HomeMy WebLinkAbout20162096 - PermitCity of Santa Ana 20 C iv ic C ente r Plaza (M-1 9), Santa A na, C", 92702 Electrical Permit#: 20162096
Perm it Co unter: (714) 647-5800 In spection Re quests: (7 14) 667-2738 Inspector Secti o n: (7 14) 647-5853
Project Address: 1715 W McEvoy Ln
Assessor's Pa rcel: 101-531 -04 Lot: 97
Owner: Thanh Vu
Add ress: 1715 McEvoy Ln
Santa Ana , CA 927061332
Ph o ne: (714) 425-0852
Tenant Name:
Contractor : Owner-Builder
A ddress:
Pho ne:
State Li e #:
Li e Type:
Bus. Li e #:
Work ers' Compensati o n In suran ce :
Carri er :
Policy #:
Exp ires:
Building Use: Single Family Dwelling
Addition
Occupancy:
Unit:
Block : NA
R-3, U
VB
Bl dg : Ad dress Ra nge:
Tract: 2887 Hi stori c: No
Fee Type
0 111 6002 51603 Addn/Res
0 111 6002 5 1603 A ir Conditioner
01 11 6002 5 1603 FWU
0 11 16002 5 1603 De dicate d Circuit
0 1116002 5 1603 Low Voltage/Res
0 1116002 51603 Serv Mete r
0 111 6002 51600 Genera l Pla n U pda te
0 111 6002 51603 Issuance
Pin#: 92108
Suite Range:
Zoning: R1
Amount Qty Fee
0 .1 3 80 7 .00 $10 4 .9 1
90.25 1.00 $90.25
23.09 4 .00 $9 2 .36
23.09 1.00 $23 .0 9
34 .2 0 1 .00 $34 .20
49 .63 1 .00 $4 9.63
20.56 1.00 $20.56
5 1.2 6 1 .00 $5 1.26
J ob Type : Constr Type :
Nature of Work : Remodel/Addition/Serv MeteCod e: CEC 2013 Not es : Upgrade serv meter/ha ndout give n. 1-FWU = Whirlpoo l
Tub.
Planning Conditions: A/C in rear yard. All materials to match existing.
Plannin g Approv al By: Date:
Pl an Checked By : Date:
Permit Iss ued By:
Subject to Fi eld:
Brod owski , Teri / _., Date : -'9...--12/01/2016
Account#
Building Permit #: 10189377
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days a fter its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 180 days after the time the work is
commenced.
Inspector MID#: 2016-126212
0 111 6002 51 600
0 111 6002 51 603
Misc. Rece ipt:
Misc. Rece ipt:
Misc. Rece ipt:
To ta l
$20.56
$4 45.70
Fee Total:
Paid to Date:
Balanc e Due :
$466.26
$0.00
$466 .26
ELECTRICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG. CQMMF.NTS
1---------------------;--;-------+------➔-------S it e -Work
Underground
Pole Bases
Light Standards
Spas , Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor ,
Bondinq / Groundinq / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rough
Ceilings (T-Bar Rough) I I
Meter Release
I
h
Rouqh
Service Meter I -
FINAL
Notes, Remarks, Etc.
OWNEI! IIUI LDEI! DELCA l!ATION .•
I hereby nffinn undc.-r pcm1lty o r pe1jury that I mn exempt from the Co111rncto rs· License Law fo r the fo llowi11g rcn so11 (Scc.7031.5
Bus in1.-ss and Pro fes sion Code): Any Ci1y or Co1111ty which requi res a permit to const ruct. alter. imp rove. demol~l1 or repa ii ,my
structure. prior to il s issmmce. also requires t he a pplicant fo r such permit to file a s ig ned statement that he o r she is licensed o ursu ant
10 the provisions or 1he Contrnctor·s Licensed Law (Chapter 9 . C onunencing with Section 7000 of Divis ion 3 of 1hc Bus iness and
Professions Code) or that he or she is exempt therefrom and t he basis IOr th e alleged e,xcmplion . An y vio lation of Se ct io n 70.' 1.5 by any
applicant for a pennit subjt.--cts the app licant to a ci vil penalty of no t more than fi ve hundred dol lars ($5 00}.
·--r}__1, as owner o f the prope11y. or my employees with wages as their so le co mpensat ion. wi ll do the work and the stnicHm,: is no l
intended or o fTered for sale (Sec.7044. Business and Professions C'o de: The Contrac1or's License L.iw does not apply to an owner of
the propt'Tty who bui lds or improves thert.'On. and who docs such work himself or hersel f or through his or her o wn em ployees.
provided th,,t such im1>rovt.inents are not intcndt.."<l orofTcrcd for sale. If. however. the build ing or improvement is so ld wi1hin one year
of cumpk:tion. the Owner Buildt.i· will have the burden of pro ving thal he or she did not build o r imp rove the pro pe11 y for the puq:,oseof
sale).
_I. as owner o f the pmpei1y. am c .xclu sivcly contract ing with li censed contracto rs to co nst111c1 lhe project (Sec . 70-14. Business
and Pmfcss io n C'odc : T he Co ntracl or's License Law does no t apply t o nn owner of propc11y w ho builds or imp roves 1hercon.
rind who conlrncts for such projects with a Cont ractor(s) licensed pursuan1 to 1he Cont rac tor's License Law).
_I am e.xempt un der Sect ion, ________ . B. & filct J,o r this rtason.
1>111<: • \ <--1 -lb Own cr:-,C. ·-rt{/{/A,,v--
--~---~~---'-;-\"vo=R7K"E;;\wt,S~' ~C~O~~~IP;:;E°'cN:;;Sc;-Ac;.1;:;.lccOccN.,-------------
DECLA llATION
I hereby affirm under penally of perjury one of the following dccl:lrat ions:
~' h:l\'e and will ma inta in a Ce1t ificatc of Consent to Sclf.Jnsurc for worh,·s · compens.1tion. as provided fo r by Section 3700 o f 1hc
LaOOr Code, for the performance oflhe work for which lhc permit is issued.
_1 have and \\'ill maintain workers· compensat io n insurance. as requi red by Section 3700 of1he Labor Code. for 1hc pcr fon nanrc of
th e work for which th is pcnn it is issued . My workers· compe nsation insuranc e canier and po licy num ber are :
C'mTier: __________________________ _
Polic y Number: _____________________ Expirc s : __________ _
i::ii certify that in t he performance o f t he work for wh ich 1h is pci-mit is issued. I s ha ll 1101 employ .iny person in any ma nner
so as to become subject to the worktTs ' compensatio n laws of Californ ia. and agree 1hn1 if I should bec ome subject to lhe
workc.,·s' co mpensation prov isio ns ofS<."Ct ion 3700 of th e Labor Code. I shall. f011 hwi1h comply with ll1osc proYi sions ..
\~~RN ING : f.ailure to secure workers' ccm1pcnsa tion l'Ovcr:i_gc is,~.11~lmatvfi I. and slrnll subject :m ~nplo)'t::r to t1iminnl 1~m11tics and
c1v1l fi nes up to one hundred 1housa nd dollars ($100,000). m add1t10 o 1c cost of co rn pc nsa1 1011. damages as prov1ded for lh e
Section 30i 6 of the Labor C'od~. in terest and att orney's fees .
. . ..-'-
Dale: • l '1--j -f 0 Ap1ilirnnl: )(._ Ll-,C~'E"',N~S"E,-.D-(-;;;:JO~N~-1~-R~A...,C"':·1"''0"1,-! ____________ _
DECLAl!ATION
1 hereby affirm under penalty of pe1jur y that I am licensed under provi~ion o f Cha pter 9 tcommencing. wi th Section 7000 ) of Division 3
of the Busi ness nnd Professions Code. and my license is in full force and effect.
License Class: ______________ License Number: _______________ _
Dale: ____________ C ontrnclur: _____________________ _
CONSTltllCTION LEN DI NG AG EN CY
I hereby nffirm under penalty of pc~jury timt there is a consl m clio n lending agency for t he perfonnan cc o ft he work fo r whi d1 this pc.,in it is
issued (Sec. 3097. Civ. C.).
Lender's Name: _________________________ _
Lender's Address: _________________________ _
APPLICANT IJEC LAl!ATION
I hln:by afiinn under penalty of perjury o ne of 1hc fo ll owing declarat ions:
Demo lit ion Permits.Asbestos Notifi cat ion Federal Regu lations (Tille 40. Part 6 )
_Required Lctterof N01ificatio n
_I cei1ify that 1he federal regul.11ions regarding asbestos re moval arc not applicable-lo this project.
~ I> ~I cci1 1fy tha l I have 1cad tlus applicatio~~l and , te that the nlxn e mfonnatron 1s correc t I agree 10 comply \\ 11!1 all C'Hy and County
ord in ances and Slate Laws relatmg 10 build ing 1 1uct1011. and he1eby au thorize 1cpn:sentat 1,es of this C ity and County 10 enl cr upon 1he
abo .. c mentioned property fm ms pecllon pm
t-----------------------------------------------------1 A1>p lic:111torAgc111 Signat111 e "ii(. -D:1te ,. / ]_ -t -jb
Pe rmitce name (print): \c.
MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Vicente Sarmiento
COUNCILME MBERS
Angelica Amezcua
P. David Benavides
Michele Martinez
Roman Reyna
Sal Tinaj ero
Dear Property Owner:
CITY OF SANTA ANA
PLANNING & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box 1988 • Santa Ana, Cal ifornia 92702
www.santa-ana.org / pba
NOTICE TO PROPERTY OWNER
CI T Y MANAGER
David Cavazos
CI T Y ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
17 I > Y'1 c.. Evoy L A-rJ~ , 5 /f:N'D:1-MA-C/----v 7 D (:, I I
We are providing you with an Owner-Builder Acknowledgment and Information 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information .
-:r}_ 1 _ I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I,
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 inju ries to
workers on my property.
TV 2 . I understand building permits are not required to be signed by property owners unless they are respons ible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
---3J/._3_ I 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 perm it filed in his or her name
instead of my own .
~ 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
,V 5. I understand if I employ or otherwise engage any persons, other than California li censed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
"employer" under state and federal law.
\ J 6. I understand if I am considered an "em ployer" under state and Fede ral law, I must register with the state and
federal government, withhold payroll taxes , provide workers' compensation disability insurance, and contribute to
unemployment compensation of each "employee." I also understand my fa ilure to abide by t hese laws may subject me to
serious financial risk.
~ 7. I understand under California Contractors' State Licen se Law, an Owner-Builder who builds singl e-family
residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
licensed subcontractors and the number of structu res does not exceed four within any ca lendar years, or all of the work is
performed under contract with a licensed general building Contractor.
M[guel A. Pulido
Mayor
MPulido@santa-ana .org
SANTA ANA CITY COUNCIL
Vicente Sarmiento Michele Martinez
Mayor Pro T em, Ward 1 Ward 2
VSarmiento@san ta-ana .erg MMartinez@santa-ana .erg
Angelica Amezcua
Ward 3
P. David Benavides
Ward4
Mmezcua@santa-ana.org DBenavides@santa-ana .prg
Roman Reyna
Wards
RReyna@santa-ana.org
Sal Tinajero
Ward 6
STinajero@santa-ana.org
~ 8. I understand as an Owner-Builder if I sell the property f<>r •h'fhis 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.
1 \) 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the Un ited States Small Business Administration, the California Department of Benefit Payments, and the
California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board
(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
-rV 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
address: \715 l!Vf e-:f?vr:7 ~ J pA-NP.. ki¢ Cf 7../7ob
~ 11. I agree that, as the party 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 .
~ 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. If 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. It 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. If 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. · PY of the property owner's driver's license,
form notariza table to the a uired to be resented when the ermit is
issued to veri
Signature of Property Owner_--b.L....-----------------·Date: i 2 ~ / -I(::,
Print name of Owner ~ ft VIA...
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): ________________________ _
Project Location or Address:----------------------------------
Name of Authorized Agent:----------------------------------
Addre ss 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 accura cy .
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 required to
be presented when the permit is issued to verify the property owner's signature.
Plink:WP51 /CounterActivity/AssemblyBilfs/Noti ce to Property Form 03-14-2016
Miguel A. Puli do
Mayo r
MPulido@santa-ana.org
SANTA A NA CITY COUNCIL
Vicente Sarmiento Michele Martinez
Mayor Pro Tern, W ard 1 Ward 2
VSarmiento@santa-ana .org MMa rti nez@santa-ana .org
Angel ica Amezcua P. David Benavides
Ward 3 Ward 4
AAmezcua@santa -ana.org DBenavides@santa -ana.org
Roman Reyna
Ward 5
RReyna@sa nta-ana.org
Sal Tinajero
Wa rd6
STinaiero@santa-ana .org