HomeMy WebLinkAbout10189377 - PermitCity of Santa Ana
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20 Civ ic Center Plaza (M-19), Santa A na , CA 9 27 02 Bui lding Permit #:'-1 0189377
Permit Counter: (714) 647-5800 In spection Requests : (714) 667-2 7 38 Inspector Section: (714) 647-58 5 3 Pin#:\ 13697
Project Address: 1715 W McEvoy Ln Unit: BlrJ g:. · Address Ra ng e:
Assessor's Parcel:
Building Use: .
Jo b Type:
101-531-04 Lot: 97
Single Family Dwelling
Addition
Na ture of W o rk: Remodel/Addition
Ex isting Bldg. & U se : SFD w/att garage
Pro p osed Use:
Bl ock: NA
O ccupa ncy:
Constr Type:
C ode:
Flood Zone:
# o f Sto ries:
Tra ct: 2887 Hi sto ric : No Zo
R-3 , U 1st FL A re a: 807 Patio:
VB 2 nd FL A re a : Tl.A rea:
CBC 2013 Othe r A r e a s: Y a rd s Re q'd:
X-0602320144J
G arage A re a :
1
Total: 807
Valuation: $87,963.00
Description of Work: Convert (e) kitchen into (2) bathrooms re de walk-in closet, Add kitchen, dining room , laundry room and
extend (2) existing bedroo deferred truss submittal/GGUSD # 4574
Planning Conditions:
Own er :
A ddress:
Ph one:
Tenant:
Thanh Vu
1715 McEvoy Ln
Santa Ana , CA 927061332
(714) 425-0852
io1«,1~,$1
Contractor: ~ner~
A ddress : ~
Ph one:
State Li e #:
Lie Type:
Bu s. Lie #:
W orker s' Co mpensa tion In surance :
Carrier:
Po li cy#:
Ex pi res:
Plannin g Approval By: Guevara, J erry Date : 11/03/2016 Misc. Receipt:
Plan Che cked By : Mazarji, Zac Date: 11/03/2016 Misc. Receip t:
Pe rmit Issu ed By: i Hernand ez, Kath y Dat e: 11/08/2016 Misc. Receip t:
NP DES lnsp. Req'd : Subject to Field:
PWA l nsp. Re q'd: No Fire ln sp. Re q'd : No
Pl annin g l ns p. Req 'd : No Poli ce lnsp. Req'd: No
Landscaping ln sp. Re q'd: No Fl oo d Zo ne Cert. Req'd : No
Every p ermit issued shall become invalid unless the work on the site authorized by
such p e rmit is commenced within 180 days after i ts i ssuance.or if the work a uthorized
on the site by such permit is suspended or abandoned for a period of180 days after
the time the work is commenced.
Inspector MID#: 2016-126212
Account#
0111 6 0 02 51 6 0 0
0111 6002 51 6 01
0111 6 0 02 51 6 12
0111 6 002 5 3600
0111 6002 57770
0 89010 01 2 4 000
En gin eer:
A dd ress:
Phone:
Li ce nse #:
A rchitect I
Des iQner:
Address:
Phone :
Lice nse #:
680 8 0
T o t al
$20 .56
$81 7.21
$4 .00
$24.21
$4 2.00
$11.44
t ;·.
'; ,:.<f' j_
,•.I~ -1 ,•••,1
Donald J fn·man °&1'!i\ssociates-J .. ,,/ !:OL, -'~0 ,_,J. Fi"i
Donald J lnman • .. r:t on , ,_.,_ i ,-l .,·. ;;
5131 Fox Hills Avenue
Buena Pa~k; CA 90621
(714) 521-_R?,5'.t; ). ,. ](lj'j t:,·,k c,; ,· ,;;,, {'.LI_! •. ,(
11888 '1, ·' j,_,,:,__ '.,.t:.,\!;,_,,_;._.
'":L l 1 •Ji f !9
-lJ .. ~Ji.iU.,:: '.~·12!)1,~,• ,
l. J1~~ ·:·t::.!·::~-f-~e·..-icd.\, 1 ;,3
:) .I. .t} :,,YJ . .:: 1
~: -~: t . UfJ:J ·•
: Ii J;
0 11160gf, N~9.t-Pf.f!J1J\l 1~i:1--
0 ll1 600 2 ., 5 3 60 0 Plan C heck Fee $935n7.i;'.:::
,.-, .. '< :(!~$42).DO 0 111600 2 5 7770' Mi crofi lrif ReGord s
0890100 1 2400 0 SM IP -Catego ry 1
0 1116002 5 1 612 Bld g. St ds . Re volv in g
01116002 51 600 General Plan Up date
01116002 51 6 01 Iss uanc e
Fee To ta l:
Pa id to Da te:
Balance Due:
$11.44
$4 .00
$20.56
$51.26
$1 ,830.28
$910 .86
$919.42
BUIL DIN G -IN S PECTOR RECORD
SITE-WORK
Set Backs
Fo r m s/St eel/Ho ldowns
Erectio n Pads
UFE R Ground
~ SLAB Fl oo r
Su bfl oo r/Vent/l nsu lation
Roof Shea thin q
Shea r Wall
Fra mi ng
lns ul ation/Ene rqy
Drywa ll
<E xt)/l nt. Lath -
Brown Co-crf .5c.fA-rtAJ
Masonry
Pool Fence
T-Ba r
Handicap Rea .
Deputy Fina l Report
Enqineer Fina l Report
Fl ood Zone Certif.
FINAL
\
)
')(_ \
I I
Certifi cate of Occupanc y
Notes, Rema rks, Etc.
DATE ID/S IG . -C O MM ENTS
I I I ,, I
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,A ..J ?
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OWNER B U I Ll)ER l)EI.CA l!ATIO N
I hereby nffirm under pc::nnhy or pc1j111y thm l am e:<cmpt from the Coutrnctors ' Liceuse L.1,,· for the followiug rcn~rn (Sec.7031.5
Business mid Profession Code): Any City or County which requ ires a pcrmil to constn1c l. .iltcr. imprtwc, dc11m1\1l o r repair•any
structure. prior to i1s issuance. nlso requ ires th e nppli cm11 for s uch pcrmi1 to file n signed stntc111cn1 1hm he or she is lkcnscci ptll'Sl~'lllt
to the pro visions of the C'ontractor·s Lict:nsed L.,w (Chaplcr 9. Commencin g. wilh Section 7000 or Oivisio11 _:; or the Business and
Profossions Code) or th nt he N she is exempt 1herefro111 and the basis rur the alleg ed exemption. l\ny \'iolation orSc<:tinn 70J 1.5 J:iy ,Jy
applicant for a pcnnit subjects the applicant to a civil penalty of not more tha n fi ve h1111clrcd dollars l $500). "
_I. as owner or the prope11y. or my employees with wages as their sole compcns.1tion. will do th e work ;mt.I the stnu.:turc.: is not
intended ororTer ed for sale (Scc.7044. l3usinl-SS and Professions Cmlc; The C'ontrnc.:tor·s LIL'cnsc L:1w docs not npply to m1 O\\'ncr of
the propt.--i1y who builds or improvl'S thereon. and who docs such work h imsclr or herself ur thr0t1g.h his or her t m ·11 emp lll)CCS.
provided that such impro\'Cmcnls arc not inte11(lcd oroncrcd for sa le. If. however. the bu ild ing. rtr impn:wement is sold wi1hi n one year
of completio n. the Owner Bui lder will h1we the b1irdcn o f proving tl mt he or she did not b11ild or i111prove th e pmpa1y for tl 1e p11q,oseof
sale).
_I. as owner oft he propc11y. mn c.-:clusively co111rn1.:ting with l it:ensed contrnctor~ to CC'lllStruct the prrije\'.t (Sec. i0•l•I. !111sin~
and Profession Code: The Cont racto r's License Law docs 1101 apply 10 an owner or properly who builds or improves th,.:rt:tm .
nnd who contracts fo1 such p10Jecls \\ 1th a Conll,ll"lru(s) licensed prnsu,111I to the Cuntt ,u:lor ·s L11:c11st.: L:m)
_I .1111 exempt undc1 Sect mn _______ ~•· ·B·. &J'Jlf~r th is rc,mm
D ate _j_{-".13' ~r ,b O1\UCr tj "",ff/JJ..J.;.__"
-1ro-R_K_F .. ,1"'1s"'·--c-o_;~:..11-=,E=c,N_S_A_II_O_N_' -------------
V ECL ARATIO N
I hereby arftrm und er penalty of pciju1y one of t he fol lowing. declarat ions:
_I have aml will nmintnin n C'c,1 ificntc ofC'ousent to Self-Insure for workers· compens.lt ion. ns prov id ed for by Sectit,11 >700 of the
Lnbor ('ode. fo1· the performance of the work fo r wh ich the pt.,111i1 is issued.
_I have and will 111ni111 ni11 workers· compcnsatirn1 ins ura nce. ns required by Sect ion .HOO of th e 1.-.,bur C:utlc:. for the p,::r li.H ma11 ce of
lhe work for which 1his pen nit is issued. My wNkcrs· compensat ion insurnncc c.iffier ,md pol icy num ber (I.re:
C"nffier: __________________________ _
Policy Number: _____________________ Expircs: __________ _
_I cc11 ify th nt in the performance of the work for which this permit is is~;ucd . I shnll not employ any person in an~ manner
so ns to become S\tbjcr:I to the workers' compens,11io11 law!'. orCalifornin. and ng.ree tlmt if I slmul d bcco111c sub.iel·t h-' the
workers' compensation provisions of Section .,700 oft he Lnbor Code, I shall. fm1hw ith cnmply with those prnvisirn 1s.
WARNING : Failure to seC11 re workers' compensmion ClJVcrage is uni, 1vJ l. :met shall subject an employer to nimi,ial ptimlt ies and
civil fines up to one hundred thousand dollars ($100.000). in ndd i1iij y 1_,
11
1hc c1,s1 o f compensation. dam.lgcs a s pnHidcd for the
Section 3076 oft he Labor Code. interest and attorney"s fees. ,,
Dale: ( ('--~,--(k, A1>11lir:1111:~~K __ ----l----1i~vL~-WA_-=-___,,, __________ _
Ll<"EN~cll C<M<T RACTOII
V ECI.ARA TIO N
I hereby a mrrn under µcua lty of perjury thflt I nm licensed u11dcr pm visi m 1 of C'h npler 9 (com111c111.:i11g. wit h Sect ion iOOO) of Division 3
of the Business nnd Pro fess ions Code. and my license is in full force and crTcct.
License Class: ______________ Liccnse Num ber: _______________ _
l)ate: ___________ Contrncl or: _____________________ _
C O NSTRUCTION LENDING AGENCY
I hereby nni nn und er pcnnlty of pe1jury 1lrn1 th ere is a construction lending agenc y for the pcr formnncc o f tin: work for whid1 t his pc.,in it is
issued (Sec. 3097. Civ. C.).
Lend er·s Name: _________________________ _
Lendcr·s Address: _________________________ _
A l 'l'LICANT DECL A RATION
I hereby allinn under penalty of perjury one of the fo llow ing dcdnrations:
Demolitio n {'cnnit s-Asbcstos No1 ifi c.i1ion Feder.ii Rcgu l.itions l'fit lc 40. Pnrt6)
_Require d Let1er ofNotificntion
_I ct.-,tiry thnt the federal regulations regarding nsbcs10s removal arc 1101 npplic able 10 this projec1.
_1 cert d'y thm I have rend tins apphcation an~w:tc that the alxwe 111fo 1111at1on 1s co n ect I t1 gree to comply w11h nll C1tv anli County
ordumnccs rmd Stntc Lm,s 1clnt mg to bud dm! · nst111c110n. nnd hc1cby authonze 1ep1esc111at1ves of tlus C'1t y nnd County lo cntt.,. upon the
above men tioned prope11y for ms pec\lon puq
Appllcnnl or Agcnl S ig natu re ~ --71 , I\. I).,,. I ( -'6 ~r b
Pe nnil~c name (pr inl): ___ 1fh,w,_._,.LLL:.-:Jt..,__ __ \)..:.,._,____,,_ ______________________ _
MAYOR
Miguel A. Pulido
MAYOR PRO T EM
V incen t F. Sarmiento
COUNC IL MEMBER S
Angeli ca Amezcu a
P. David Benavides
Micilele Martinez
Roman Reyna
Sal Tinajero
Dear Prope rty Owner:
CITY OF SANTA ANA
PLANN ING & BUILDI NG AGENC Y
20 Civic Center Pl a z a
P.O. Box 1988 • Santa An a, California 92702
w ww.sa nta-ana.org /p ba
NOTIC E TO PROPERTY OWN ER
C ITY MANAGER
David Cavazos
CI T Y ATTORNEY
Sonia R. Carvalilo
CLERK OF THE COUNCIL
Maria D. Hui zar
An application for a bu ilding per mit has been submitted in your name lis ting yours e lf as the builder of the property
improvements specifie d at
(1 {£ it( C-t\J br Lif,v ~ 9b"iD4 ~A: qlrJ of, I
We are provid in g you w ith an Owner-Builde r Ackn owl edgment and Informat ion V er ification Form to make you aware of
your respo nsibilities a nd possible risk you may incur by having this permit iss ued in your names as the Owne r-Bu ilder.
We wi ll not issue a building perm it un til yo u have read, initialed you r understa nd ing of each provision, s igned , and returned
t his form to us at ou r official address ind icated. An ag en t of the owner cannot execute this notice unless you, the property
owner , obta in the prior approval of the p ermitting autho ri ty.
OWNER'S ACKNOWLEDGMEN T AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
rt_ 1. I understand a frequent practice of unlicensed persons is to have the p roperty owner obtain an "Owner-Bu ilder"
building permit that erroneous ly implies that the property owner i s provid ing his or her own labor and material persona lly. I,
as an Owner-Builder, may be held liable and subj ect to ser ious financial risk for any injuries sustained by an unl icensed
person and his or her employees while workin g on my property. My homeowner's insura nce may not provide coverage for
those injuries. I am willfully acti ng as an Owner-Builder and am aware of the lim its of my insurance coverage for injuries to
wor ke rs on my property.
~2. I understand building pe r mits are not required to be signed by property owners unless they are respons ible for
t he construction and are not hi r ing a licensed Contractor to assume this respo nsibility.
,-J 3. I understand as an "Owner-Builder" I am the responsible party of record on the perm it. I understand t hat I may
protect myself from po te ntial financial risk by hiring a licensed Cont racto r and having the perm it filed in his or he r name
instead of my own.
~ 4. I understand C o ntractors are requ ired by law to be licensed and bonded in Californi a and to list their li cens e
numbers on perm its and co ntracts .
·,J 5. I understand if I employ or o therwise engage any persons , other than California licensed Contractors, and th e
total value of my c onstruction is at least fi ve hundred dollars ($500), includ ing labor and materials , I may be cons idered an
"employer" u nd er state and federa l law.
-'( J 6 . I understand if I am c onsidered an "employer" under state and Fede ral law, I must reg is ter with the state an d
federal government, withhold payrol l taxes , provide worke rs' compe nsation disability insurance, and contribute to
unemployment compensation of each "employee." I a lso understand my fa il ure to a b ide by these laws may subj ect m e to
s~)ious financia l ris k .
~ __ 7. I understa nd under California Contractors ' State License Law, an Owner-Builder who builds single-family
re sident ial str uctures ca n not legally build them with the in tent to offer them for sa le , unless a ll work is performed by
licensed subcontractors and the nu mber of structures does not exceed four w ithin any ca len dar years , or a ll of the work is
perform ed und e r contract w ith a lice nsed general buildi ng C on tractor .
Miguel A Pulido
Mayo,
MPuhdo(@santa•ana.org
SANTA ANA CITY COU NCIL
Vmcent F. Sarmiento Michele Martinez
Mayor Pro Tem, Ward 1 Ward 2
VSarm1en1o@san1a-ana .org MMart1ne z@san1a-ana.org
Angelica Amezcua
Ward 3
P. David Benavides
Ward 4
AAmezcua@santa-ana .org DBenav1des@santa•ana.org
Roman Reyna
Ward 5
RReyna@santa-ana .org
Sal T1na1ero
Ward 6
ST1na1er9@santa-ana.org
..:r.:{_8. I under stand as an Owner-Buil der if I sell the pro perty for"Wh iel ,~his perm it is issued, I may be held liable for any
fi nancial or persona l injuries susta in ed by any subsequent owner( s) tha t result from any lat ent construction defects in the
workmansh ip or mater ials.
T\J 9. I u nderstand I may obtain more information re garding my obli gations as an "employer" fro m the Internal Revenue
Service , t he United Sta tes Sma ll Bu s iness Adm inistrat ion, the Ca lifornia Department of Benefit Payments, and t he
Cal iforn ia D ivision of Ind us trial Accide nts. I also u nderstand I may contact the Ca lifornia Contractors' State License Board
(CSLB) at 1-800-32 1-CSLB (2752) or www.cslb.ca .gov for more information about licensed contracto rs.
-(\I 10. I am aware of and consent to an Owner-Builder build ing permit appl ied for in my name, and understand that I am
the party legally and financially respo nsible for proposed construction activity at t he following
a ddress: 11'1 rPlc..:F\Joy L~ I s~ 14:rJ+ T-7--70,6
~ 11. I ag r ee that, as the party lega ll y and financially responsible for th is proposed construct ion activity, I will abide by
all ap pl icable laws an d requirements that gove rn Owner-Bui ld e rs as well as employe rs.
T'112. I ag r ee to notify the issuer of t his form immediately of any additio ns, del etions , or changes to any of the
i nformation I have provided on this form.
L icensed contractors are r egu lated by laws designed to pr otect the public. If you contract with someone who does not
have a license, the Co ntractors' State Li cense Board m ay be unable to ass ist you with any financia l loss you may sustai n
as a result of a complaint. You r only remedy against un licensed Con t ractors may be in c ivi l court . It is also important for
you to understand that if an un lice nsed Contractor or e mployee of that ind ivid ual or firm is injured whi le working on your
property, you may be h eld lia ble for damages. If you o bta in a permit as Owne r-Builder and wish to hire Contactors, you wil l
be respons ible for verifying whe t her or not those Contract ors are properly licensed and the status of the ir worke rs'
compensation insura nce coverage.
Before a building permi t can be issued, this form must be completed and signed by the property owner and
ret urned to the age ncy responsible for issuing the permit. Note: A copy of the property o wner's drive r's license,
fo rm notarization, or other verification acceptable to the agency is required to be presented w hen the permit is
issued to veri the ro ert owner' i nature.
Pri nt name of Owner ----'~_......"+-'-,,_lf-XF--V~v-....'---"----------------
AU THORIZAT ION O F A G E NT TO ACT O N PRO PE RTY OWN E R'S BEHALF
Excluding the Notice to Property Owner, the execut ion of which I understand is my personal responsib ility , I hereby authorize the
following pe r son(s) to act as my agent(s ) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Perm it fo r my
project.
Scope of Construction Project (or Description of Work):. _______________________ _
Project Location or Address:---------------------------------
Name of Authorized Agent:----------------------------------
Add ress of Authorized Age nt: ________________________________ _
Phone Number of Authorized Age nt ______________________________ _
I declare under penal ty of perjury that I am the property owner for the address listed above and I personally fil led out the above
i nformation and certify its accu racy.
Property Owner's Signature: ______________________ Date: _________ _
Print Name of Owner: __________________________ _
N o te: A copy of th e owner 's drive r's ficens e, form notar ization, or other ve rifica tio n acceptable to th e age n cy is required to
be presente d when the p ermit is issued to verify th e prope rty own er 's signature .
Miguel A. Pulido
Mayor
MPuhdo@santa-ana.org
SANTA ANA C ITY C O UNCI L
Vmcent F Sam11en to M1che!e Marune;: Angehca Amezcua P. David Benavides
Mayor Pro Tern. Ward 1 Ward 2
VSarm1ento@san1a-ana.org MM ar11nez@san ta-an a .org
Ward 3 Ward 4
AAmezcua@santa-ana.org DBenav1des@santa-ana.org
Roman Reyna
Wards
RReyna@sanla-ana.org
Sal TinaJero
Waro6
STina1ero@santa-ana.org