HomeMy WebLinkAbout103104991 - Permit (2)Project Address: 1034 S Main St
\Assesso/s Parcel 0't 0-234-12 Lot '13, 15
Unit Bldg: Address Range: 1030-1035
Tract: SOUTH SIDE ADO Historic No
Suite Range:
Zoning: CSMBlock 1'l
City of Santa Ana 20 Civic Center Plaza (M-'19), Santa AnaFcA 92702 Building
Permrt Counter (714) 647-5800 lnspection Requestsr (7'l4l667-2738 Inspector Section: (714) 647-5853
Permit #: {O3104991
Pin #: 96666
Building Use. Commercial Occupancy B 1st FL Area:
Job Type. Alteration Constr Type V B 2nd FL Area
Nature of Work Relocate tnterior Door Code. CBC 2019 Other Areas:
Existing Bldg & Use: Q6mmspglxl Flood Zone: X-0602320276J
Garage Area
Proposed Use: # of Stories;
Totall
Dsscription of Work: Relocato the storage room door and demo existing shower. Legalize washer and dryer.
Planning Conditions: lnterior Tl only. No exterior alterations/modifications.
Patro:
T I Area
Yards Req'd:
Valuation:$1,000.00
Owner:
Addressl
Contractor
Address
Owner-Builder
Engineer
Address:
Phone:
License #
Architecl /
Desiqner:
Address
Phone:
License #
Moiza Saiyed
18725 Wright Place
Art$ia, CA 90701
(.3231274-5423 Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd:
Police lnsp Req'd
No
No Account#
Kelaher. Selena
Ahangian, Kathy
Verduzco, Violet
Dale 1Ol2Ol2O2O
Date 1012012020
Dale 10l2Ol2O2O
Subject to Field
Mrsc Receipt
[risc. Receipt
Misc. Receipt
o 777 60 02
017760 02
011760 02
08907007
0 777600 2
o77760 02
0 77 7600 2
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 2
Bldg. Stds. Revolving
General Plan Update
lssuance
.J!
57607
5i 600
57 770
24000
57672
57600
57607
$172.64
$'119.67
$4.05
$0.50
$1 00
$23 79
No
No
No
No
Total
Flood Zone Cert Req'd No
Every permit issued shall bocome invahd unless the wo* on the s/le authonzed by
such peflnl $ commenced wlhin360 days aner its issuance.ot I lhe work aulhonzad
on tho sile by such pefinil B suspended ol abandoned for a penod of360 days after
tlre ltmo lhe wo* ts commenced
lnspector MtD# 2020-162256
011 16002
011 16002
01 1 16002
01'1 16002
011 16002
08901001
51600
51601
51612
53600
57770
24000
$23 79
$231.94
$1.00
$119 67
$4 0s
$0 50
Fee Total
Pard to Date
Balance Oue:
$380.95
$0 00
$380.95
Phone:
T6nant:
BUILDING- INSPECTOR BECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNEIT BUII,DER I'ELCANATION
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apnlicanr tir a omir iubjslr rt aoplicmr to ! civ'l p.Mny of B,r nNErh liv. hudrcndol{s (S1ll),
l. D\ uwror .fr hc EoFny. or nry cnlloyccs wilh $r8cs 6 ihcn cnc mmFns&ln'n, till d, rrt work urxl lh. sMsu is n
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and *lr) .otunfr \fth lioFB f, h, (lrdEron.,l.!.<d nuFu h rlE (inrrrrtn.licM l,*,
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DETLIEtrUITN
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-Erpn.sr
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rhis (-[ynnd (innry t' r i.t !Frrhc
^,. /o1/z/2,
Set Backs
Forms/Steel/Holdowns
UFER Ground
SLAB Floor
Sublloor/VenUlnsulation
Rool Sheathinq
Shear Wall
Framing /c -zzat /L.A E?,/
lnsulation/Energy
Drywall la 2'?-U Lc z--7
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif .
FINAL //-z-za Le ,s*to3 Zry
Certilicate ol Occupancy
Notes, Remarks, Etc
Rev 0B-07 2015
Erection Pads
T-
=
T-
Plann ing & Building Agency
Building Safety Division
20 Civic C enter Plaza
P.O. Box 1988 (M-1 9)
Santa Ana, CA 92702
(714) 647-s800
www.santa-ana.org
APP-13 CBC 2016
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 D
We are providing you wjth an Owner-Builder Acknowledoment and lnformation Veriflcation Form to make you a',vare of your
re spon srbilitle s 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 offlcial address indicated. An agent of the owner cannot exscute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
OWN E R'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this infomation.
Z't I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildef' buald-
ingFpermrt that erroneously implies that the propedy owner is providing his or her own labor and material personally. l, as an
OwnerBuilder, may be held liable and subject to serious flnancial 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 iniuries to workers on my prop-
erty.
,,//
--Z!!_Z I understand burlding 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.
4Z 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 flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
^,/t'/ 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permrts and contracts.
4-S I understand jf I employ or otheMise engage any persons, other than California licensed Contractors, and the total
valde of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
"employe/' under state and federal law.
^y'/ U. 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 subiect me to serious financial risk.
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 licensed subcontrac-
:ors and the number of structures does not exceed four wathin any calendar years, or all of the work is performed under contract
l/ith a licensed general building Contractor.
n
4, ,understand as an Owner-Builder if I sell the property for which thrs permit is issued, I may be held liable for any finan-
:ial 5r personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
;hip or materials.
o
^ Z-n I understand I may obtain more informahon regarding my obligations as an 'employei'from the lnternal Revenue Ser-'"vicb the Unrted States Small Eusiness Administration, the California Department of Beneflt Payments and the California Drvi-
.sion of lnduskial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-
321-CSLB (27 52) or ,Mnu.cslb ca qc't for more information about licensed contractors.
..4r|.l am aware of and consent to an Owner-Builder building permit applred for in my name, and understand that I am the
party legall and flna nc
U
ia ll responsible for pro sed construction activit at the followi ng ad-
d ress o -t0 o/
1 1. I agree that, as the pady legall/ and flnancjally responsible for this proposed constructron activity, I will abide by all
applicable laws and requirements that govern Owner-Builders as well as employers.
,., ,il,, 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 thrs form.
Ljcensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a
license the Contractcrs State Ljcense 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 indrvidual or firm is inlured while workrng on your property you may be held
liable for damages. lf you obtain a permit as OwnerBuilder and wish to hire Contactors, you will be responsible for veriiTing
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. Note: A copv of the properlv owner's driver's license. form notariza-
tion. or other verification acceptable to the agencv is req uired to be oresented when the Dermit is issued to verifv the
proDeftv ownet's sionature.
Srg nature of Property Owner Date C ,z/o-r-
Print name of Owner
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excludrng 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.
ot 9/+o\/'lE<otr ,{ld"94ER-
Scope of Construction Project (or Description of Work)a
Project Location or Address c4 o/
Name of Authorized Agent:Se(r Belrlgr
Address of Authorized Agent D'e ?z
Phone Number of Authorized Agent ?/7-?zs- N6e
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 Ownel,s Signature Date lv o
Print Name of Owner
Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is rc-
quired to be presented when the permit is issued to verify the propefty owner's signature.