HomeMy WebLinkAbout10195256 - Permitq
Assessor's Parcel 099-21247 Lot NA
Unit Bldg: Address Range:Suite Range:
Zoning: R2Block: NA Tract: NA Historic. No
city of Santa Ana 20 Civic Center Plaza (M-19), Santa A.ra Ct 92'/02 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Permit #: lO{95256
ein*: J 32a2s
Building Use: Single Family Dwelling Occupancy: R-3 1st FL Area: 240 Patio:
Job Type: Addition Constr Type: V B 2nd FL Area: T.l.Area:
Nature of Work: Addn Code: CBC 2016 other Areas: yards Req,d
Existing Bldg. & Use: Sfd Wporta-cochere Flood Zone: A-0602320139J Garage Area: Valuation:
Proposed Use: # of Stories: Total: 240
Description of Work: Convert existing aftached porte-cochere into a familv room & full-size hathroam
@.FloodzoneA,Existinghouse104Gf,proposedaddithhztsf;lesFthan40%.
Planning conditions:
547
$31,246.00
k.D t a ! fi:r?g 1 9f r r
Owner-Bualder
Enganeer: Frank Y C Liu '' :'
Phone:
Tenant:
Contractor
Addressl Address
Peter Pham
5302 W Roosevelt Ave
Santa Ana, CA 927032428
(714) 642-6608 Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation Insurance
Carrier:
Policy #:
Expires:
Frank Y C Liu
P O Box 212
Cerritos, CA 90703,,
(s621832.4fl4., : ,
64806
cenerat grtiiaing oesi;er
Mike Huynhl :
P O Box 2198 :
westm i nstbl,i CA'gzs8-g' '
(714) 448:s515
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #
Planning Approval By
Plan Checked By
Permit lssued By
NPDES lnsp. Req'd/No
lns R d
n scaprng
Date: 06/11/2018
Date: 05/2512018
Date: 06/11/2018
Subject to Field:
o77750 02
07176002
0 77760 02
08907007
0 77750 0 2
017760 0 2
017160 0 2
57607
53600
57770
2400 0
57672
57600
57601
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
Orozco, lvan
Maza(ji, Zac
Amsden, Julie
Account#
't0461
Total
l,4isc. Receipt
lVisc. Receipt
l/'lisc. Receipt
$507.86
$514.39
$s0.68
$4.06
$2.00
$21 .25
$s2.98
$1 ,153.22
$514.39
$638.83
o Fire lnsp. Req'd: No
Police lnsp. Req'd No
Flood Zone Cert. Req'd. No $21 .2s
$560.84
$2.00
$50.68
$4.06
Fee Total:
Paid to Date:
Balance Due:
Evary pennit issued shall become invalid unless the work on the site authorized by
such permit is comfienced within 180 days aftet s issuance.or if the work authoized
on the site by such pemil ts suspended ot abandoned fot a peiod of180 days after
lhe lime the wo* ts commenced.
lnspector
01 I '16002
01 1 '16002
01 1 16002
01 1 16002
08901001
51600
51601
51612
57770
24000
j
Planning lnsp. Req'd; Yes
Proiect Address: 5302 W Roosevelt Ave
Owner:
Address:
MtD#. 2018-140775-
SITE-WORK DATE ID/SIG.COMMENTS
Set Backs ---1 /-^;-)
Forms/Steel/Holdowns '26 /3,cea Yr"'
Erection Pads
UFER Ground
SLAB Floor
Subf loor/Venti lnsulation
Roof Sheathino 81 7t a4n
Shear Wall tg UA/r(?)x
Framino Ito >rr 24l,,
lnsulation/Enerqy 7 t4 -.u*rd,)
Dryrqall q/201"{ -'Exjlnt. Lath q t'7 I g ..1-,(24{r I
-Eiown Coat 161-r-tl t 'qt(ad
l\4aso n ry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report \
Flood Zone Certil.
iirn*dFINALl1,l9t (*'4)
Certificate of Occu anc
Notes, Remarks, Etc.7
BUILDING- INSPECTOR RECORD
OWNER BTIILDER DELCARATION
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Bu\incs and Pnrc$nrn Codd) Any ciry .r Coutrry whi.h icqntrc( r Fanrir lo con{o.r, rlrd. imnrorc. {rcmlirh ot rcpat ony
{tu.rrrc. rrior i, \ ksurtrcc, aho rcquncsrhc alplicrtrr ix such p(rnir ro lilc r siamd {0rcm ihrr hcor shc h li.cisd PtrNIntrl
ro rhc [ovi\i,,n\ olrtr Cont].r.i\ Lrcnsrd hw (Chiprd 9. CoNnencin8 *irh Scdn TfiX).1Oivision I of rhc aurincss rnd
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dr *" *.,,rr *,0. s".,
o," z /rr/ "arg o"V ?E-Ig & ?+14A./ . W(IRKFR{ C(ITTPLNSAT!(,N
DECIAf,AIION
I hcrchy alfiirn undcr pcnllryotperuryoe ofrhc followine dftldrln F
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tjb.r Cod.. fi,lhc p.ifonErcc., rh. *.* f(, whi.h rh. Fm is issuci.
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hrlc and *iltnri rin porkcH .omrcnsolion insurcncc, as rcqoird hys..Lotr 37u)ollhc Lll,or Codc, rorlhcrc otmonccoi
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Poli.yNunrl{r-
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rorkc!{ onnensarion pmvi\n,ns of Scdbn ll00 ol rhc bbor C(lc. I lhill. lirnhuirh .o llly wnh rhos Pmvi\n,ns
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cilil finrs up k' oN huftlrcd rlnusand dollm ($lOll.UI)). irr addiln,n i(, rhc.o( ol conrpenslrioi. datugts a\ Piovidcd l'or th.
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b/L]aot$ N.PE-rER ?tl4,t1urxNl:ulllNMlq!]a
DEC| At{\]r()N
I hcrhy alfirnr xndfi p.trrliy of pcrjur,lnar I a'n licenkn under pmvi\n,n orch,fls 9 (com.Ercins wirh sc.rion 7m0r oll)ivnion 3
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-
LANETXJ]qI9NIINDUC-dCrNI}'
I hcrchy alltnrrid.r F lrtorlcrjlryrhdlhcrcntrc.trnrudi(rbndiicr!.ncyrdrhcl)rrr.,nmmcolrh.*orkrorwhichrhisPcn.irh
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btrdcr's N.,ncr
-AELTCANLDISAAAIIAN
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Dcnolirion Pcrnik Ashc$os Norificntion Fcdcr.l RcEul!'ionr (_rnt.1()- Pnn6)
Rcquir.d lrn.r or Norifi calion
l.cnnyrh[ rhclc(lcr{lrcgul]rions rc8Iding"sb.(oic n,!r1tu. for rp|]li.xhlc hrhi\ pqcrr
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o ininccs a Slorc l-aws rcl in8 b firiklin! .on{tucrn[ atrd h.t hv runrrizc tnrc\cnbri!.\,]frh'\ any rnd Counryro cnrcr llloi rhc
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MAYOR
N4iguelA. Pulido
I,{AYOR PRO TEM
lvlichele Martinez
COUNCILIVEI\4BERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
Sal Tinajero
Juan Villegas CITY OF SANTA ANA
PLANNING & BUILDINC AGENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, California 92702
www.Santa- ana.or9. pba
NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
o
We are providing you with an OwnerBuilder Acknowledqment 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 underslanding 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.
p?__X-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. 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 property.
p L__d 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.
PP 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.
fl 6. Iunderstand if Iam 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 compensation of each "employee." I also understand my failure to abide by these laws may subject me to
serious financial risk.
lP 7.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
SANTA ANA C{TY COUNCIL
ACTING CITY MANAGER
Gerardo l/louet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
N4aria D. Huizar
moulido@saoia ana oro
Mayor Pro Tem. Ward 2
mrm6ninezrosanla ana.oro
Vrcenle Sar.flento
samienlo@saola-6na oro Eqbli9@sa!lai!3!!s
P Dav,d Be.avides
dbenav deslasanla an6.oro rvilleoaslasanl6-ana oro st naierorAsanta ana.oro
lp 3. lunderstand as an "Owner-Builder" Iam the responsible party of record onthepermit. 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.
?P 5. I understand if I employ or otherwise engage any persons, other than Caljfornia 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
"employer" under state and federal law.
licensed subcontractors 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.
P P 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the
workmanship or materials.
PP 9. lunderstand lmayobtain more information regarding my obligations as an "employer" from the lnternal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the
California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board
(CSLB) at 1-800-321 -CSLB (2752) or wlvw.cslb.ca.qov for more information about licensed contractors.
pP 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
P? tt.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.
I P 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 againsl 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 coDv of the proDertv wner's driver's license,
form notarization,ot other verification acceDtable to the aoencv is reouired to be Dresented when t.he oermit is
Signature of Property Owner Date: oL ltr/z orR
Print name of Owner E
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 llle 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
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 yerificalion acceptable to the agency is required to
be presented when the permit is issued to verify the property owner's signature.
SANTA ANA C TY COUNC L
mDUrido@sanla-ana orq
Mayor Pro Tem. Ward 2
mimaninezrasanla-ana oro
V.ente Sam e.ro
vsam e.lo@sa.ta ana.oro so oro@sanla-a.a oro
P Davrd Benavides
dbenavidesOsanta-ana.oro N eoas@sanla-ana oro sli.a erorAsanta ana.o.o
issued to verifv the Dropertv owner's siqnature.
D1J A T)
Address of Authorized Agent:_