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Home My WebLink About10496533 - Permit (2)EProject Address: 310 E Goetz Ave Assessor'sParcel 4'11-052-05 Lot. NA Unit Bldg: Address Range Suite Range: Zoning: M'lBlock: NA Tract: NA Historicr No 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 #: 10496533 Pin #: 76933 Building Use: Job Type: Nature of Work: Existing Bldg. & Use: Proposed Use: Occupancy: Constr Type Code: Flood Zone: # of Stories: B VB cBc 2016 x-0602320274J 1st FL Area: 2nd FL Area: Other Areas; Garage Area Total: Patio: T.l.Area: Yards Req'd: Valuation: lndustrial Demolition Demo INOUST/OFFICES & WAREHOUSE 0 0 0 0@0 9s,000.00 Description of Work: $5000.00 to be added to future Ti for accessibility compliance. Demo unpermitted shade structure and interior mezz. Planning Conditions: 0 P,rrtchi I rr41il? - 6/1/2t1tB olf ice; t:lYH lrflnsil 21iri:ct+: Ref+ I K,:pt.+:[12299675 - 6/7/zntg L'(nsoct i0n Total 10: onoroleslS 1 ,ri' i r [r49,i533 1l :26 Al1 t2.t3. 11 Engineer Address: lell ihed qr sOwner: Address P hone: Tenant: Jeff Thedars 310 E Goetz Ave Santa Ana, CA 92707 (714) 981-3623 Theders Contractor Address: Owner-Builder Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance Carrier: Policy #: Expires: Phone: License #: Architect / Desiqner: Address: Kemme Marcus 228 Crc l,irild in! rlI I I6r:I"12 - Il6r:rIrlt-r(r- 6enâ‚¬irol Fl.nn Updote Fee r_tl I 1 6|]02-' l6rlt]t:rt[]- P lds Stds [,:evol v ins - ,! ,lir ./ " :4 Auth+ !lr9.i6{,1 un,ts- t:ti | /t-tl'-t{-|J_ Phone: License #: Hunti (714) 5 c-29552 F ??911*r;+,i,, Planning Approval By Gomez, Pedro Dale: 05121120'18 Niisc. Receipt: 710'ts Dater 06/06/2018 [iisc. Receipt Date: 06/07/2018 Misc. Receipt Subject to Field: No No Account#Total Plan Checked By: Permit lssued By: NPDES lnsp. Req PWA lnsp. Req'd: No Planning lnsp. Req'd: No No 0777600 2 07776002 07175002 07776002 07176002 07776002 57607 53 600 57770 576 72 s7600 51607 $'154.26 $213.86 $3.62 $1 .00 $21.2s $52.98 Mazatji, Zac Amsden, Julie Permit Fee Plan Check Fee Microfilm Records Bldg. Stds. Revolving General Plan Update lssuanceFire lnsp. Req'd: Police lnsp. Req'd Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No Every permit issued shall become invalid unless the work oh the 6ite authoized by such permil is commenced within 180 days after its issuance or il the wo* authorized on the site by such pemit is suspended ot abandoned for a petiod of180 days after the time ttle wo* is commenced . lnspector l\AlD#. 201A-143471 01 1 16002 01116002 0'1 1 16002 01 1 16002 5'1600 51601 5161? 57770 $21.25 $207 .24 $1.00 $3.62 Fee Total: Paid to Date: Balance Due: $446 97 $213.86 $233.11 BUILDING. INSPECTOR RECORD SITE-WORK DATE COMMENTS I'W\},R BT II,Df,R DFI,('AR{TIO\ I hcrchy o,lirm utucr ncn.'lry nf pcrjur) rlrr I dn crcnpr fft,ft rh. G,nad.^ Lkcnsc lrw for ric lirllowin8 rc.nrn (Sc.70ll5 Bu\i"r* ,tr,i Pu,tusion C,\lc) An, Cir) or Coutrr, shich rlllncs a rErnrn ro con(rucr. olrcr. irlrovc, dcnolnh or rctrn any !rurrurc, | .r rn \ ^sdrn!r.0lso Ntutr srhr3[rnl'!r tu su.h pcmir t, filt r siSrd surcmnl lhlr tE or \hc i\ li.cn\cd tur$lnl r' rhc nnntinns .r rhc Cnnlrd tr'\ LiccneJ LJw lChrplcr 9. ConrnErcinS wilh Scclion 7O0O of Dilhion 3 or 'hc Burin.s xnd Pr,rc{i,,n\ C'dci,tr rhor hc,tr\hc nc\cmnr rhcrcrromrnd lhcl,aris tor thc alL-qcd excnDtion. AnyviolllionolSecri,n?03l5hyony /?t!,di{.fan {bJ.\r.rhc Jrfl'.rnrt,J.'u'l|caotvdnnrm'crhMfi!chundNdiilh,\'95rn' ( L/^ .",*, , u'. r ,*d j. or my c'nrirL,rc.\ r n h wrscs is rhctr $k conrFnsnrion. wir do rhc {o.k a rhcsr*ru,ch trn ,inrcndcd ur.llcrcd r{ $h tscr 7LXl. tsu trc$ rid ftufcrsi{,ns Cot: Thc Cont&ktr r l-i.cn\c k} d.cs not spply ro si .qtur of rh.In,Fny sho nuiB\ or inr{m\$ rhcmn. ind qh. des skh eork himrlfor hcsclfor (hou8lr his or h.r own.n{btccs. nnrir(d rhrr\d(h imrI ^cmnr\ rrc nur inrcndcd nr orlcrcd for {h. t( lD"qcr. rlEhuiUiryor nn0mvcm hsldwirhinom}tr .r'.nl'1lrlclrtrrtrO{rrBtr'tr.r{illhJK,hrhurdcn,,fnovin8rharh(or\hrtlr.l n hoitt !r inErrr rh- pn)fcny aor dr plrF,{ of -1. !\ owmr oihc Profdry. rtrn .r.hrnrly .ontrrinB wir h li.cns.d rontr.ri'n iJ .on(tu.r irr,n,icr (S( 7Or]- Bunnc\r xnd Plofc\si Codc.1hc Conrracrois l-iccnr L!$ doc\ trol rntlyk) itrowrcr.lnropcnywh') build\ or nnp(^cs rhcrcon. {nd qhu.onrm.rrnrsu.hpnl]tcr\wirhaCofirttrG)liccnscdpu^ur n,rhcConrrcttrsljccnEl!*r. lr cxc pruid.. Scrron .R &PC larrhisrcrv,n |ft,"," u/t/r/ y,, DLCI,ISAIION I h.rch) llimunrlcr Fnrhyollcrjuryotrc ofrhc loll.sd! drclrrari("r\ -l hrtc nfrl qill nMinh$ ! Ccnific.tc of C.ns. b S.lf lnsrrs,ar workc^ lrnnpci\arnnr. r\ pmlidcd tur l,y Ser i{{ .17(X) ol rhc tih.r C:{nlc. Li rhc lrdontuncc ofrhc work tu shi.h rhc pcrnril is isud -l hnlc ond *illnlinrain worker'cotrrpcnsation insumn.., as to\tutcd bysccrio.l?troolthc Uhor Cbdc,lor rhc pcrfor rmn.c or lh. work lor whth rhh pcrnril is hsucd. My sortcs conr!..slrion insuDne .nhr kl lrlicy numb.r dc Poli.\ \u'nh{. _ H\nm, :jz,/r(nrry rhd m rh. If,rr rnurkr urrhc work ntr sh'rh rhi\ Frmlr n nso.d. I rhrll nor cmtk,J, any p.rson in aiy mrnncr7 i ' A I' hd,m uhj(r ro rhc q nrlc6 (nrFnslFtr hws of caliLrni.. Md ,8rcc rhar if I should hi-.onr subjccr ro rrr trorkcr' coarpcns n,n previ\ion\ oI Sdn'n 37m ol rhc tjhtr Codc. I sl$ll, lonhwilh mmply wilh thor pBvnions WARNIN(;: Faihh ro $.urc sorrch coml.nsrior covcmsc is unllwlul. und shrll suhJcct !n cmpk'rr to crininrlpc rltics and civir fitrcs up k' oic hundrca rh.xsan dollrs (3lOO.ONr. ir lddilbn k, tnc cosr ol conrpcnsltion. dlmrs$ as previdcd l'or rhc sNrl,r 3076o1rhc l.rl!r (dlt id(r.n nlrr(tr).!\lo.s,t/,.,,,," b /7 //y W,* -r-F/I U r t('t Nrfl' ('i,l,t4(( LR DICI,A.IAIION I h.rchy !finm undcr pcD.ltr.fpcrjuryrtu I im li.cn*l und.r lr,,vnioi ofChrprcr 9 (.unnftn.'ng wirh Seri.n 7(X[) ofDivhiir:] ol rhc Bu\im\{ and Prof.\\i(,n! Cod.,0nl nry liccn{ i\ in full fircc ud cttarl IATSIruJIIIONI.INDINIj-II1i$TII i(u.d (Sr( 1097. Ci! C ) A.TTUCAIIDICIdAAIION I hddry allim lnder pcnallyrfpâ‚¬rjury onc ollh. iollouin8 dal.rations: Dcmlition Pcflnih.Ash.(os Notinc ion Fcdca, Rcgul io.s{Tirld 40. Pd6) -Rcquned Lcncr olNoriarcrtion -l ccnily rhar rhc rcdcrol agularions rsdditrs astEstor rcmvaldc nor +pli.,blc ro tht lmidr4 :,,lEJ.cnrty rhxr lh u rcrd rhh arpr'.a,n'n inJ nJrcrhr rhe ahov. iDlorrorion iscorccr l3srarocomplysnhtrllCiryandCoonr, Gaitranlc(rndsrrt.tjeiftbr'ner.hd'Urng..ni.'ion.adlhcrcbyrurhorir!ar..snrdiiv.s.rrhi\Cirydndc.unryrocnr.rxF,!rhe $i,vc nrnrioncd px,txdr- f{n in\pccri{)n purporc\ \q,pri.,.r ".,rg*r si,'*u* 3"- .r .,-e (prinr):-4*Je/â‚¬fue4t5 ),., 412/r? Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Sublloor/Vent/l nsulation Roof Sheathinq Shear Wall Frami ng lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Itilasonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif FINAL t-LL- t6 JA.t -+,T1- Certificate of Occu pancy ID/SIG. Notes, Remarks, Etc. Li.cn* Clts:-Licc.s. Numb.. - Drle conlr.cror I -T_------ MAYOR Miguel A. Pulido MAYOR PRO TEM [,4ichele Martinez COUNCILIVIEMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villegas ACTING CITY i'ANAGER Gerardo Mouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.org/ pba NOTICE TO 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 - .--'1 to Y"'- Loe*z- L1e- 9-,- L* &...------- 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 autho.ity. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. tJ/,lunderstandafrequentpracticeofunlicensedpersonsistohavethepropertyownerobtainan"Owner-Builder" '(lihing 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 homeowneas 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. 9.JZ I understand building permits are not required to be signed by property owners unless they are responsible for t fe,donstruction and are not hiring a licensed Contractor to assume this responsibility. /)-2/3 I understand as an "Owner-Builder" lam the responsible party of record on the permit. I understand that I may frotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. A- ik/ q. I understand Contractors are required by law to be licensed and bonded in California and to list their license &rf bers on permits and contracts. k/ t t understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the {otdl 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. 0) A. I understand if I am considered an 'employer" under state and Federal law, I must register with the state and ffd6ral government, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serlous financial risk. 17ZL7 I understand under California Contraclors' State License Law, an Owner-Builder who builds single-family (esldential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL mou do@santa-ana oro Mayat Pta 1e6, Wa"d 2 m maninez@sanla-ana oro Vicenle Samienro vsamiento@santa-ana oro isolono@sanla ana.oro P Davd Benavides dbenavides@santa ana.orc vlileoas@santa-ana oro st .alero@sa.la-an a or! Dear Property Owner: 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 general building Contractor. 4t A. I understand as an Owner-Builder if lsell the property for which this permit is issued, I may be held liable for any /ftiancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. lL-./ 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue 6gr/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 Wvvw.cslb.ca.qov for more information about licensed contractors. l),- ) to Fi6nv address: I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally and financially responsible for proposed construction activity at the following u4/. / ll.l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by y'all bpplicable laws and requirements that govern Owner-Builders as well as employers. ALIZ.l agree to notify the issuer of this form immediately of any additions, detetions, or changes to any of the ,{nf6rmation 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 permit. Note: A copv of the propettv owner's driver's license, form notarization, or other verificat!94 acceptable to the agency is required to be ted when the permit is issued to verifu the ertv owner's sianature. Signature of Property Owner Date 6/z / 7g 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 prolect. Scope of Construction Project (or Description of Work)o shJe-4A /a //ra 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 inlormation 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 yerification acceptable to the agency is required lo be presented when the permit is issued to yerify the propedy owner's signature.,-,., SANTA ANA CITY COUNCIL mour do@sa nta-a.a oro Mayor Pro Tem, Wa.d 2 m ma,line2iosantaâ‚¬na ora Vce.te Sarmrenlo !sarm enlo@santa-ana orc isolor o@sanla-ana.oro P. Oav d Benavrdes dbe.avrdes@sanra-ana.oro ivilleg-a!@E!E:4c.es sl.ae.oAsania-a.e ora