HomeMy WebLinkAbout10282189 - Permitcity of santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702 Building Permit #:1o.282189
Pin #: 92630PermitCounter. (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Proiect Addressi 12215 Linda Wav Unit:Bldg: Address Range:
Assessor's Parcel:109-383-06 Lot: 28 Block: NA Tract:2248 Historic: No
Suite Range:
Zoning: Rl
Building Use: Single Family Dwelling Occupancy: U 1st FL Area: Patio:
Job Type: Alteration Constr Type: V B 2nd FL Area: T.l.Area:
Natureofwork: Altar_nrv Code: CBC2013 OtherAreas: yards Reqd:
Existing Bldg. & Use: Sfd wratt gar.g. Flood Zone: X46O232O257J
proposed use: # of stories: Garage Area: valuation: $l'000 00
Total:
Descriptlon of Work: In garage - remove unpermitted partitiona wallB (including bedroom, bathroom, kitch.n) & r.tuh to original intendod use. Remove
d4lwall from ceiling & l.galizo drywallon w.lls.
Planning Conditiona:
Owner:
Address
Phone:
Tenant:
Ruben & Nazaria Garcia
'1221 S Linda Way
Santa Ana, CA 92704
17141222-3427
Contractor
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
NOTICE OF VIOLATION
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:
Orozco, lvan Dale: 0811112014
Date:
Date:08/18/2014
Subject to Field:
$ ,"rn"ndez, Kathy
No
No
No
No
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07776002
07776002
07776002
07776002
57607
57607
57607
s7672
57600
57607
Permit Fee
lnvestigation
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
$141.26
$85.31
$214.35
$1.00
$19.46
$48.52Fire lnsp. Req'd:
Police lnsp. Req'd Account#
Flood Zone Cert. Req'd: No 01116002 51600
01 1 16002 5'r601
01 1 16002 51612
No
No Total
$19.46
$489.44
$1.00Every permitissued shall become invalid unless the work on the site
authoized by such permit is commenced within 180 days after its
lssuancq or if the wofu authorized on the site by such permit is
suspended or abandoned for a period of 1 80 days after the time the
wor* is commenced.
lnspector MID#: 2014-116012
Fee Total:
Paid lo Date:
Balance Due:
$509.90
$0.00
$509.90
*
BU!LDING- INSPECTOR RECORD
SITE.WORK DATE !D/SIG COMMENTS Owner-tluilder
I hereby aflirm under penahy of perjury thal I am exenrpt form the Contractors' License Law for the followinS reason (se 703 1.5 Businds
and Profession ('ode)r Any ('ity or Counly which rcquires a peflnit to construct. altcr. improvc. demolish or rcpair any structure. prior to its
issuance. also requires thc applicanl for such pennit to filc a signcd statemcnt that hc or she is liccucd puGuant to the prolisions ofthc
Contractor's Lrcensed Lsw (Chapler 9. Conrmencing w[h Section 7000 of Division ] of the Rusiness .nd Professions Code) or lhal hc or
shc is excmpl lh.r.from and lhc basis for thc rllcgcd cxemption .Any violation of Scction 70-l L5 by any applicant for a pcmit subjccts thc
applicanl to I civil pcnally ofnol morc lhan fir,c hundrcd dolla6 ($500).
_ -1. as owncr ofthe propcny, or my cmployees with w6ges as thcir sole compensalion. will do thc work and thc structurc is not intcnded
or offered for sale ( Sec ?044. Business and Professions Code: The Contractor's License Law does nol apply to an owner of the propcny
who builds or improvcs lhcreon. and who docs such work himsclfor hersclfor through his or hcr own ernployecs, provided thal such
improvcmenls tre not intended or offcred for sale. lf. howcvcr. the building or irnprovcment is sold within one ycar ofconlplclion, the
Orvncr-Buildcr will have thc burden ofprovinB lhat h. or shc not build or improve for lhc purpose ofsale).
I. s own.r ofthc propmy, 8m cxclusivcly contraoing with licenscd contractoF to coNtrucl thc projccl ( Scc. 7044, Buinos aod
Profession Code The Contrador's License hw do6 not apply to an owner ofpropedy who builds or improves lhercon . snd who
contracts for such proJects wilh a contractor(s) licensed pursuant to lhe contractor's Law.)
I am cxcmpt undd Scclion &lhis rcason.
Date:()s'ner:
WORKERS ('OMPENSATION DE('LARA'IION
I hereby aftlrnr under peralty ofpc{ury onc oflhe following declarations:
I hav€ and will maintain a Ccnificatc ofConscnt to Sclf-lnsure for workers' compenetion, as provided for by Section l70o ofthe
trbor Codc. for the pcrfonnancc ofthe work ior which thc pcrmit is issued.
I have and wrll maintarn workers' conrpenstion insurance. as required by Section 3700 oflhe tlbor Code, for the performancc ofthe
work for which this permit is issued. My workers' compenstion insurance carier and policy number are:
Policy Numbcr:_____Expircs:
('l his scction necd not b" .o,npl"t"d if th" p"r.it i. f* On" h,.d*d d.k, 1il 00l or lcss)
I cenify lhal in thc perfonnancc ofthe work for which lhis permit is issucd. I shall nol li anv manner so 6 to
became sublect to lhe workers @mpenstion laws ofCalifornia, and ifr
compensation provisions ofSection 3700 oflhc tabor Codc. I shall.
Datc: Applicant
lVARNING: Failure lo secure workers' compensation coverage is and subJect an employer lo criminal pcnalties and civil
fincs up to onc hundrcd thousand dollars ($l 00.000).in addition to lhc cost of compcnsarion. damaSes 6 provided for the Section 3076 of
the Lsbor Code. interesl and sttorney's fees
LICENSED CONTRACTORS DECLARATION
I hercby affrm undcr pcnalty ofpojury that I m liccnscd undcr povision ofChaptcr 9 (commcncing wirh Scction 7000) ofDivision I of
th€ Busincss and Profcssioru Codc, md my license is in full forcc md cffect.
Licesc
I)atc:
License Numbcr _
Contractor: _
CONSTRUCTION LENDING AGENCY
I hcreby affirm under penalty ofperjuy that lhere is I coNtruclion lcnding agcncy for the perfomance ofthe work for which this pcrmit is
issucd (Scc.3097. Civ. C.).
Lender's Name
Lender's Address:
APPLTCANT'S DECLARATION
Dcmolition Pcnnils-Asbeslos Notificarion Federal Rcgulations ('fitlc 40. Paa 6)
Required Lctter of Notificatioo
_l ccnify lhal the fcdcral rcgulations regarding 6bestos rernoval are applicable to rhis proj€ct
_- I ccniry thal I havc rcad this lhat the above corecl. I agrce to cornply wilh all City and Counly
ordinanccs and State laws relating to
abovc mcntioncd propeny
Applicanl or aSent
Pcmittec name (print), _
and ofthis City and County lo enter upon thc
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/VenUlnsul
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL ll / t1/ rt/^t'\44,
Certificate of Occupancy rl
Notes, Remarks, Etc.
Canier:_
*n
MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Sal Tinajero
COUNCILMEMBERS
Angelica Amezcua
P. David Benavides
Michele Martinez
Roman Reyna
Vincent F. Sarmiento CITY OF SANTA ANA
PI-ANNlNC & BUILDINC ACENCY
20 Crvic Center Plaza
P.O. Box I 988 o Santa Ana, California 92702
www. san ta-ana.org / pba
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
improvementt to""'t'"x%- \ S L-\&* Lr)..- 5... .,i 7
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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
llp'-r. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
building 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 property.
D J Z. 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.
t] !'g. I understand as an "Owner-Builder" 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.
U :'J' + I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
l.f ,O'S I 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 ($SOO1, including labor and materials, I may be considered an
"employer" under state and federal law.
p-l$ 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 compensation of each "employee." I also understand my failure to abide by these laws may subject me to
serious financial risk.
O-D.-Z lunderstand underCalifornia Contractors'State License Law, an Owner-Builderwho builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors 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.
CITY MANAGER
David Cavazos
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
s4i
.l.l
tV
Jt'oB
U!-A 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
workmanship or materials.
\
il_ll_1-g I understand I may obtain more information regarding my obligations 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.
[91=ltO. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the party and financially res JorL{)
proposed construction activity at the following
address
Ll U, t 1. 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.
tqDn.l 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'
com pensation 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 propertv owner's driver's license.
to
Signature of Property
Print name of Owner
Owner Date
-cr?/-
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
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 Owner's Signature:
Print Name of Owner:
Date:
MPulrdo@santa-ana.oro
Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is reguired to
be presented when the permit is issued to verify the propefty owner's signature.
PLink:WP51/Counter Activity/Assembly Bills/Notice to Property Form 03-1 3-2014
SANTA ANA CITY COUNCIL
I Vncent F. Samiento I Michele l'rart,nez i Angehca Amezcua i p. oavlo B€navides i Roman ReynaI wardl i wa,( 2 | - ward3 | wano+ I ward5
I VSamrento@santa-ana.oro I MMartinez@santa-ana.oro lMmezcua@santa-ana.oro lDBenavides@santa-ana.oro lRRevna@santa-ana.oro
Mrguel A. Pulido
Mayor
Sal Tinalero
Mayor Pro Tem, Ward 6
STrnaiero@sanla-ana.oro
I