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Home My WebLink About20170590 - PermitProject Address: 2349 N Siemon St Assessor'sParcel. 101-042-01 Lot: 34 Unit: Block: NA Btdg: Tract: 3537 Address Range: Historic: No Suite Range: Zoning: Rl City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA127O2 Electrical Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit #: 20{ 7O59O Pin #: 663{trI Owner. Address Contractor Address: Phone Andy Dang 5712 Ocean Vista Huntington Beach, CA 92648 (7141724-0256 Owrer-Builder 011 16002 51603 011 16002 51600 011 16002 51603 01116002 57770 Amount 57 .20 3.91 Ands onns Qty 1.00 1.00 1.00 1.00 Fee $55.37 $22.95 $57.20 $3.91 Eotch+:53386 - 1/14/2A2fJ ID: CCUFi.t.Al:officel CTYH TrsnEi: 15 1 of 1Acct+: Eef+: ?01705rr.r ftcpti:0?865404 - 1/14/2lt2i 2r1l Pn Tronsoct ion Totol $ 139.43 Phone State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance Carrier: Policy #: Expires: Planning Conditions: Planning Approval By: Plan Checked By: Permit lssued By: Subject to Field: Building Permit #: Single Family Dwelling Miscellaneous Subpanel Chavez, Davev' Occupancy: Constr Type Code: R-3 VB cEc 20r9 Notes: lnstallation of subpanelatmainSFD. Owner-Builder form on file. Date: Date: Date: N.4isc. Receipt: l\4isc. Receipt: l\,4isc. Receipt: Total 01t14t2020 Account# 01 1 16002 51600 01 1 16002 51603 01116002 57770 Fee Total: Paid lo Date: Balance Due: $22.9s $112.57 $3.91 lnspector MID#: 20'19-149692 Fee Type Subpanel General Plan Update lssuance lvlicrofllm Records i22.91 $112.57 di oi t139,43 Tenant Name: GPnerol Plon updote Fee 011161102- 51600000- Electr icol r'rl I l6[rr]2- 5161131100- n icPof ilr & 0ocu6ents 011161102- 57770000- ICL Check 001150 Building Usel Job Type: Nature of Work: Every pemit issued shall bocome invalid unless the work on the site authorized by such pemil is commenced wilhin 360 days aftor its issuance, ot ifthe wo* authorizod on the site by such pemit is suspended ot abandoned lor a period of 360 days aftet the lime the wotk is commenced $139.43 $0.00 $139.43 ELECTRICAL.INSPECTOR RECORD ID/SIG.COMMENTS OWNER BUtLDEtr D&ITANATION I hdcby amrn unde ldalry oa pdj"ry that I dr excmpt liorn th€ Contmclo6 Lic.@ Lrw aorlh. aollowiog r.eo (Sd 7031.t ausir6s md Profsion Cod.) Any City or Counly which r.qut6 a ponil lo .odirucl, .hd, imFov., &rDolieh or r.Fir e, smcI@, rior ro ns isgudcq abo r.qliB lh. sppli.mt ao! such pcmil lo 6lc a sisncd llaoc that n or sh. i! lic@.d p@rn lo tn. prcvisions oarhc Contmcioas Licmsed t.v (Chapld 9, Codtoc.ci"s vith S.clion 7000 ol Divirion 3 oflic BGiIH Md IhoGsions Cod.) or rhar h. o. shc t cxopt rhocFod dd th. b.sb for rfi. all+.d.rdrlion Aoy violal,on ofselion 7011.5 by aoy ffiffi ;il;ffi ffiffi ;;ffi ;i*,:#:riffi ff "H.,rh. Fdrdl sno hril& or impmr6 *E6n. tud sho dc sucn w& hi6s.lt or hNl f or rimu3h his or hE own mplo,€6, prcvided thar such imp,ovo€nls @ nor hrdd.d or ofiod ao. sh. If. hovd6. tic biiiBi.s or nnp.or@l is eld within onc ,@ olcoopldiorl rh. (,*dd Buildc sil ha!. rhe bud6 ofproving tfid h. or sh. d'd nor build or improle tlE pmpaly lor d. purpos ol .1. soM6oirh. Fop6ry. ancxclGn.lyconkdcri.s with licm.d conlractoslo coNtrucl projxt (S( 7044, BBi6s buil& or inpmlcs rhdon.dd P,oi6sin Codc: Thc Contacrort Li.eN. Law do6 nor oppl, to own6 oapropaly .nd who conn ls lor sudr pmj.cc wirh a Conllscto(O liccBd pursuer b nE Co OECI.ABAIIOT I h(.by afiim !.d6 t6.lr, of pojury on. oarh. follo{i.g dsleatioE Ih.!crdwill'ui.inaCdific&t.ofcoNntroS€lUnswcforvork6codFsrion.6FovidcdforbySdtion3?00ofltc hbor Code. aor th. pcfonnmc of the *o* for ut'ich thc p@n 6 Nudl _ I havc ,.d vill nai.rain vor!6 conpcBalion iBurece, 6 r.qut.d by SEtion 3?00 of lh. Labor Cod.. for ln. poao,ijjm. of rh. worl for which rhis pdmir i. irsu.d My workd comp€ffilioo ireuroc€ ceid dd policy nunbd d.l Dic) Numb.r l\pr6:/ln- '!f I ccn 'f, r har m r hc Ffomrncc of lhc worl lor which this p6,nn is i$u.d. I shall ool mploy &, p.rsn in &y mmd $ d ro bdom. subjer lo rhc w*d' omFtsaion laws olc.lifom4. ed r8B tnd ia l stould b€omc subJdl to llE work6 cohpecarion pIorisiom oa sdrion l?00 of thc Labor Code, I siall. fon hwilh.omply u to su. *orkdt coopssation co dploycr 'o di,nir.l p6Ell hun&cd rnousdd dollm ($100 sddirion ro rhe.o$ of.o Cod., inrdcsl md atonErt !lcLL!tL(!.N,!]B !1!)-B DECLAA{I]O! I t.r€by amm undo p6ahy of pdjury lhar I &n licc$dl lndd prolision oach.pl6 9 (comocins *ilh S€.lio. 7000) of Divilio. 3 of th. Busin6s ud Prol*ioB Codc. dd ny lictuc is in fuu forc. md .fidl. CONSTRUCTION Lf, NDINC ACENCY I heby alImr undcr poahy of p..jury thar ttqc is a.on$tucrion lcndrnS .g6cy fo.lhc pafo,tmc. of the wo tur vhich lhb pamit b isucd(Sd. 3097, Civ.c.) APPLICANT DECT-ARATION I ho&yafmund.r p.naly olpcrjury on ofrh. aollowinS ddlmtions: D.mlition Pmils-Asb6los Notific.rion F.d.ral Rcsuhriohs (Till. 40, P.n6) _._.Rcqurcd L.(d of Norin€lion c icsedinB 6b6tos rdnoval arc I asrd ro.onplr*th.llCnyand Coum, iv€s.frhis Ciry ud Cou.rylo orr upo. rh€ above nrcntion€d pop€ny tor Appli.afl t or Ag€nt Signhtrre:o a. Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communrcations Cable Building Under Slab / Floor Bonding / Grounding / UFER Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release I I <) Rough 5 4il1),Dttulufi !6) I 1lN,, W FINAL :A '.)t lL'.r\1\ulf ta-v" Iletes, Remarks, Etc \JI I -) Rev.0B'07-2015 APPROVALS DATE Transformers Service lvleter )4\y1-V^5 . fu)q-Yt+'Al a.( hkLYtillveS 'Mtr/ N 2pu2 2H\/A I --------T------ I Planning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 (714) 647-s800 www,santa-ana.otg APP-13 CBC 201 6 NOTICE TO PROPERTY OWNER Dear Property Owner An applicati specified at on for a building permit has been submitted in your name listing yourself as the builder of the property improvements 21>L/.1 1ir nao;J 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON D/RECI/O,YS; Read and initial each statement below to signify you understand or verify this information. Q.a -{fi . t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build- ing permrt 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 sub.ject 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 injuries to workers on my prop- erty. r'.1\/-4j t, 2. 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. tLNa f 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. -t]4* , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. [ ) A S I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total v-alue 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. C[-U. ' understand if I am considered an "employer" under state and Federal law, I must register with the state and federal gbvernment, 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. 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/l 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. i\ lr- ]fl U b. f understand as an Owner-Builder af I sell the property for which this permit is issued, I may be held liable for any finan- cial or personal iniuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. )fu I understand I may obtain more information regarding my obligatons as an "employel'from the lnternal Revenue Ser- vide, the United States Small Business Administration, the California Department of Beneflt Payments, and the California Divi- sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 'l -800- 321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the Z?::":"t2\.;i*77:,ty?r1yle for proposed construction activity at the forrowins ad- N#,l '1. I agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. -DhZ 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 inlured 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 foi issuing the permit. /Vote.' A copv of the DroDertv owner's driver's license, form notariza- other verification a to the ,s dtobe when the It ,s issued to the o.t ot// r{/ /-<2 za)Sig nature of Property 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 file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Name of Authorized Agent Address 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 ceflfy 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 verify the propefty owner's signaturc. Sh DroDertv owne r's sionatu re. Print name of Owner Project Location or Address: Phone Number of Authorized Agent: