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Home My WebLink About10196687 - Permit (2)City of Santa Ana Permit Counter: (714) 647-5800 20 Civic Center Plaza (Nil-19), Santa Ana, CAg27o2 Building lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit #: {0196687 Pin #: 92927 q Proiect Address: 1118 S Golden West Ave Assessor's Parcel;109-09247 Lot: POR 23 Bldg Address Range: 1114-112O Hisloric: No Suite Range: Zoning: R2Block: A Tract: 604 Building Use: Job Type: Nature of Work: Existing Bldg. & Use: Proposed Use: Single Family Dwelling Oemolition Demo SFD R-3, U VB cBc 20t6 x-0602320257 J 1st FL Area 2nd FL Area Other Areas: Garage Area: Totat Patio T.l.Area Yards Req'd Valuation Description of Work: Demo unpermitted dtructure attached to SFD. Auth on file. Bqt,:hi:442r15 - 6.,'9./ltr l g off i,:e: (:TYH TrflnEii g,r A,:ct+ i lrEf; r Rcpt+rLl:290694 - 5 g rrri! Trunsoct ion Totql $1,000.00 Planning Conditions: Contractor Address: Owner-Builder Engineer: Address SILVIA ROMERO 1,I,I8 S GOLDEN WEST AVE Santa Ana, CA 927043204 (7',t41 7 59-',17 s4 Generql Flrn [Jpdote l-e 111 I I3r:rr'l?- 516D'10r:rB- B,u ild ins r:rl I I6r:fl-l?- 5l6l:rlrlUr-r- EIds Stds Re,.,olv ine ttl I I6tl!12- 51,91:!r1r:rrr- (:o sh f,hange Phone: Stale Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance Carrier: Policy #: Expires: Phone: License # $1,i + * Planning Approval By: Plan Checked By: Permit lssued By: NPDES lnsp. Req'd: No PWA lnsp Req'd: No Planning lnsp. Req'd: No Landscaping lnsp. Req'd: No Orozco, lvan Zuniga, Allissa Date: 05/08/2018 Date: Date: 05/08/2018 Subject to Field: Misc. Receipt Misc. Receipt Misc. Receipt 07776002 51501 Permit Fee 07776002 s7672 Bldg. Stds. Revolving 07776002 51500 General Plan Update 07176002 51501 lssuance Fire lnsp. Req'd: Police lnsp. Req'd No No Account# Flood Zone Cert. Req'd: No Every permit issued shall becomo invalid unless the wo* on the site authorized by such permit is commenced within180 days after its issuance,ot if lhe wo* aulhoized on the site by such pemit is suspended or abandoned for a period of180 days aftet the time lhe wotk is commonced MtD#. 2018-142771 01 1 16002 51600 01 1 16002 51601 01 1 16002 516'12 Fee Total Paid to Date: Balance Due Unit Occupancy: Constr Type: Code; Flood Zone: # of Stories: Owner: Address; Phone: License #: Architect / Desiqner: Addressi Phone: Tenant $154.26 $1.00 $21.25 $52.98 Total $21 .25 $207 .24 $1.00 $229.49 $0.00 $229.49 lnspector BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Sublloor/Vent/l nsu lation Roof Sheathin s Shear Wall Framing lnsulation/Eneroy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req ty Final Beport Engineer Final Report FINAL 1\5 \\r tAAAl9t Certificate of Occu pancy Notes, Remarks, Etc OWN!:R BUII-DNN DELCARATrcN I lrrchy il1lr undcr p.fuky ol Ftury rhjr Ln crcnllr riofl rhc (irntu.t8 t-i.cnsc tjw aor rhc tulloling rerson lss 70ll 5 lrusinc$ rd Profcssion Codc)r Any Ciry or Counry which rcqutcs a pcrmir to con(rcr- llrcr. in,provc. dcnblirh or tuprn nn! {tucrure. fi{r h ik is$ancc. al$ requtc\ rhc trptlicanr i, such F.r i( h filc r si8ncd qarcmnr rh hcor shc h li.cnsd plrsuutrl lo rhc [ovnions ol lhc Conrrrcroi\ Licen*d Lie (Cnnpicr 9. Connncncins wirh Sr.ri,in ?(xn or Divhn,i ] orrhc Bu\inc$. d' Pn)f.s\n,.\Codd)orrhrr h.or\hc is.xcnft rh.r.lro md rhcbd\i\ lor lhc rlLScdc\cmprion. AnyviohriorofSedn,nT0:rl5byany !p!licanlInr ! 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I hcrcb!.fin utrdcrt n.lr' ol lErjury om ol thc 6ll.wir8 dccld diotrs -lh{vcudwillnui rinaCcnifralcolCotrr.lroSclf.lNurciorsorkcn conl',.n\cri(,n- ar t,n,vidc{lrorbyS.dionl?molrhc trbor Codc. foi lh. p.rfonrokr ofrM w.rk for which rhc rcnnn k issucd. _lhrlcrndsillnBt rin*o*. conr|f,ilrrion in\rrxNc. ss rrquind $yS.rrnnr 37(nofrhc ljh.rC.dc. forhctcrli'inrnccof lh. sqt forwhichrhh Fnnir is isu.il Mt sorkcr'compcnsa,ion in\urd.c .rri.r dxl Fri.! nuDbcr m c8rier:- PolicyNumber:-Eipir$ I ccnifyrhrr$rhc |crlmmrncc frh{qolklirshi.hrhispcnnrtnt$d.Ishlllnorcntplotoi,tAoiindynritur $ h hconE suhrcd ro ric sorkcrs comr.n\aiion trws ol'Crlifornir rnd rgRc rharifl should bc.onr suhjtct to lhc *qkcrs compcn\rlbn povi\n,n\IfSc.rion:17(noirhc lrhtr Codc.lshall. ndhwirh.o'ntly siih rhoe ptuvisnN railur. t, {.u'. s6k.rs conlkniari(,n.ovcrrlc i\ unlnqtuL iM shrll subJccr (n cDDbrc k, oR hdtrdrcd rhou\rhd dollrrs ($lm.mO), i'r addti(itr k) rhc D&I'.AMIIQN I ncrchy 0rfirnundcr pcnahyo{!.rjury rhnr I ar licctrxn undcr provnn,n olChsprcr 9(c.rnf,n.in8 Birh Scclirn ?OO0) otl)ilhnu l oi thc Busircs.nd Pnicsions Cone. ud nry liccnsc is ir tull hrcc ordcilccr De: !ANI|IAIJEIIONIINDINC.d(iENCI I hcEhy atlirm lndcr p(nillyolpcrjury rhd rh.re n, con{tucrion hddi',9 rlcn.y nn rhc Frbnrrflcc olrhc $ork fin *hich lhh lf,rn,ir i! is{rd isc. 1097. Civ C.) ATTUCANLDIiILAAAIII}N I llrb! dmnn undcr t nlhy ol rerjry orc oI thc follouinB d(lar.rions: Dc mlniotr P$nrir$Aih.{os Nolificario. Fcdcrrl RcguhrionslTirlc 40. Pan6) -Rcquncd t.llcr of Norifi calirn I ccnifyrhJr rhc l.dcrrl rrgullri,)ns rcgrrding a\tf,no\ rrnntrr]rc ior rttlrablc k, rhl\ |n,,l..r l.idifyrhd I ha!. rcril rhii {tli.drion turl starcrhir rlx dx^r rli)nnd agre rocomllywirhrl Cnyr d CouN) ivcs or rhnCnyaDd Cotrnryh cir.r ur,, rh.o rncr\rnd srrrc I r$\rlrri,r! k,iunrg (otrnn:.rnn, r hfch\ rrr rtxrc nrnri,nrd nmai.nr lbr ii ADpliNnl or Aâ‚¬nl Sitnnlu(A'h-A,r}le--1e:/* Set Backs Flood Zone Certif . Lcndci" Addrcs - ---T------ otr -J ,1 t_ (- . -- r\ r )q-+ - .\ a-J FJN \s , '. ^ \ \) \),o$) \ olr t \\)=\ s { \S( '- { t- - [r JF?+ =o o&o.o. .)c! - J\- ) )_ l _ :> J -_ 5 - \ q_s- s&IE: - tiF : i i= :' '- 5 . 8t 1B F- I I 5ozlI IA ? I o (,2 ',(DotJ l IJtr(,r() lr J= S's \\ t, . , i ': } . - (j ui o-EFlutL ,- l I \I o -. I ul O(Jo _! r . . . - i - . _ _ MAYOR MiguelA. Pulido MAYOR PRO TEM Machele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorlo SalTinajero Juan Villegas ACTING CITY MANAGER Gerardo l\,4ouet CITY ATTORNEY Sonia R. CaNalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. 8ox 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 yo urself as the builder of the property e ecified at %zo,y//" 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. 9l{-t. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder' building 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. ^/,g f\-2. I 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. Sl*9. t understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protebt myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ) K. +. t understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. /'n> \5 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total velue of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employel under state and federal law. - /'t =_.<-6. I understand if I am considered an "employer" under state and Federal law, I must register wilh the state and Iedera) 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 serious financial risk. 5&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 a// work is performed by SANTA ANA CITY COUNCIL mou do@santa-ana oro Mayor Pro Tem. Ward 2 m marl ne2@sa.la'ana orc v cenre Sarm -"nto vsa m e.lo@santa-ana oro soiono@sanla-ana oro P Dav d Benavdes dberavdes@sanla-a.a ora v eoas@sa.1a-a.a oro slrnalero@santa-ana oro 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. I R S. I understand as an Owner-Builder if I sell the property for',ivhich 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 workmanship or materials. 1R-5. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Servibe, 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 lwvw.cslb.ca.oov for more information about licensed contractors. -rJ. t 1nEEl't 0 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am ly and financially responsible for proposed construction activity at the following add ress _11.1 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. 12. I 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 important for you to understand that if an unlicensed Contractor or employee of that indivldual 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' com pensation 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. ivote.'owner's driver's licens form notarization, or other tion acceDtable to the aaencv is required to be when the oermit is the s nature Signature of Property O b Print name of Owner v c> 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) Address of Aulhorized Aoent: 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 certify its accuracy. 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 required to be presenled when the permit is issued to verify lhe property owner's signature.:.':':|...: SANTA ANA CITY COUNCIL Jose Solono mp!lldo@santa ana.orc Mayor Pro Tem, Wa.d 2 mrmarl nez@santa-ana oro Vicente Samienlo vsarmientolasanla ana oro so oro@sanla-a.a oro P Oavid Benavrdes dbe.avides@santa-ana oro iv eoas@sanla-ana oro stinaiero@sanra-ana.oro Proiect Location or Address: Name of Authorized Agent: _ Property Owner's Signature: