HomeMy WebLinkAbout30141791 - PermitProject Address: 945 N Fair Way
Assessor'sParcel: 1O5-212-Os Lot: 40
Unit:
Block: NA
Bldg:
Tract 2980
Address Range: 945-947
Historic: No
Suite Range:
Zoning: R2
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, cAg27o2 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 3O141791
Pin #:9995q{
Owner:
Address
Phone:
Tenant Name:
Contraclor
Addressr
Juan Armenta
945 Fair Way
Santa Ana, CA 927031807
(71415s2-5207
Owner-Builder
01 1 16002
01 1 16002
01 1 16002
ol 116002
5160i
5160C
5'160'
5777C
Amount
46.25
22.95
57.20
3.91
Fee
$46.25
$22.9s
$57.20
$3.91
Fee Type
Sewer Alter/Repair
General Plan Update
lssuance
Microfilm Records
Qty
1.00
1.00
1.00
1.00
State Lic #:
Lac Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Ju0fi Armentn
6ener(l Plon Update Fee
rll I I6011?- IiI6t:-1tut1-
Plu b ine
01116[02- 51602[trrl-
n icnof i Lr l. Oscufients('l I 160u2- 3777[r-]00-
Viso
tC+: *******rx*r*5949Single Family Dwelling
Miscellaneous
Sewer Drain Repair
Occupancy:
Constr Type:
Code:
Aulh+:r-tBuilding Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
..v
Date
Date
Dale
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Zuniga, Alli
Every pemit issuad shal becono invalid unless the wo on the sile
authotized by such pemit is commenced within360 days aftet its
issuance, or if lhe wod< authorized on the site by such permit is suspended
or ebandoned fot a period 01360 days aftet the tine the wo* is
commonced.
lnspector MID#: 2020-156981
R-3
VB
cPc 2019
01t09t2020
Account#
01 116002 51600
01 1't6002 51602
01116002 57770
Fee Total
Paid to Date:
Balance Due
$'r 30.3'r
$0.00
$130.31
$22.95
$103.45
$3.91
Phone:
Botchi:53804 - !/?/21r2(r I0r HGARCIToffi(e! CIYH Trone+: 13 1 ofAcct+: frelil 3{1141791
Itcpt+:02861326 - L/9 /2t)2tt gr39 An
Tr0nsoct ion Totol tlstl.'JI
Notes: Repair existing sewer in private property. Auth on lile.
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OTVNER DU'LDI'N D!:I,CARATION
I h.rch! rfirn u dd l)chrlry of Frjury rhd I am dcnlpr fnnn rhc Contrctni l-i.c s Lnq {or rhc folkrrinS rc!{)n rsc..7orl 5
Bu\nL'sr xl llrtc\snnr Co c) Any(iryoi(i)unryshi.hrcqtrnN.t nr n,.on(rcr. rkcr. irnlnrc. dcnmli(h,t Rt,Jn dn],
itu.rlrc. nriort' ir\ is\urncc. aho rcqune\ ihc rppli.rd lar nr[ nriinirl' ri[ r silncd {dc rnr rhI ltor \hc n liccn\cd furu
r) rh. porisi.trr ol rlr Gtrtr..rois l-iccnsd ljs (chur.r r), Co mcftin! Birh Scdion rdx) ol Divnion .l ni rhc Burim$ rnd
Itolislion\ Codc)orrh{ hc orshc is crnrpr rhclcnom!
'hchr\i\lnrrhcrlicscdqcnDrnnr.
Anyliolirionots(ri.n?0.115hyrny
r!fli.inr f(tr dp.nnir subj..r( rhc rlrfli.dnr b acnilpcfulryofnor 'ftftrhrtr fiLc hundrcddulldrs (55tX))
-l-
\ oencr of I hc pn,p.n y. {n nry cnrdoyccs wil h $ir$ rs rhcn q,b lannp.n\r nu. } lll do rl{ suk ud rhc iuh is n.l
lnrctu.d oroil.rc tu !'lc(S& 7(!J. Bu\nr$md Prolt\\i{,ni Cod. lhc(ln rnktrrl-i.c \.ljqdocsn.rrml,n,0no$ncrof
rh. pFpcny {tu, 6Iil& or ing,mrB rlxmn. md uho d{f,r sch so* hi.tr.llo. hc^cll or rhron3h ik or h.r oso.nDlorcc\.
prniJcd rh{t su.h inpnr.rtrrs.e n idcn !{ or.ff(cd fir rnL ll hort!.r. rh. t^riklin! or nntn$mir is {'h s iriin .N )c!r
ol .ompLrior, llE ()wts BuilL(r *ill hM rh. hi!dcn ol tovirp rln hc or slr di mr tnrildor im|novc rhc nm|cn, trhcl)urFis.f
*0sowncrofthc |Iorny. anrcxclusivcly conra*in8 qirh li.rtrsd .onr!*$ Io otrsdd rhc tmjsr (scc 7044. Burircs
Pn,fs\i,n Codci l he Co.lrdcttr s Liccn\c Lrw doc\ nor slnly r. an os.cr ofpopcn! {ho huildr or ifrprovcs d$co6.
rnd who ootmcts for such pmi(ls with . Contelo(n [rciFd puBu to rh€ Conrr.crols LtcrE Lrw).
-l
er.x.mfl lndcr 56r B. & P.C. tor rhh rcaso!.
e4-fAlllBtrlBltaulult a!
lEcldaArlQ!
I trcEby aruo u.d.r F..Iy of Frjury oc of (E lolLwirg dc.linrhrci
_l havc .rt eill nDinr0in n C.niforc oI C.nent ro Sclf,l isurc 16r wort.ts comr.hdio.. as pmvidcn 6r by Setion 3rGl of ihc
ljhor Crn(. for lh. FrfornMc oI lhc *olt lor which rhc l,ermil h issucd.
_l h.rc lnd will moinrain wor*ctr' .oq,.n$rion in$mftc. I rcauiEd by Sc.liotr 3?00 of lhc bbor Cod€. for lhc Frfornlmc of
rhc *ol fot wfiich lhii Fmil is isnicd. My *ortqi .omn nelion insur.Nc erkr 8nd policy nlmbcr @:
Poli., Ntrtr$cr: [ll)ic(
l.cniry rhlr rnc l).rfortune otrhc work lin Bhich rhh lr.mir t hsu.rr.l rhrller crphy lny p.i$n a" nny mMncr
s s
'o
bccom sbiNt ro rhc wolkcs' conp.nsarion $ws ol Crlifomi!, ond .8N lhal if I should bcsm subicl to lhc
*o*ss cotrrrxn$rbn provh
'ns
of Seli.n l?00 of th. t{ktr Codc. l shrll, font*il h omrly wirh tno$ rmvhio.r
WARNINC: railur. t, s.xE workcB' .ompcnslrion ('!m8c is unlnstul. rd shtrll *ubjccr !n .,ntlLr't to aininal Fnihics and
civil fincs up ro om hu r.d lhouq.d dolhre ($100,000), in 0ddirhn ro $. cost of coryEnslion. damScs $ providcd ibr lhc
L.bor C!dc, irlcEn lnd rnormy s
o o )-a
^
DICIJ.BAIION
I h.nhy trfllrnr u d$ |x ahy.l lcrjury rhd I rnr li.ci*lundcr |flrtnnr olClrpi$ 9 (connNmir8 sirh Sc.rion ?U[) olDivisior:]
o, rhc Busincs and Prnn$tnrs Conc. nnd nryliccn\. n in tulllnrcc dcic.r
SJISIBIJCIIONIIiNUINCJqEN.CI
I hcrcht .{ h m u ,ld ,.Mlty u I lErjury rh.r rhcr. is , on{n.li'tr hndiu r8cn., for r hc l)criormrncc .f rhc sork tur which rhir pcnnir is
hrucd (Sm :1097. Ci! C )
APIIICANLDECIAIAII(}N
I h.t+y afiinn hdcr pcnalt, .l rrjuy oic oalhc aollo*itrE dala,alknrs
Dcnnlnion Pcrmirs^slEnos Nolificarion Fcdcrrl R.BUhln'ns ('I nb iO, Pdn6)
-Rcquircd
Lcrts of Norifrdbn
l.c ilirhd rhc icdcr rclrhriinr\ tog:trding r\hcn.\ r.nr'!rl rrc nor rPpli.ftt t, rhillmUrrr
**rirhd I havc rcdd rhir applirarhn md Ndc rhd rhc aborc infomurn,n k cotrd l,Bre ro coq'ly wirn allCnyand Colnty
and Slare La{t rlnrins ro buikling coi\mdn$. ud hcrhy auh,ia rct$.nru'ivcs olrhis Cny,nd Counlylo cnlcr ur.n lla/e//t ?DA
UNDER GROUND
Waste & Vent 7-lt2d ra<2,
Water-Under floor
Gas-Underf loor
Building Sewer
Area/Storm Drain
lnterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Lawn Sprinkler
Sanrtary Sewer/Cap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
FINAL z-//-4 fs-r >t-t t,tds J.^)
Notes Remarks, Etc
*,"tell o1,1 ZP
lrlrJ.i\ A,ldrcs
.'htrc'rnriLn'c'l pn.n(dy 1,tr i"\nc..ri,,!llll@!s.
n*r*,*n**,o***/{/ +ftJ'4,611f
*^u**.*,,n*('/ t J4 rA4g1ft!1t-A
Roof Drain
Water Service
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-'t3 CBC 2016
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An applicat '1r'',d ing t has been submitted in your name listing yourself as the builder of the property improvements
specifled at 64
We are providing you with an Owner-Builder Acknowledoment 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 offlcial 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or veify this information.
J. f\ 1 . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builded' build-
ing 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 workers on my prop-
erty.
JA-, 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.
aAS I understand as an "Owner-Builder" I am the responsible pa(y 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 flled in his or her name instead of my
own.
IAt-a I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
'tn
:J. I+_5. I understand if I employ or otheMise 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
"employe/' under state and federal law.
J:A-O 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 subject me to serious flnancial risk.
.-r-
J,{l Z. 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-
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.
-JS-g 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 latent construction defects in the workman-
ship or materials.
f.lAr. f understand I may obtain more information regarding my doligations as an "employel'from the lnternal Revenue Ser-
vice, the United States Small Eusiness Administration, the California Depa ment of Benefit Payments, and the California Divi-
sion of lndustrial Accidents. lalso understand I may contact the California Contractors' State License Board (CSLB) at'1-800-
321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.
.'1-^J' l+ 10. I am aware of and consent to an Owner-Builder building permlt applied for in my name, and understand that I am the
party
dress
s ly ro daland financiall y responsible for
FA-t n- ul
struction activit v at th e following.ad-
lTI f f . I agree that, as the party legally and financially responslble for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner-Builders as well as employers.
1{ L':'r.1 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.
Signature of Property Owner Date: , O
Print name of Own ^l €
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Prope(y 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.
Project Location or Address
4 €N
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 Ownels Signature Date
Print Name of Owner
Note: A copy of the owne,'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 verffy the propetty owner's signature.
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 amportant 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. ,Vofe.' A copv of the propertv owner's driver's license. form notariza-
tion. or other verification acceptable to the aaencv is required to be presented when the permit is issued to verifv the
proDeftv owner's sionature.
f "q /to
ScopeofConstructionProject(orDeSCriptionofWork):