I value of my construction 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, I must register with the state and ederal government, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to unemploymenl compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 1ffi I understand under California Contractors' State License Law, an Owner-Builder who builds single-family fesi'dential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CiTY COUNCIL moulidolasanla ana o.o Mayor Pro Tem, Ward 2 mlman nez@santa-ana oro Vrcente Sarmrenlo wamlento@sanla-ana.oro isolorio@sanla-ana oro ivlleoas@sa.la.ana oro sl narero/asanla ana oro P David BenaMdes dbenavrdes@saola 6na.orq licensed subcontractors and the number of structurei does not exceed four within any calendar years, or all of the work is performed under contract wjth a licensed general building Contractor. n ncia I I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. & I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue â‚¬ey'vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division 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. 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am p rty le and financiall v res ib for pos co ion activ at the followin address 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by a ll applicable laws and requirements that govern Owner-Builders as well as employers orm 2. I agree to notify the issuer oi this form immediately of any additions, deletions, or changes to any of the ation 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 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. 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 pe rmit. Note: A copv of the propeftv owner's driver's license, form notarization or other verification table to the ,s ired to be issued to the owner's re. Signature of Property Owner Date 2LO'' ,/)c 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. ScopeofConstructionProject(orDeScriptionofWork): Project Location or Address Name of Authorized Aqent 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 Illled out the above information and certiry its accuracy. Property Owner's Signature Date Print Name of Owner: Note: A copy of the owner's driver's license, form notarization, or olher verificalion acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature-r .r i:.:ri i_- .r, i.r , .r :.:::,,: ..ti r'.,:.. .. i-:::.r. i -- i-, ..: ::.: SANTA ANA CITY COUNCIL isoloro@sanla-ana oro P Dav,d Be.av,des dbenav desrasanIa an6 oro villeoas@santa-ana.oro stinaero@sanla ana.oro M9!e A Pul,dc McheeMannez Vce.teSarmenlo Mayor Nlayor Pro Tem Ward 2 ward 1 mpuhdo@sa.ra-ana oro a marl neu@sa.1a-ana oro vsa rm e.ro@sa.l.-ana oro