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Home My WebLink About10196598 - Permit (2)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 #: {O{96598 Pin #: 75063 E Project Address: 1051 W Civic Center Dr Assessor's Parcel 405-181-15 Lot. I Bldg Address Range: t05l-1053 Historic: No Suite Range: Zoning: SD20Tract 731 Building Use: Job Type: Nature of Work: Existing Bldg. & Use Proposed Use: Ouplex Reroof Reroof Duplex Wdet garage R-3, U VB cBc 20't 6 x-0602320144J 1st FL Area: 2nd FL Area: Other Areas: Garage Area: Total: Patio: T.l.Area: Yards Req'd Valuation:$4,245.00 Description of Work: Reroof duplex only - install 15 squares comp shingles over 1 layer comp shingles to match garage. Repair related fascia to match existing. Handouts given. l'/Planning Conditions: Mark Allen 1055 W Civic Center Drive Santa Ana, CA 92703 (714) 450-2816 r'q l't 5(l i tot o 11 l-irrrk A1l en l) Owner Address Phone: Tenant: Contractor Address: Engineer Address: Phone: State Lic #; Lic Type: Bus. Lic #: Workers' Compensation Insurance Carrier: Policy #: Expires: Phone: License #: Architect / Desiqner: Address: Phone: License #: Auth+rr-l Planning Approval By Plan Checked By: Permit lssued By: NPDES lnsp. Req' PWA lnsp. Req'd: Planning lnsp. Req'd: Landscaping lnsp. Req'd N.4cCann, N4elanie Amsden, Julie Misc. Receipt Misc. Receipt Misc. Receipt 07775002 515'0.1 Permit Fee 07776002 57672 Bldg. Stds. Revolving 07776002 57600 General Plan Update 07176002 51601 lssuance $308.s2 $1.00 $21.25 $52.98 o No No No Fire lnsp. Req'd; Police lnsp. Req'd No No Account#Total Flood Zone Cert. Req'd: No Every pemit issued shall become invalid unless the work on the site authonzed by such pemil is commenced wlhin 180 days after its issuance,ot if the wotk aulhorized on the site by such permit is suspendecl ot abandoned for a period of180 days after the time the wofu is commenced. $21.25 $361 s0 $1.00 $383.75 $0.00 $383.75 lnspector MID#: 2018-143684 01 1 16002 51600 01 '1 16002 51601 01 1 16002 5'1612 Fee Total: Paid to Date: Balance Due: Unitl Block: NA Occupancy: Constr Typel Code: Flood Zone: # of Stories: Owner-Builder Btl i ld ins n 11161102- 516r-1 10r:r0- P'1dg Stds lievol v ing irl I 16002- :i16t2rl0r:r- 6enerol PlBn updote fee nt1t60tl2- 516l]t:ttrlu-ilitn t(:+ : rx*r**rtlirxg9gu Date: 05/31/2018 Date: Date: 05/3'l/2018 Subject to Field; BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG,COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor WRoof SheathinqT-l/ O l*U7n 112J4 <'a >7.rJ Shear Wall Framin g lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat lvlasonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report I FINAL h//r'rf >.1 7) Cert iticate of Occupincy -7 Notes Remarks, Etc OWNEN BUILDER DELC,!RATION I hcrci'r,innr lNlcr pcnall, ol pcrjurr rhat I m excnrfl 6onr thc Contraclom'Lknsc t w lor lhc iollovirB rclen lscc.70]1.5 Busirc\s nnd Pi(nassi,)n Cod.): Any Ciry or Co! , which rcquircs I I.rmit lo on\lrucr. altcl iqrrcvc, dcmlisn or rcI]on lny srrucl!,c- Fior ro ilr hsuarcc. aho rcquncslhc applic0trr ro! such Fi'nir lo filc r signcd slar.nrnr rhar t[or shc is h.cn$d t'UHUnnr ro lhc pmvisions.rrtr Conkr.rors Li.cnsM L!* (Chlllrer 9. Comrcncins sirh Sccrion ro(n of Division I of the Bu\inc\s lnd Pmr'csions codc) or rh,r rr or shc h.rcmpr rh.r.rroo Md rhc tEsi\ lor rhc allcs.n dcmplion. Anyviolaiio.ofSucrionT0.ll5hyan, ffi ffiilffi;-=#;;;;ffiffi ,*,**i,*,**.,, rhc fn,Frly wh' builds or i.pnrws rh.Nn. ud who dNs sch srk himscll or h.^e ll or rhmtrCh hi\ or her o*n cmpkrycc\. ,nrvid.d rhrr such inrmEnnh aflx, inrrndcJ or ofieEt ior sh ll h.scrcr. rlE hoildins or in{,orcmd is eld vilhin onc ){u o,con{,kli,n. rhc Owmr Buit+r will hurc Ihc bud.. or povin8 rh,r hor shc dkl mr toild or if$tulc tr tmltny ror IrE puqns or !\ooncrorrh.pn)pcn!.0'ncxclusirclvcoMicrin8*irhriccnrdconaldorloconsrrucrrhcDrojcdrsc. Tlx-1.Bunncs rRl Pnni\sion G)dc: Thc Contrrttr\ Li.cnsc Law du.\ nor apply ro M owner ofpropcn, who build\ or inpmlrs rh.rc.i. a.d sho conrEcts lu su.h Eojccrs sith ! Conh.rons) lianscd puNaN 'o rhc Conrrtoas Liccns tjw) li' Ist I $ "-*", DECI,AE6IIO! I r-chya,nirnundcr lEmltyolacrryotrcoirhc rollo*ir! d.cldrarion\: ' /l havd rlwillnrnnrinrC.nificridorCoo\cnrroSclflnsurclor*orkcr'compcnsdion.!stmvidcdfo.bySccrion:lTlnolrhc Lrtrr C{xlc. r'or lhc pc olmnccoflhc work lo,which thc psnrn n kucd. vcrtulrvill rtr ni'rwo cN.(nnpc satn,n in\urrncc. rs rcquircnhySccti()n.l7lx)olrhclih.rCod.,ntrrhcpcrfonmnrol $.rk,nr$hicIrhisNnn[r(isuLrlMysork${.on1pcn\]ri,n,nLurrnc.umcrrdB,lir"tr!n,h(rnrc Polic\ Nunrhcr'- l-\nR, I(irilyihnri'rrhc|*nnnnrnc.ofrh.sorklnwhichlhislErnlnhsucd.Irh3llnoreutloynnypc6oninatry,rn'u s'srohcconEshlcdr()rhcw{)!lslconrNnsarionlawsofcdlifoni{indigic.rhnriflsh)uldh...trrsuhjo.rrorl.. *rrkcn' conrFr\orion fovi\ ions oi S$lio 37([ oi rhc Lrbr Codc. I drll. tonhwnh comtly sirh thos pmvisnnr. WARNING: hilulc n, B.urc Norkcn .omrensrrion corcmsc i\ unhwtul. rnd shrll suhjccr rn cmDlorcr lo crimiNlpcmllic\ Jtrd .'vLl lnros ut, ri .n. l,tr rdl rhou\rnd :::-"5',r;ilt? """ {loll6 l!l(xJ.0U)). ir iddir lrc cosl ol coDrpcDxatim. I I(]IiNSED CoNTRAL''I'('R DrlttaAr.loN I hcrcbydlllrnu rr FnJly.fFrjury rhar I nm li(nssl uodcr prorhion ofChapter 9 (.ofrftncin8 wnh Sdrbn 7000).fDivisn,n l nr rhc Bu\nr\\ und fnlt$i(in\Codc. uod nry liccnsc n i. tull forcc d.ftirr caNElf,ltcuoNrrNllltia{i[NtI Ihcrchydflirn\u.rJrnrlry.lr.rjuryrhrrrhcrcisa.onntudionkndinErgcncylnrrh.Frfortun..ofrhcrrtrknnwhEhrhisFynm( i\\ucrtrs.c lll)7. Civ C r A.TTLICANLDECI,INAUON I tErhynitrurdcr pcn.lly oipcrjury onc olthc fol6wnr8 dc.lftrn ns D.rmlIn P.rnrir$Ashc(osNorifi. nr Fcd.rrl RcAulari{,ns('Iirlc,10- Pfi6) -Rcqutcd l.rrcr ol Notiicdiotr l.dnrly rl rrh.l.tl.ftltululxriiiDs rclrnliDSr\hc{o\r.nn,vrllrc f.r !J,l]li.ihl. n, rhi\ fr!..r ..nlrrrhnrlrDlcrcrdrhisrfplirari(Det\rrrcrharrh.{hnrinlonNio.i\corc.r l!E *roconuly$irhrllCirta Counry oftlnirN.\ nd Srnc l-r$\rLri',9 n) rh,r. nrd iinRl In)pdr ry lnr in\Fcr AD[lic,nr or Agenr Sitnniue Pmnirce nore lDri nl)r 'a(,,-â‚¬Lt 'i".''uil;fifl Sublloor/VenVl nsulation Flood Zone Certif. I l.n'llr'\ \J\l,c- T,IAYOR ft4iguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas ACTING CITY MANAGER Gerardo [,4ouet 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. 8ox 1988. Santa Ana, California 92702 www.santa-ana.orglpba 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 improvementsspeciriedrt lc5) -\o, R h-/, Civic C.e uv-lev Pu^, 5 N 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 DI CTIONS: Read and initial each statement below to signify you understand or verify this information. bui din 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" g 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 ers on my property 2. I understand building permits are not required to be signed by property owners unless they are responsible for the truction and are not hiring a licensed Contractor to assume this responsibility 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numb;irs on permits and contracts./v'/ I u,/ 5. I understand if I em ploy or otherwise engage any persons, otherthan 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 ''enlployer" under state and federal law.//'-/1Z,/ U. ,understand if I am considered an "employef' under state and Federal law, I must register with the state and federal gorernrnent, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to unemployment compensation of each "employee." l also understand my failure to abide by these laws may subject me to s financial risk 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family resldential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL houlido@sanâ‚¬-ana oro Mayo. Pro Tem, Ward 2 hrmatunez@santa ana.oro vsarmienlo@sanla-ana oro isororio@sanla-ana oro dbenavrdes@sanla-anaoro N eoas@sa.ta-a.aoro slhaEroiAsanla-a.aoro licensed subcontractors and the number of struclures does not exceed four withjn any calendar years, or all of the work is performed under contract with a licensed general building Contractor./4), .t4_8. I understand 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 owner(s) that result from any latent construction defects in the workmanshio or materials. 2.,..)u// S. I understand lmayobtain more information regarding myobligations 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. /''. /4410.1 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 financially responsible for proposed construction activity at the following ad SS 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by al pplicable 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 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. form notarization or other verifi table to the enc ,s to be ted when the ermit is ,ssued to the Signature of Property Owner Date 6 t( Print name of owner ltv\ a [|b A(l VA 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 file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent: Address of Authorized Agent: Phone Number of Authorized Agent: 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 presented when the permit is issued to yerify the propedy owner's signature. SANTA A\A CIT/ COUNC - mpulido@s6nta-ana o.o Mayor Pro Tem Ward 2 mimarlinezlosanta ana.oro Vlcente Samienro 6armlento@$ola ana.oro E9l9!9@c3!.b.3!3.9!s P David Benavdes dbenavrdes@sarla-ana.oro iv trasl@sanla-ana.oro sti.aiero@santa-ana.oro 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. /Vote.' A copv of the Drooertv owner's driver's license. I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certii/ its accuracy. Property Owner's Signature: