HomeMy WebLinkAbout101101553 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, C492702
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Bu ild ing Permit #: t Ot { Ol 553
Pin #: E4934
S-'
Project Address: 4926 W Kent Ave
Assessor's Parcel 108-373-08 Lot: 76
Unit Bldg: Address Range Suite Range:
Zoning: RlTract: 3528
Building Use: Single Family Dwelling Occupancyr R-3, U 1st FL Area: 0 Patio: 13'l
Job Type: Patio Cover Constr Type: V B 2nd FL Area: O T.l.Areal
Nature of Work: Patio Cover Code: CBC 2016 Other Areas: o yards Req,d:
Existing Bldg. &Use: SFD w/att garage Flood Zone; X-0602320256J Garage Area: Vatuation: $2,535.00
Proposed use: # or stories ' 'o''" 5ll!:;g'efii - +X{111:''l:
I0: rrru,rirlr
Description of Work: Remove (e) patio cover and add new wooden patio cover/extend patio cover issued undeeEf, #101 100080 lier'+,' 1r:r1 1r.r 1l:iai.i
Iicptir0?775501 - 1(r/11/2019 1?r51 ['ll
Tr(nsqct ion Totol $.i?6 ',1t1
Planning Conditions: All materials to match existing.
P hone
Tenant:
Thao Ngo
4926 W Kent Ave
Santa Ana, CA 927041935
(714) 383-0002
Owner-Builder
Address
TMC Engineers lnc
Tien Cht68lEroI Plon Upd0te Fee
95a2 Pacllld i#l!2- 51 611r-r Lrr'r rr -
ananermlEldCi0dl
tzo azsfffi 'jio']; l:3:i lji:i;72324 ttt!t6t],t12, fl 6l?[ur,] -
,"o, r."ti6f, dffii! A3rnnoru.
JosePh ffi41o1 ; 1r A Dsr-uinent:;
17927 Toiiffi60-,1)le 5 /77ur,["[:r-
Fountaindl?Sey, CA 92708
(714) 454gPill |]t] I - 21ur:[:fl-fl:I]
V isa
c,r,) ori
1207 .?fi
t1.r]tl
,7i. |:r0
$19.55
90.50
$326.2r:l
Phone:
State Lic #:
Lic Typel
Bus. Lic #:
Workers' Compensalion lnsurance
Carrier:
Policy #:
Expires:
Phone:
License #
Architect /
Desiqner:
Address:
,'',\..[l.4.OOa,'r7n
Planning Approval By
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Date: 09/2412019 N/tisc. Receipt: 73508
Dater 09/30/2019 Misc. Receipt:
Date: 1O/11/2019 Misc. Receiptl
Subject to Field:
No
No Account#Total
0 77 7600 2
0 77 7600 2
0 77 760 02
08907007
0 77760 0 2
077760 0 2
0 77760 0 2
$150.00
$150.00
$19.5s
$0.50
$1.00
$22.S5
$57.20
d No
s7607
5i50 0
57770
2400 0
57572
51600
5760 7
Fire lnsp. Req'd:
Police lnsp. Req'd
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every permit issued shall become invalld unless fhe work on the sile authorized by
such pemit is commenced wilhin 360 days aftet its issuance ot if lhe wo aulhorized
on lhe sie by such permtt is suspended or abandoned lor a period 01360 days after
lhe ttme the wo* is commenced.
01 1 16002
0'1116002
01 1 16002
01 1 16002
01 1 16002
08901001
$401 20
$75.00
$326.20
lnspector It/ lD#: 2019-1 51 1 59
51600
51601
51612
53600
57770
24000
$22.95
$207 .20
$1.00
$75.00
$ 19.55
$0.50
Fee Total:
Paid to Date
Balance Due
Block. NA Histor rc: No
Owner:
Address:
Conlractorl
Address;
Engineer:
Phone:
License #l
Graham, Jeffery
Chehade. Nabil
Amsden, Juiie
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
BUILDING. INSPECTOR RECORD
OWNDR B!ILDER DELCARATION
I hseby amnn rndq poalt! olpdjuryrn l mcrdnpl 6oar lhe Conlraclo6 Licflsc Law forlhc lollosin3 ra.on (S€.70115
h6in6s and Pnlixsion Code) Any Cily or Counry Bhich rcqun6 a pfl1il ro coGrrud, ahd, nnpro\., danolich or rcplt any
s'tu.iurq prior to its hsuan... rl$ requn6 rh. appli.anr lor ruch ,imn to fiI. a si8n.d salmd lh8l h. or she b licd*d puEuant
lo lhe prcvisions of lhe Contracto.s l,icdscd l,aLv (ChaDre. 9. Comnrc.cins Nirh S*rion 7000 of Divtsion I oalhc B$in s ed
Ptufdrio.s Cod.)orrh.r h.orshc is qcmfl rhdl6o6 dd rh. haiis for &c all.scd erdprion. An, \iol.tionoascclion 70ll 5 by.ny
appli.ani for a pnnil subj(Brh. appli.anr ro a.ivilpenalrtol'nor nor. rhan livc hundred dolles l$500).
l, ar osnftnlrh. propcny, or nryc.Dloy6 sirh *as6 ar thc'r sl.( pderion, \ill do lh. $ o.l dd fi. $nxru. b ml
intmd.d or otrded for elc (5(.70.,14, RBin6 and PmiNions (nd. Thc (-onradois Lic.ns LaN do6 nol arply ro u o\r( ol
rh. poF.rlr- Nho bnildr or inpro\ 6 rh-Bn, ,nd who do6 such slrk hims.ll or hd*lf oi tlroush hir oi h6 os n cnplorce.
pror idrd r har such i'npdvmnrs e. ton i.rod.d or oftdd flr slc lf. ho\ 6 s. rhe lnildint or mlmvmr is $ld rhin"nc)€
ofcodplcrirn. rhc O\rrs Buildq vill har. rh. hrdo ollro\ing rhar h€ o' sn. did nor hild or ihptu\ e rh. popdy lor lhc pd,F* of
6 o{ner ofrh. p6pdr!. m cr.lusir.ly comr,.rinu trirh li.Nd.oiIrrco6ro co..ltuct rh. projd (Sd 70J4.lrEins
and hof6i.n cod. TneCookocrors Licen* Lawdo6 n r appb ro oNnero|prop.nyvho builds or mpod rhstun.
and trh{ conrBcG for such trojccl. \r,rh a Conlnch(s) licmcd puGund ro rh.conka.rdis t-icds.l^v)
lm erenrpl ond€. SErion 3. & P.c. rofs
,X_tsLttlLg_
I n€rcby a,IrB undo p.n.lly o t pdju, y oo. of lh. folloNin! ddl&ariom
IhaveddNillmnr3ina(€dincsteofConsdlroSclf-lnsur.lorsorlqs compc.srio!.6 p.ovid€! for bySdion 17(I0 oalhc
libor Code. tor rh. ElcnndLc.trl.. \o* l.rtr'hrch rh. pmn is isucd
I hav. and eillnainraio *orkdr' corrpcBalhn iNurrnc., s requned hy S(rion :l?00 oarhc Labor ( od., aor $c pdtomhncc ol
lh. sort for shich rhis pdnil is Ls.d. My *orl6e ..mpssrio. ialrMce cmi6 ed policy nu'nb6 r€
Poli.lNtrrnbd: Expt€s:t/'(4t.a,b rt'^r
'n
rl'. rornt.inc. otrh. $ork for whrch this p6mir is issuc{L I shall nol oploy any p.Mn in any ndnd
$ ai ro bc.ohc subjrtl lo rhc No&6 .ompc.erion la*s otc.liaoBia dd ,eft rhd ia l should b..o,n subid lo lh.
\0116 &npoerio. pftiri.ioEolserion l?00 ofrhc Lrhor Code l !h.ll. fodhs'ilh comply Rith rlmppmvisioN
\IVARNINC: Failur€ to ss. \ork6' comp.trdion cov.h8. is unlnqtul. and shall subjrl e flploys l. fininal FDhi6 and
.ivil lires up ro one hundred lholsd dollaE (t100.000). ir flddirio cosr or.o'n!.Nrio.. dmald d prorid.d a.r rh.
Sd'on 1076 orth.l,ahtrCodc, inlfd aod arlomq-s rE
"lrt I t a
I hmby amrnr unds p6ahr ol psjury lhat I an licdsdi ondd provision olcfiaplgI (
of rh. Busin6s dd ProacioN cod.. d ny li..nse is in tull tunc and .tld.
sih Sarion 7000r.f1)'\ isi.n
Li..nsc Numbc: _
(0liltrlcflalliNultcd;.ENc!
I n€rcby amm undd penalt, olp.rjurythot lh6. is a coniructiotr lsdlnA o-!.ncy for In€ pqlonnmce oftheryork lir $tich lhis pomir is
issucd lsc. l0'r7. ( n (')
AIIIICAI[DECLAAAIIQ!
I lE€ty afim und€r p.n0lty olpcrj'try one olrne lollo\cinr dc.lar.lions:
D.rnoliriotr Pcanils-Asbrsos Notincation l,edsrl Rcrulalions 0 nL 40. Pan6)
R.qxircd Lexd of Norincolion
l.dily rhd rhc fcnddr+ul.rio6 rqddinr 6h.s(os rdno\ al oc tror lpplicable to this pDj..l.
.dilvrld I h.\€ rsd rhis aprlic ion $.t.rha! rlE aiFv€ inlomration is corsr. lasreto coDpl, \vilh allCiryand counry
ordinancB d Slarc Ij\ s rclotin! to tui
abov. nrc io..d popdy tu impaxion
6 ofthis Ciryed Counryro.nrd trpon rlr
SITE-WORK DATE tD/stG.COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathing
Shear Wall
Framing
lnsulationi Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Itila son ry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report .!
Flood Zone Certif
I
FINAL rl 1 q-\iiv> )
Certificate of Occupancy lr :
Notes, Remarks, Etc
to1lu
1 4o o
Planning & Building cy
Building Satety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
www.santa-ana.org
Dear Property Owner:
An application for a building permit has b sub itted in ur na Ing
specified at
list yo rself as the builder of the pr.)rty improvements
e-
We are providing you with an Owner-Builder Acknowledoment 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 ACKNOWLEGM ENT AND VERIFICATION OF INFORMATON
D/RECIIOiVS; Read and initial each statement below to signify you understand or verify this information.
f \ 1. I 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
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.
L" 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.
( ' 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
hyself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.,)
L-!_4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
dn permits and contracts.
1__( S. f understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
lalue of my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an
"employer" under state and federal law.
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 subject me to serious financial risk.
( ( 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
;li-rctures 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.
L !4. t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
EiEi? personal injuries sustained by any subsequent owne(s) that result from any latent constructron defects in the workman-
ship or materials.
APP-13 CBC 2016
NOTICE TO PROPERTY OWNER
L 9. I understand I may obtain more information regarding my obligations as an "employel'from the lnternal Revenue Ser-
vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi-
sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-
32 1-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors.
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 financially responsible for proposed construction activity at the following ad-
dress:
11. I agree that, as the pa(y 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 12. 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 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 permit. /Vote.' A coov of the oroDertv ownet's driver's license, form notariza-
tion or other ve
Signature of Property Owner oate: I O lt
Print name of Owner
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 flle the documents necessary to obtain an Owner-Builder
Permit for my prolect.
Scope of Construction Project (or Description of Work)
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 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 to ve fy the propefty owner's signature.
propeftv owner's sidnature.
O