HomeMy WebLinkAbout101104487 - Permit (2)city of Santa Ana 20 Civic Center PIaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspeclion Requests 1714) 667-2738 lnspector Sectron: (714)647-5853
Permit #: 1O11O44A7
Pin #: 84144
Proj ect Address: 1901 N Olive St
Assessor's Parcel 399-051-12 Lot 5
Unrt Eldg: Address Range Suite Range:
Zoning: RlBlock NA Tract 1315 Hrstonc No
Building Use:
Job Type
Nature of Work.
Existing Bldg & Use
Proposed Use:
Single Family Dwelling
Alteration
Bathroom conversion
SFD
R-3
VB
cBc 2019
x-0602320163J
Patio:
T.l Area.
Yards Req'd:
Valuation: $10,000.00
Occupancy.
Constr Type
Code:
Flood Zone
# of Stories:
Oescription of Work: Convert closet to'l/2 bathroom
Planning Conditions:
Ownerl
Address
Phone:
Tenant:
Jeff Jordan
1901 N. Olive
Santa Ana, CA 92706
17141 5424442
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expares:
Contractor
Address:
Engrneer
Address
Phone
Lrcense #:
Arch(ect /
DesiqneI
Address:
Phone.
Lrcense #
Planning Approval By.
Plan Checked Byl
Permat lssued By
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Soto, Ricardo
Chavez. Dave
2?',
Date: 08128/2020
Date
Date: O8l28l2O2O
Subject to Fieldl
Misc Receipt
Mrsc. Recerpt
Misc. Receipt
K Ahangian
07776002
07716002
07776002
o 777600 2
07776002
0 777600 2
57607
53600
57770
57672
51600
57607
$172.64
$172 65
$4.05
$1 .00
$23.79
$59.30
Permit Fee
Sub,ecl to Field
Microfilm Records
Bldg. Stds Revolving
General Plan Update
lssuance
No
No
No
No
Fire lnsp Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
NoNo ry9ryq Total
Every permit Esued shall become nvaltd unless the wotk on lhe sle authonzed by
such perml ts commenced $/fihtn 360 days aftet ls tssuahce or if lhe work authonzed
on lhe sle by such penntl ts suspenalecl or abandoneC fot a penod of 360 daysafter
lhe ltme lhe work ts commencec!
51600
51601
51612
53600
57 770
$23 79
$231.94
$1 00
sl72 65
$4 05
$433.43
$0.00
$433.43
lnspector MID#: 2020-161'156
011
01'1
011
011
011
16002
16002
16002
16002
16002
)
1 st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
Fee Totall
Paid to Date
Balance Oue:
BUILDING- INSPECTOR HECOBD
SITE-WORK ID/SIG.COMMENTS OlvNllR BtlILlrl:R Dl'iLC,'l R?l l lON
I h.rchy rlfrfl uftLr p.rrliy of p.rjury $di I an .(mpt liom rk ({,nka()n l-ic.ns L* tu rh. nrltusi,,8 cnsn (5(.7011 !
tlurin.sr .nl Prnf.$irn Codc): Aiy C y .r C6un(y *hkh hqunc\ i ltnnn r, onnru.r, ihcr. lryrnE. &rNlth or allJn riy
nruchrc, p.i)r b ir1 issuou. rl$ eqrE(rll dlDlhd ntr$.hFmd ni llku n3*'l {!r.nEN ild lE.r ch. ( lr.nsd N^uxnr
1o rh. rnvisions .I rhc Conkrroi! l-t.nscd Ij* lchapr.r 9. (lo'nmcn.ing wirh Sccrhn 7(xxr o! l)ivni.n I .l rtE tlurims ind
Pk,i.s!'o,rsCodelorthrMor\h.xd.mritrEtionanilrlEha\\ntrrlEnll.{.d.i.n{'i!,, A yvtrn!(,! Sec[rn?0]l5hyloy
ipplicrnr forap.mii:ubt ckrtE lPplicrnt b rc'vilp.nrhvofftl mr.rhtrn liv. hunddl dolln (Jtlx))
l.a\.*..,o11ri.Irolrnv.n nyc'nplolcclrh*agc\r\rh.nlrk,omr^'n\Ik{.*'lld rhc *(k anl rl* {nrnm s Br
d. .J ororT.r.dattrvlcrse7 11, Bu\in?\snJ Prufc\lon\ c{rl. nE(inir.trtr'\ I kcNc In!d(E\nnr {p1,n, d!n.,rl
ihr pDfrdy wlx) hdilds or rTo 'lr hLnnr lr or lrnelr , tr rhrn'Fh hs r lE! .str .n{'l! 'E.\,pr.r d.d rhar \u.h moov.mn( re n, id.nd"d .r 'rlcrrn l n {! Il. hrucra rh ll' ln! .. nryormd \ rlil wtrh'n om r.r
ofr.q,ll.'\ rh.{)sEr Bu'&r w,ll hnE rlE h!^l.n.fPnlvn! rld lr.r \rr.lrl rr h!'! or r{r.E rlE nnrFdy I!tr irE IUqh{ ol
-1,
I o**r ol rh. prr{Eny. m.r.L.n.ly c.ddrin3 *[h li(Md .odr*r6 r, !rD(D.r rlr F]rrr (36. 7x,r. Bu\iEs
.d hof.\ih Cod.: th. Co r'olr l.jetr! L.* der N q,rlyk,.no*Nr orr.ortny$ln l illlr or mlr,oE ,Hs(
,d vho mdBr lor suh FoF r wnh a Conrdodrl lEnsd n[r@ k, 'h. cldt&'ols Li.N L.*)qR%^_,,"."x-WI h.rchy anirm und., I'.Mlry ol oc4ulv om .f rh.
I lBv. rn *'ll ndu r C.n'li:r. of C(fuDI ro S.lal6ft tu so si.rqrneriD, o! ttuvrr.d ft,6y s.(Dn J7m oltlr
lrtq Cod., ttr !h. FrrorllEtr. ollhc *nt fq *hEh rhc ncrmir s L$*d
_I hrv. a'rl ll roinrzin kL6 .!trp.Nrb, in\urxtu.. I EquiEd try Sdrnr l7m orrh. bhor cld., n, tli F.tol*.*. of
fi. *rr lu ,rh lhn pomi ir asrEd My rirk6 onp(Nlhn nrurrlK l::nr dl Fnky tuml{ !.
-l
(nify ihnt in rh. Itrforur otilr *rk tc vrhich fii! If,rmir ii Lsu.d. I shrtl rer .n{tby r., !.dr in .., mnm
e aro b.dm3ulr.{t t th. m.t6 onp.Mnn L*r of Crfirom{. rnd r*B rh, ifl sh{ld b..or {l'ld ro thc
*o si .otr'rEnertun p,DrLrN orsarb, ]7m oldE t:tor (:dL. I slull. fdfiwirh Nn?ly *ith rlrE tDvBFB.
WALNINC: Failur b re *dcB onpcNdnn mEngr ! unl2wfirl. md :hrll hrcr .rq'hrq h ml tlMiB lnd
.,v'l fiEs up r. oE hunJral rhoue'ti d.llm lll(n.lrrl. r nr .n c.n$ron. dJN!.\.n Prtr al
D(
I h.r.hy dlir'nund.r lxMky.l p.rllrv rhd l rm li.lniri und.r F{,vhtr'nrl ,ko nrrci3 ' hScdnn r I i I I r o, I )
'
1 tr i' n I
C.'1.. ml nrv lmn\d h r lulln,(.,rlrll(.r
D'r._ Conr*r
C!lllI&]!Jl ilIN]LIl;r!C[.N!l
atudrs.(.ll(n7 Ci\ C).
d}ILISANLIECLASAIII]N
I lrnt y lrmr und.r p.n.lryofpeirry o* ofrh. followi',9 d{lxrrin'nr:
tlnllirion P.rmir! Asbcnor Ndifi.ari'r F.'1.ru| R.guldion\ (Til..l0, PJn6)
-R.qui.d
l.lrcrof Norinualion
!,rnnnrrlr. nor i|)|r]r.'hl. r, rlnr t8'ldd
(.n\nt w rhrll( r)r ti,u y
l'^ I iyfil( o(dyn,. rd (Ftr' (E
.rpplirrnr or 1!.nr Silnxrur -dqz"'
Erection Pads
UFER Ground
Subf loor/VenVlnsulation
Roof Sheathinq
Shear Wall I I I
Framinq ,t a lbu UY}Tlq6,LA
lnsulationi Enerqy lr
Drywall (WZO ADa@A f6
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
FINAL .M tu/h de&
Certiticate of Occupancy
Notes, Remarks, Etc
Rev.0B-07-2015
DATE
It
LNn( Numh.r
-
I
rll l lr\.,c,'Ll rl,\rtflnir onmJ !, drh,
Set Backs
Forms/Steel/Holdowns
SLAB Floor
Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
www.santa-ana.org
APP-13 CBC 2016
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An applicati
specified at
on for a building permit has been submitted in your name listing yourself as the builder of the property improvements
tec, ru Ctvt lr-<tr S< ^r. ri,* CA .f?2..
We are providing you with an Owner-Builder Acknowledqment and lnformation Veriflcation 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 otficial address indicated. An agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permittlng authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
tn
h
1 . I understand a frequent practice of unlicensed persons is to have the prope(y owner obtain an "Owner-Buildei' build-
rmit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an
er-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and
or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I
am rrrillfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for in.iuries to workers on my prop-
erty.
I understand building permits are not required to be signed by property owners unless they are responsible for the
truction and are not hirang a licensed Contractor to assume this responsibility
3. I understand as an "Owner-Buildei' I am the responsible party of record on the permit. I understand that I may protect
lf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
o rmits and contracts
5. I understand if I employ or otheMise engage any persons, other than California licensed Contractors, and the total
of my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an
ployer" 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 federal
rnment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com-
ation of each "employee," I also understand my failure to abide by these laws may subject me to serious flnancial risk.
/..\\IL l. t understand under Cahfornia Contractors' State License Law, an Owner-Builder who builds single-family residential
stlfltures cannot legally build them with the intent to offer them for sale, unless a/t work is performed by licensed subcontrac-
tdfJ 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 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workman-
r materials.
cra
shi
s
3
he
I understand I may obtain more information regarding my obligations as an "employef'from the lnternal Revenue Ser-
United States Small Business Administration, the California Depd.t.'nent of Benefit Payments, and the California Divi-
dustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-ln
1 -CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors
'10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
d S
legally and financially responsible for ploposed construction activity at the following ad-. ,cr; /L' ()lrs? '>n"t/ * ^/- Ay^a C/4 qZZ.L
1 1. I agree that, as the party legally and financaally responsible for this proposed construction activity, I will abide by all
a able laws and requirements that govern Owner-Builders as well as employers
2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
rovided on this form
Lacensed 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 financlal 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 flrm as 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. A/ote: A coov of the propeftv owner's driver's license, form notariza-
tion, or other verification acceptable to the adencv is required to be presented when the permit is issued to verifv the
propertv ow ner's sion atu re.
Signature of Property Owner Date
Print name of Owner ?cv/a
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)
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
information and certify its accuracy.
Property Ownef s Signature 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 re-
quired to be presented when the permit is issued to verify the property owner's signature.
?y'2s,/,o?,,