HomeMy WebLinkAbout102102832 - PermitPin #: 12726
Assesso/s Parcel:399-053-11 Lot: 6
Unil Bldg: Address Range Suite Range:
Zoning: RlBlock: NA Tract 9451 Historic: No
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA,27O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1lJ21lJ2832
Building Use:
Job Type
Nature of Work:
Existing Bldg & Use
Proposed Use:
Single Family Dwelling
Alteration
N/V - Drywall
SFD Wdet Garage
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories
R-3, U
VB
cBc 2019
x-0602320144J
'l st FL Area:
2nd FL Area:
Other Areas:
Garage Area Valuation:
Total O
$1,000.00
Description of Work: Legalize drywall on garage walls.
Planning Conditions:
l{r
li?lr:r?S
3:?3 Pn
$696.i9
R ie0berto Pere:
Owner:
Address
Rigoberto Perez
940 W. Eighteenth Street
Santa Ana, CA 92706
(714) 206-0016
6ener(t1 Plnn Updote Fee
r:11 I 1 3r102 - 5 I 6r:1110r-11-r-
Bu i Id ine
r:rl l16r:tD2- il6Bl [0r]-
P,lde Stds Revolvins
r.r11160[2- F1612ur]r-1-
Ilicrof i1m & Docuren ts
l:t1 1 1 6002- i1 7 7(rfit1t1 -
V isn
CC+ : *Ir*rxrx*rxx 1971
--.
$1;? 6.?9
-- $1. tllr
$l,r1
$6'16.59
Auth+:162131
Owner-Builder
Engineer
Phone:
License #l
Architect /
Desiqner:
Address:
Phone:
License #
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
Graham, Jeffery
Chavez, Davqv,
Date: 01/15/2020
Date:
Date: 01/15/2020
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipl
0 77 7600 2
0 77 76002
0 77 7600 2
017 7600 2
07776002
07776002
0 77 75002
57607
57770
57607
57607
5 7672
57600
57507
Permit Fee
Nlicrofilm Records
lnvestigation
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
No
No
No
No
No
No Account#Total
$166.s3
$3.91
$100.57
$252.69
$1 00
$22.95
$57.20
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
Every permit issued shall become invalid unless lhe wo* on the site authorized by
such permit is commenced wthin 360 days aftet its issuance ot if the wo* authorized
on the site by such permtl ts suspended ot abandoned lot a pe/iocl of 360 daysaftet
thelime the work is commencecl
MtD#. 2020-157054
01 1 16002 5'1600
01 1 16002 5160't
01116002 51612
01116002 57770
$22.95
$576.99
$1.00
$3 91 Fee Total.
Paid to Dale:
Balance Due
Project Address: 940 W Eiqhteenth St
Patio:
T.l.Area:
Yards Req'd:
Contractor:
Address:Address:
Phone:
Tenant:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
$604.85
$0.00
$604.8s
lnspector
SITE-WORK DATE tD/stG.COMMENTS I hcrchy rrhnn un,lcr Foalr, ol !.rjury rhd I m ckmfl ln,m rhc CnnrracroF' Lic..sc L.w ltr rhc tullowi,3 rcaYm (S'c 70.t1'5
Bunnc$ !",., Pnncsioo C l.): Any Cily or Counry whth rcquncs , Fanil ro c.n{ru.r' llr.r' imPovc. dcmulirh or rcPan 'nv,
nru.rurc. Ilior (o irl isuan0c, llso rcquircs lhc.lPlica ntr \n.h Irmil to ilc a $sncJ i,rcmnr rhar h. or shc is liucncJ IjuRUa'r.
lr lhe povirions ol rlE Contrluror's !-ic.{'l hw (CIEI'lcr O, Co.ncncn! wirh Sccrnn 70m of Division I ofllE Busituss d
Pnn.s\n'N Cod.) or lh.r lE or sh. is crcmfl rhcrcfmm a!,i rh. br$ lnt lh. alLged .rcmPthn. An, vnrhuon ot Serbn r0.l I 5 bv tnv
xltlic, n)r.lcmnrslbjeckth..ppli.anlk,a.ivrl!.nalryor.otmorerhdfivchun!rc,ldoller($500)
A4atr ow$ or rhc pmrdr, or ny .nployccs * h wrs.s as rh.n sb Nnlcnrain,n. qill do rfu v$k drl rhc srfrrN is tur
dr.frLil or o,Icrc'l ttr sh (se.7044, Busim* &d Ptur.*ion. Cds T hc Cdnlr..nxi l-ien* bw dNs not a{'plv b an owmt of
rhc pmpcdy wk, bnius o, iqmwr rhcon..nj wrn) J,rcs skh kfi hrmscllor hcrcllo. rhn,ufh hF or hcrown caPlovccs,
|rn,,id;,i rhd .kh ihpruvcmtrls m fr, i .nlol or oilcrctl lnr salc lt h)srct. lhc h( 'ling or in{'rorcmnr i s'n wnhin Drc }ttr
;r conplcli,'. rhco*;rBu ddwi harc llE ltJen.llovinC rhll lE or rh. Jrr d huill o. inqtov. rh. ProlElv f{{ rhc noQoe ol
,. !s .*ncr oI rhc ,,sNn y, sN ex.lusiv.ly co rachns with li.ctr*J conk&r1,6 b .onntud rh. Pr)Fcl (Scc 7044 Burms
rnl h.f.\\.nC(klc-lhcC.ntacrorsLrccn*LawJltsfr dpPlyroanowncroltrol'crlvwhob,rldrorrmFovcsrhcr'on.
.tri who onkacrs tur $rch pntct w h a Conkdcn)(s) lircnscJ pursuMr !' rhc ci,nta.ttr's t-lcns lj* )
u.dft Seln,n-. A &P
. l-/J'- )-o
PECIAEAIION
I hcrchy a0nm uhd.r lEo.lly ot If,dury otu or lhe following d.cl,r{ions:
-I
lravc.nl will roinrah t C.ttilic.ic olconse b S.lf_lnsurc l[ u*c(' conFnsrtion ss pturid.d lor bv Secrion l7m or rh'
Lt or Cod.. ior inc pcrfotu. of lhc mrt for *hicn !n. pdn rs issuc!
-l hav. .nd sill nainr,in workcs comFnsarion irsur.Nc. &r rcquicd by Sel n r 1700 ol rhc Llbor CoJ.. nrr fi' F rbmucc of
ilE srk lbr whih rh6 r.rmir is ilsu.n M, wor*cn urmpcnerion nsutec osicr,nd rdltv nlmt4r @:
@d,ry rhd in rhc pc nmrtu. of rhc work tbr *hrh rhi\ n rm is ksucJ. I nrllnol crylov anv p.so. i. anv tunmr
$ s ro h.!om shjcd b ihc wo crs q,ol.nsaron ldws ol Calibrni{ and l8rcc lhai ii I should Lc.om slbJcd ro rh'
worlcG.{hpcn!,rtr)dpbvisionsofS&rionl?LxJofthcLaborCul..Ishitltndh{i$conPlvqithlhoeF)v6'ons
WARNINGT i{turc nr Bsc wotkcs'.omFnsarion (.vc.,e. F unhwlnl atu] \h l slbje.r ro mplov.r lo ditrinal ItM[Es lnl
c'en irr\ trD b.& hun'imJ rlbusu dollar (!l{Yy.-z.k^,***,-y:"'^.-*"**S&rtrm l07a ol lhc LrhtrCol., dcrslaDJ i otrry
l-tcDNst:D ( ()NTR,\cloR
DI:(]I,ARATION
I hcrhyrtltrnundcr F-nalryolpcrjurylh l ao l'(.nQl undcr Pnrvsion of ChaPl.r I (Nmmncrn! w,lh Sc.lPn 7ff1) rDlvtrir)n t
ol ih. Uusdcss dnJ Pmlc$ionsCodc. d fty|ccn* i\ in lull lt*cc {rlcllccr
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D61€:- Conlmcto.
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CAISIBUCIIO!.IIIDINiAGINI:I
I h.rchyrflumtrndcr lcnrlryol !.rjury rhrl lhcrc isrq,n{tucri(,n L ing!!.ncyforrhclctJtrmmccotrhcuorklo.wlr'chrhir|}crmiris
hsucd (Scc :1097, crv C.).
bnJcr'r AJLlr.sr.
APILICANT I'FCLARATION
I hdrly ,ltinn undcr pcnllty ol pcrjuy onc oI lhc l'olbwins dcunl ions:
DcBririon P.rnirrAshcskx N.ril,c.lio. FcJcEl Rc-s!L! ions lTnb 'rc, Pan6)
_R.qur.d Lllcrol Nrilicdon
I ucdfy rhar rhc rcJcrllrcsubrniN ft'8,rdiIr8 rst'cnos r.B,!.ldc nol ll,tlli..hlc 6 lnls F iccl
44{niryrl-t I h,"c rc rhis lmlicxt ()n ihJ starc rhar rh. atx,vc inrorn i,tr kroftcr Iasncbo,mplvwirhallcirva counrv
"nnnn"c\ rni surcIf,q\ rcLrDs r! bu Jtrr(!qtu(|tr.n.rnlhrrchvJurlxryqRP.qnrcrtrc\orrhsctrt.n,la.un'yrucirdUFDrh.
Jhrc mnlii,nc,r ntuF.dy rir ^i,.-.*&/ l-r' ,/-/
ApD,ic. or^penrshm,orc Y K4"0(t 4*;. thta ' t 'tJ/- 20
r"^t***,oa,r,.Vt. (tGoB€ A7'tt C. l'LLtz-
Forms/Steeli Holdowns
Erection Pads
UFER Ground
SLAB Floor
Sublloor/VenVl nsu lation
Rool Sheathino
Shear Wall
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif .
FINAL r /zJ/ )a2a Pl;fasl
Cert it i catezabaan6a n c y
Notes, Remarks, Etc
-.+
BUILDING. INSPECTOR RECORD
Set Backs
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Planning & Building Agency
Building Safety Divlsion
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, cA 92702 '
(714) 647-s800
www.santa-ana.org
NOTICE TO PROPERTY OWNER
Dear Property Owner
An applicati
specified at
on for a blilding permit has been submitted in your nam
'1 +o Lt tgr* 37 5 a,.r*e listing yourself as the builder of the property improvements
At'A Ca. g\1 0L
We are providing you with an Owner-Builder Acknowledqment 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 AN VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information
D t-l l. 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 sub.iect to serious flnancial risk for any injuries sustained by an unlicensed person and
his or her employees while working on my property. My homeowneis insurance may not provide coverage for those injuries. I
am willfully acting as an Olvner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prop-
erty.
tlr?-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.
Ltj 3. I understand as an "Owner-Buildef' 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.
E4-o. ,understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
k4 s. t understand if I employ or otheruise 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
"employed' under state and federal law.
-/,4U t 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 conlribute to unemployment com-
pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious flnancial risk.
l?tl l. 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.
Rc? S. 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-
cial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workman-
ship or materials.
APP-13 CBC 2016
!2a!.-g. I understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser-
iice, the United States Small Business Administration, the California Department of Benefit Payments, and the California DivF
sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-
U1-CSLB (2752) or www.cslb.ca.oov for more information about licensed contrdctors.
lLc? fi.1 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 respgnsible for proposed construction activity at the following ad-dress: q{o O . / erk sf 5 a nrla ApA c* I L1 ob
qcl IL 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
?c?t. 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.
Signature of Property Owner Date: / - /{- 2olt)
Print name of Owner /,?ootlt-ro c. f(1L2-
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.
Address of Authorized Agent
Phone Number of Authorized Agent:
I declare under penalty of per.iury 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 notaization, or other verification acceptable to the agency is re-
quired to be presented when the permit is issued to verw the propefty owner's signaturc.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned
to the agency .esponsible for issuing the permit. ,Vofe.' A copv of the propertv owner's driver's license, fom notariza-
tion. or other verification acceptable to the aaencv is required to be presented when the permit is issued to verifv the
p ropertv ow ner's s i on atu re.
ScopeofConstructionPrgect(orDescriptionofWork):
ProJect Location or Address:
Name of Authorized Agentl