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Home My WebLink About20172048 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA\27O2 Electrical Permit Counter: (714) 647-5800 lnspection Requests: (714],667-2738 lnspector Section: (714) 647-5853 Lot ll Unit: Block: NA Btdg: Tract: 3962 Address Range: Historic: No Suite Range: Zoning: Rl Ownerl Address Contractor Address: Phone Judith M. Hernandez 2423 S SALTA ST Santa Ana, CA 927045625 (7141 545-3247 01116002 51603 o1116002 51600 01116002 51603 01116002 57770 Amount 57.40 23.79 59.30 405 Fee Type Serv Meter General Plan Update lssuance Microfllm Records Qt) 100 100 100 100 Fee $57.40 $23.79 $59.30 $4.05 Owner-Builder P hone Stale Lic f: Lic Type: Bus. Lic i: Workers' Compensation lnsurance Carrier: Policy #: Expires: Building Use. Job Type: Nature of Work Planning Conditions: Planning Approval By Plan Checked By: Permit lssued By. Subject lo Field: Building Permit #: Single Family Owelling Miscellaneous Service Meter Upgrade Chavez, Dave!a- Occupancy: Constr Type Code: R-3, U va cEc 2019 Notes Service metcr upgrade. Handout given. Owner-Euilder form on file. Date Date Date Misc. Receipt: Misc. Receipt: Misc. Receipt: Total 10t08t2020 Account# Every pemit issued shall become nvahd unlossthe work on the stte authonzed by such pemit is commenced wilhn 360 days afier ils issuance. ot tthe wo* aulhotizeat on the sile by such pemil is suspended ot abandoned lor a pe od of 360 days aftet the time the work is commenced $144.54 $0 00 $144.54 lnspector MID#: 2020-162008 01'1 16002 51600 011 16002 51603 01116002 57770 $23.79 $1'16.70 $4.05 Fee Total: Paid to Date. Balance Due Permit #: 2O172O4E Pin #: 42924 Project Address: 2423 S Salta St Assessor'sParcel: 412411-22 Tenant Name: ELECTRICAL-INSPECTOR BECORD APPROVALS DATE ID/SIG.COMMENTS oWNI;R BtIII,DER D'I,C]AI'ATII)N I h.Eby.iam und.r rrDhy ofFrrlrr rhir I m.&nfl rtu rh. funtfrroa'Li(nt La* ldrtl n'lb*in3 Ea$. 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Pd6) -Rcquird LMq ol Ndific,lion #"*u,**-r,* lldrral'clulnitn,rrdJ'nr lrstxk! ^rlm. nd ilt,l{$lcni rlns!r'rr'(r ( l rlx\ .'r,rl'.nnrn r crlL rl'cih){ tr,ld'trLi!D r('{rc(t lr8(rr,.,nnlvuihJlltdrnntlti(ny *stri iry r, h{ilJin3 (on(n.rit trriz. rcFcvnr.h!( olrhr([y hd( $.r. nElrion.d nop.ny f," \t'Ilnrd or \A$t si,tn{r I tl1 nlct0 1) Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding / Grounding / UFER Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinos (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough Service It/eter ///otha 70 ,lxu i) Notes, Remarks, Etc. -+ ITranslormers I I I I I I FINAL L.nih ! A\!r.s' r;l A. Planning & Building Agency Building Safety Divisio,n . 20 Civic Center Plaza P.O. Box 1988 (M-1 9) Santa Ana, CA 92702 (714) 647-s800 www.santa-ana.org aPP-13 CBC 2016 Dear Property Owner: An application for a buil specafied at n NOTICE TO PROPERW OWNER permit has b submitted in our name list gv ourself as the builder of the f,ro pe provements We are providing you with an Owner-Builder Acknowledoment and lnformation Veriflcation Form to make you aware of your responsibalities and possible risk you may incur by having this permat 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 thas notice unless you, the property owner, obtain the prior approval of the permitting authority. WNER'ACKNOWLEGMENT AND VERII-CA ON F NFOR DIRECTIONS: Read and initial each statement below to signify you understand ot veify this information. . I ,'1 t t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build- ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an OwnerBuilder, 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 limlts of my insurance coverage for injuries to workers on my prop- erty. 'J ll 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. ,-\tl S I understand as an "Owner-Builde/' 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. t;r,J 11 4. I understand Contractors are required by law to be licensed and bonded in Callfornia and to list their license numbers on permits and contracts. f.i.-\lJ S. f 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 "employed' under state and federal law. IU,. ll ' 6. I understand if I am considered an'employer" under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- pensation of each 'employee." I also understand my failure to abide by these laws may sub,iect me to serious financial risk. J li z f understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential -structures cannot legally build them with the intent to otfer them for sale, unless a// work is performed by iicensed subcontrac- tors 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. tt I J-.ll-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 finan- cial or personal injuries sustained by any subsequent owner(s) that result from any latenl construction defects in the workman- ship or materials. .ltt g I understand I may obtain more information regarding my obligairons-as an "employei'from the lnternal Revenue Ser- -vrce, the Untted States Small Business Administration, the California Department of Benefit Payments, and the California Divi- slon 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. 1il J l' 10. I 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 dress: a c spo nsible fo ro const vity a the foll ngron ad-Ct (cI J l1 t t. 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. rl)ln lZ. t agree to notify the issuer of this form immediately of any additions, detetions, 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 p ermit. /Vote.' A copv of the property owner's driver's license, term notariza- tion, or other verification acceptable to the agency is required to be presented when the permit is issued to verifv the p rop ertv owne r's sio n atu re. Srgnature of Property Owner Print name of Owner 1 h Date l0 () d,\(tv (l 1[( n(t, AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner. the execution of whlch 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 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 fo verify tha property owner's signature. q) Name of Authorized Agent.