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Home My WebLink About20153163 - PermitProiect Address: 2035 N Poinsettia Sta - Unit: Block: NA Bldg: Tract:1335 Address Range: Historic: No Suite Range: Zoning: RlAssessor'sParcel: 003-133-17 Lot: 50 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 lnspection Requests: \7 1 4) 667 -27 38 I nspector Section: (7 1 4) 647-5853 Electrical Permit #: 2O1153{63 Pin #: 595{9 City of Santa Ana Permit Counter: (714) 647-5800 Owner: Address: Phone: Justin Rosen 2035 N Poinsettia Santa Ana, CA 927062921 l94el254-0276 Fee Type 01 1 16002 51603 Subpanel 01 1 1 6002 51600 General Plan Update 01 1 16002 51603 lssuance Amount 45.96 19.04 47.48 Qty 1.00 1.00 1.00 Fee $45.96 $19.04 $47.48 Tenant Name: Contractor: Address: Owner-Builder Phone: State Lic #: Lic Type: Bus. Lic #: 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 to Field: Building Permit #: Single Family Dwelling Miscellaneous Subpanel Occupancy: Constr Type: Code: R-3, U VB cEc 2010 4",n"@,Dndez, Kathy Every permitissued shall become invalid unless the work on the site authoized by such permit is commenced within 1 80 days after its issuance, or if the wotu authoized on the site by such permit is suspended or abandoned for a peiod d 180 days after the time the wotu is commenced. !nspector MID#: 2013-111535 Date: Date: Date: Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Notes: Fee Total: Paid to Date: Balance Due: 01 1 16002 51600 01116002 51603 $19.04 $93.44 $112.48 $0.00 $112.48 I <J ELECTRIGAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Ow-Build6 D$lurtioo I horcby affim unda pcndty of pajurythetl m qcmpr fom thc ContnltoB'Lim$ Irw for thc following rmo (u.7031.5 Burinor md Profosion Code): Any City or Cdtrty which requiu r pcrmit to @Em(t, dt r, imFovq darDlirh or rcpdr uy rtrudw, Fitr to itt isorm, rls rcquirc OE rpplim for $ch pqmit to 6lc . rigr.d rbtcmtf th.t ha tr rlE is lieilcd punuit to th pmiriou oftlr Cotrtr&dq's Liccru€d Lrw (Chrptq 9, Comtriog with S6lior 70OO of DivirioD 3 of tbc BuirB Ird Profqriou Codc) or thrt hc or shc i3 dcmpt thsc&om rad thc bsir for rhc dlcgcd acmption .Any violrrion of Setion ?031.5 by uy rppliom for r pcmir sbjcsrt th! rpplicrnt to a civil pcnaity ofnot m thu ftvc hundrod dollu (t500). _1, d ow of thc popqty, or Ey mploya with wrga r thcir rclc ompcnutioq will do the work Id dr ttructe is mt intqdcd or offacd for slc ( Sc.7044, Buciur .rd Profcrriqnr Codc: Thc CoffiEtq't LieE Lr du nc ryply to u ow of thc popety *to buildr or improve tlso4 ud *ho dq mh work himrlf q hsrelf or tlrorgh hir or hc m cmploye, pwidcd rhn sch improvcmcnts e not incndcd or offqcd for nlc. I[ howr, thc building or imprwcmcm is sld within m yu of omplaio4 thc Omq-Buildcr will hqvc drc burdcn ofproving thrt he or tbc not build or improvc for thc purporc ofulc). _I, a ow of thr p.opsty, rm qclurivcly @trtrrdia8 with liccned @nrrctors to @rot uct thc prcj@t ( S*. 7044, Burinos ud Prcfcsion Codc: Thc Coamdor'5 Lienrc hw dG rct rpply to u ow ofpreprty who buildr r improu thcon , rnd vho ontnas for och prcje'ts *ith r Contnctq(r) licored purumt to thc Cont &tor'i LieM lrw.). _I m cxcmpt undc Saim -B &for t Da@: W I hqeby rffim uods pculty of pcrjury m of thc liollowing dclutiou; _l hrvc .nd will Mintrin r Ccnifiotc of Coffit to SclGlluc fo rcrk6' @mpcBtion, r prcvidcd for by Scaio 3700 ofthc l.ibor Codq for thc prfomre of rhc wort for which thc psmit ir isrcd. _l hryc ud will mrintrin eorko' @mpoutior insun@, I work for which this pcmit ir iucd. My workm' mpcnstion rcquircd by Scction 3700 of thc Lrbor Codg for thc pcrfomne ofihc inruue mio ud policy numbq [G: a.d* Policy Numbr (This stiotr necd not bc @mplded if thc p.mit Onc hun&od dollu (t100) or lcs) _l c€niry tlut in th! pgforrrc of thc work fq which thir pomit is isod, I tldl rct cmgloy my pcru in ey m6 e s to beme sbjcd to thc wrkm' @mpcn$tion hws of Crlifomi!" sd rgre dfi if I rheld bore rubjca othc wukm' @opcnslion provi3ions of Setion 3700 of tht bbor Codg I tlpr WARNING: Frilurc b itrc work6' fin6 up to orc huodrcd thouslrd dollB ud ihall sbjet e (5100,000),in eddition to thc rcr ofcompcnstioq demrgcr u the Labor Codq intercs ard domsy'r fd. LICENSED CONTRACTORS DECI.ANATION I hcreby afrm unda pcndty of psjury tht I m limrcd urds prcvirion of Chepts 9 (omcrcing with S*tion 7000) of Divirion 3 of thc Burincs rnd Profcrsiono Codc, ud my licce ir in fuli forc ud cffct. Licctrg Liens Numbs Datc:Corrm CONSTRUCTION LENDING AGENCY I hqrby dlim unds pculty of pojury tlul tlEe i, r @rfuction lcnding rgocy ftr tlE pafme of thc work for whictr thir pcmir is isued (Src. 3097, Civ. C ) I-cndq's Nmc: Lcnder's Addrcs: APPLICAN'I"S DECT,ARATION Dcmlition PmitsAsbc*or Notifiotion Fodol Rcgulrtions (l-nlc 40, Pln 6) _ Requircd btta of Notification - I 6ify thrt th. fcdfll rcgul.tiorr rc8fding ubcxor @vrl e @t rpplicrbla to rhit prcjs. _ I c€ti& th.t I hsvc rcrd thir epplicrtim &d itrtc thr tlE sbow informrlion it @rrc{a. I rgre to rcmply with all Ciry ud Cq$ry rcprcrnrtivcs of this City ud Conty to abovc mcntioned propcny for Appli@r or sgmt sig Pcmitt@ n!mc building .Jo upon the Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Sub-Panels F-XPIRED Air Conditioners Roof Top Equipment AIIG 2 Z EUI: Factory Wired Unit .-adr6"gt) 4-l Walls (Conduit)sAl "-1ll ,2frt( \-t / Walls (Rough)I ltV* \-/ Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release Rough Service Meter FINAL Notes, Remarks, Etc. 03.31.06 t s.t .\ I ri rr MAYOR Miguel A. Pulido MAYOR PRO TEM Claudia C. Alvarez COUNCIL MEMBERS P. David Benavides Carlos Bustamante Michele Martinez Vincent F. Sarmiento Sal Tinajero CITY MANACER Paul M. Walters CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CIry OF SANTA ANA PI-ANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box I988 o Santa Ana, California 92702 www.santa-ana.org NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a bu ilding permit has been submitted in your name listing yourself as the builder of the property ents ed at L We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware ofyour 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 unlesJ you, tne property owner, obtain the prior approval of the permitting authority. OWNER'S ACK LEGMENT AND VERIFICATI ON OF INFORMATON DIRECTIONS: Read and initial each statement betow to signify you understand or verify this information. -[b I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builde/' 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'nhile working on rny 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 injuiies to workers on my property. S. , I understand building permits are not required to be signed by property owners untess they are responsible for thd construction and are not hiring a licensed Contractor to assume this responsibility. 4+l I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I mayprbtect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in hrs or her name instead of my own. -#:O I understand Contractors are required by law to be licensed and bonded in California and to list their license nrlmbers on permits and contracts. -il-U I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tdtal value of my construction is at least five hundred dollars ($SOO), including labor and materials, I may be considered an"employer" under state and federal law. nl(S---6 I understand if I am considered an "employer" under state and Federal law, I must register with the state and\ffderal 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. ntt l\V ,,. l. understand under California Contractors' State License Law, an Owner-Builder who builds single-family r$sidential structures cannot legally build them with the intent to offer them for sale, unless a// work is perTormed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work isperformed under contract with a licensed general building Contractor. t.hI \ 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 financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. l,lLn 38ri"" , I understand I may obtain more information regarding my obligations as an "employer'' from the lnternal Revenue the United States Small Business Administration, the California Department of Benefit Payments, and the ia Division of lndustrialAccidents. I also understand I may contact the California Contractors' State License Board at 1-800-321-CSLB (2752) orwww.cslb.ca.qov for more information about licensed contractors. Californ (csLB) /n- to iile partv I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally and financial ly respon sible for proposed construction at the followi (-address 11. I agree that, as the party legally and financially responsible forthis proposed construction activity, lwillabide by ,licable laws and requirements that govern Owner-Builders as well as employers. JJJ2.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the irifrmation 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 pro perty owner and returned to the agency responsible for issuing the permit. /Vofe;A copv of the propertv owner's driver's license. Signature of Property Print name of Owner Date: iA AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execulion 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: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. PLink:WP5'f /Counter Activity/Assembly Bills/Notice to Property Owner & Authorization Form 06-2012 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. Properg Owner's Signature: Date:_ Print Name of Owner: