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Home My WebLink About20165867 - Permit (2)City of Santa Ana Permit Counter: (714) 647-5800 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Electrical Permit #: 20{65E67 Pin #: 138,42lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Project Address: 419 N Broadway Unit: Block: 13 Bldg: Address Range: 411-419 . Tract: TOWN OF SANTA A}listoric: Yes Suite Range: Zoning: SD84 E Assessor'sParcel: 398-257-01 Owner: Address: Fainbarg lV LP '129 W Wilson St #100 Costa Mesa, CA 926271586 19491722-7400 Long Beach Tattoo Co LLC 0'1 1 '16002 01 1 16002 01 1 16002 01 1 16002 01 1 16002 01 1 16002 5'1603 51603 5'1603 51603 51600 51603 Fee Type Amount 125 Volt Receptacle 1.40 Light Switches, Occ. Se '1.52 Light Fixtures 1.01 lvlin Fee Adj 37 .20 General Plan Update 21.25 lssuance 52.98 Qty 8.00 4.00 16.00 1 .00 1 .00 1 .00 Fee $11.20 $6.08 $ 16.16 $37.20 $21.25 $52.98 Phone. Tenant Name: Contractor Address: Phone Bot,:h+:4.37?4 - :r'lri State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance Carrier: Policy #: Expires: 0 A R T iie: (:1 YH tr. t+;02?639r.!? - ns(,-t ion Tctc.l F0 inbcrrs ltl Ll-' Building Use: Job Type: Nature o, Work B VB cEc 2016 Notes:auth on file ernandez, Kathy Dale Date Date 05t14t2018 Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Every pemit issued shall bacome invalid unless the wotu on the site authoized by such permit is commenced within 180 days aftot its issuance, or il the wotu authoized on the sito by such peinil is suspended ot abandoned for a pedod of 1 80 days after lhe time the wo* is cgmmenced. $144.87 $0.00 $144.87 lnspector MID#: 2018-143349 01 1 '16002 51600 01 116002 51603 $21.25 $123.62 Fee Total: Paid to Date: Balance Due: Lot: 7,10 Owner-Builder Commercial Miscellaneous Elect Tl It:0!At.l1 I ,t,l Planning Conditions: Planning Approval By: Plan Checked By: Permit lssued By: Subject to Field: Building Permit #: Occupancy: Constr Type: Code: APPROVALS DATE COMMENTS OWNI'R BUILDER DELCARATION I hcrcb, lfiiln undcr pcnalty ol lcrrury lhil ! un crcm fmrn rh. Conrrlclor' l-tctrr t w for rh. lollo*in8 EN,i (scc 70.l l 5 Bu\incs lnd Protcssi{,n Co.lc): Aoy Cily or Cou.ry {hich rcauircs s pcrmit io snitu.l. slrcr ihProva d.nxrNh ur rcNtr ! {dcrur., I,itrro irr issur.... ds. rcquncs rh. +rlkdr for \kh Fdn t, filc a siSncd qatm.r rh lEor sh. h liccnsc,l I[GUlnt t, rhc povniinN of rhc c(,nrractr\ I-iccokd lls (Chaprcr 9- Con mEiiS wirh Sccrn,n 7(XXl oi Divirk,n :l ofthc Au\irc$ trnd Pnrfcssi,nx Codc) or rh.r lrorsh. nrx.ihpr rhcr.fr.nrnd rhc h*is fitrrhc rll.Ccd crcnrfrion AnyvioliriotrolSsrhn?0:ll5hylny lmli.lnl ld a pcnrit suhjcrrhc q'lliconr to rciviltcn.llyormr mlc thm fivc hutrdrcddolhrs (5500). I. x o{ncr oirte pmpcnr. or dycfipbrcel wirh wascs as rhcn n,b comt nerion- willdo rhcqo&d rh. sl lm is ml inlcfttjd or offcrcd for slc (Sd.7tX4. Busirc$ ,nd Pmfcssn,ns Cdl. 'I hr Conr.dor's Licen$ tjw docs nol apply lo an osncr ol rh. pmpcny *ho tuilds nr nr{,ohs rh.Nn. dxl who dks skh $urt hi'n\.llor h.r*lfor rhmu8h hk o. hcr osncmployeâ‚¬s, prolidc{ rhar such irymvcrnrs m n.l inl.ndcd., oftr.n hr !lt.li howcq.lhc huildios or irrrcwftnr i\sldwirhin.N }ta of.o,rpLion. ttE ownc. Buildfi will hrw th. bud.n or proviry tl'r! lf or sh. dil tror tuit o. in{,mvc thc pmpcrly fu thc IUrF s o, E+, * n*,. nr rt l)fi,r'.ny. ,n cxclusivcly o rucri.s wilh li.cnscd (onnacroN h con{rru.lltE rmj.cr (Sc. ?oa4. Bunndsr md P$lc$ir codc Thc contr&lol s Liccnsc Lnw docs .ot amly ro rn owncr of pmFny who builds o, imDrovcs ircreon. rtrd *ho cootrcrs tur \uchnm]c.ls{irhrConrn'.xn(sr li.cn I tuAurni rorhc Contrcroi\ Liccn\c bw). I JmcMrr UnJcr \cdFi ,","481!i) Ihivc rl will nlinuin ! Ccnillclc of C.n\c b Sclf lnsurc tn *o c6Lr,n|Ensmn)n,rc pmvidcdforbyScctinrl70l)o{rhc lihor Codc. io.rhcllc orro.ccoflhâ‚¬ wodr io! Fhth lh. pcmril i\ hsucd lhrlc rnd $rllfirintan, work$a ronfrisarn)n insrruncc. a\ r.qrned b!Sc.r()nl7(x).frh. hhor Cidc. iu rhc p.rli)nu,mc ol llic trork for whi.h rhh lxnhir ls is{cd M y *orkc6' .onlrn\rr i(,n nNrfutrcc .drcr aM F)lict Nnrb.r trc Puli.yNu'nbr Exptcs !+{.cdiiythd irrl[ lcrfoirnaRr ollhc work lor whichlhh [l.flnn n tsucd.l sh ll nol cnDloyatryrrnon in rny rnNr \, 6l$om suhrcd h rh.sollcrfco,nFnsrri,n hws ol Calii,nnir. r agN rhar irI \hould h.dnm subjNi hrrtu so*.rl .onpcnslrii)n nmri\n,trs ofSerion l7(X) ofrh.lrhr C.dc. ! rhrll. Lnhsirh coflplt sirh lho$ provisi.ns.. WARNINC: Failurc ro surc uorkc6' comrcnsalion covcmBe is unhwful. and sholl slhj.rr an c'nplorrr ro sinnn,l FtuIin dnd civil fiDcs uI to onc hundrcd rhou\nnd dollars ($100,000). in irn)n io tlrc co( oi uompcns!rion. d(.usc\ ds pR,vidcd f.r rhc o"r", \rr(Y r u-t i.tcrc( Md inoflEy r lccs Ihcrctiy arfid unddr pcnulry.rlcrjDry rhrr I a li.ci*l u.dcr in)visi(,. or Chlpl$ 9 (..nnftNir8 wil h Sc.t iotr 7O(xD ol Division .l or rhc B!\irc$ Md Pnlt$ion\ Gdc. lxl ny liccnr n in ,ull lorce ad c,Tcrr Lcndcrr N!m:- APILIIANLDESAAtrII.IN I lut6y dl'mn undcr penalry of plrjury onc orrhc nnbwn,g dccllrarions: Dc mliln,n P.nniIr Asb.(os Noiilicrrion FcdrrrlR.Euhtio,\ l, irlc 40,l'rn6) Rqun d l.rr.rof Nrrillcr.oi I..diry rl[r rhc tdcrrl tr!trl.ri(nN rclrrdirE rsrr(os rnhvrlnrc n.r rr'!li.nhlc r. rhn nnij..r ion. md hcrchyaurhorizc reprc{nr ivcsofrhtCiryodimn.cs md Sr.ic lrws rcllli a&)vc rnridrd pn)flcnvlir in A pplicnnl or Agenl Slqnoluft: Pcrnilm mn. i prin0: '?eooov'-t ?;fr*.* Site-Work Underground Pole Bases Lighl Standards Spas, Pool, Fountains Siqns (monument) Life Salety /Low Voltaqe Fire Alarm i Dam pers Communications Cable Building Bondinq / Groundino / UFER Translormers Torqueing Sub-Panels R ool Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilin gs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) It4eter Release Rough Service Meter FINAL s-|.7.-\e J).5p Notes, Remarks, Etc ELECTBICAL-INSPECTOR RECORD ID/SIG. Under Slab / Floor Air Conditioners ,4<y I hcr.hyxl}nmunrl.' F-nxlrr,'l trrju'!otrr.frhcf{,ll,rsi"gn.clrrri,r\ g)lgauclloNrENlltlljlliENcr Ihcrcbyffiinnu.rpcnaxyofFrju,ythdlhcrchronstucrirnLndinSngctrcyforlhcpolonrurcsofltc$orkror*hichrhnr.nririr i\sx.d rsc. ]m7 Civ C I II MAYOR MiguelA. Pulido MAYOR PRO TEN,II Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villegas CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I988 . Santa Ana, California 92702 www.santa-ana.org /pba NOTICE TO PROPERW OWNER Dear 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 ,ll9 rffi il,Vaorra_*1 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 OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. &f. ,understand a frequent practice of unlicensed persons as 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 em ployees 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. "@=+ I understand building permits are not required to be signed by property owners unless they are responsibte for the construction and are not hiring a licensed Contractor to assume this responsibility. 4l understand as an "Owner-Builder" 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. -/Z* I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Z> I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total 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. Z-t-* I understand if I am considered an "employer" under state and Federal law, I must reglster with the state and federal government, withhold payroll taxes, provide workers' compensation 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. z-^7. 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 mpulido@sanla-ana.oro Mayor Pro Tem, Ward 2 mimadinez@santa ana.ora vsamenlo@sanra ana.oro P. Oavid Benavldes dbeoavrdes@sanla-aru ora ivr eoas@sanl6'ana oro sli.a ero@sanra ana.oro ACTING CITY IVANAGER Gerardo lvlouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL I/a.ia D. Huizar 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 prope4y' owner, obtain the prior approval of the permitting authority. // soiorio@sanla-ans oro 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. &lunderstand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(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 Service, 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.qov for more information about licensed contractors. 4Q-,0.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party lega address: lly and finan ciall responsible for proposed construction activity at the following -?f 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. Zr.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 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. /Voae:A coDv of the Drooertv owner's license form notarization, or other verification acceDtable to the aqencv is reouired to be pre sented when the permit is issued fo Signature of Property Print name of Owner owner'nature. Owner Date /l) Re?Lht, LtGlrl y'tr tvL4 7-1^n C-)n,a-r'*- AUTHORIZATION OF AGENT TO ACT ON PROPERry 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 OwnerBuilder Permit for my project. Scope of Construction Project (or Description of Work)9t"{,+7.10 aD I L<-f 9 NrOt?&twrr 3NrA A cr) Name of Authorized Agent Jâ‚¬Ti ileoOo-"t Address oi Authorized Agent -J F9r uL lL56v-t 7f2-e12-ti-+d (A 621 Date Phone Number of Authorized Agent 1q ZZ-7qoo I declare under penalty of perjury that I am t property owner for the address listed above and I personally fllled out the above information and certify its accura Property Owner's Signature: Print Name of Owner:Ltr*, C)^a-\-t- Note: A copy of the owner's driver's license, form nolarization, or other verification acceptable to the agency is required to be presented when the permil is issued to verify the propefty owner's signalure. SANTA ANA CITY COUNCIL Migue A. Puido Mrchele Martinez Mayo. Mayor P.o Tem, Ward 2 mpurrdo@sanla-anaoro mimanrnezosanla-anaora vicenre samienlo vsa.mlenlo@santa ana oro Jose Solono P. David Benavdes Juan villegas Sa T najerc Ward 3 Ward 4 Ward 5 Ward 6 lsolono@santa ana.oro dbe.avides@sanlasna.oto iv eoas@sa.la-a.a oro slina ero@sanla_ana.ora Project Location or Address: I (647)/, /u e3A