HomeMy WebLinkAbout10294562 - Permitcity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA,27O2 Building
Permit Counter: (714) 647-5800 lnspection Requestsr (714) 667-2738 lnspector Sectaon: (714) 647-5853
Permit #: 10294562
Pin #: 21915
EProject Address: 827 S Broadwav
Assessor's Parcel 010-223-08 Lot: '16
Unit Bldg: Address Range
Tract: SOUTH SIDE ADDBlock: 10
Building Use: Single Family Owelling Occupancyt R-3 1st FL Area Patio:
Job Type: Alteration Constr Type: V B 2nd FL Area T.l.Area:
Nature of Work: Porch Repairs Code: CBC 2016 Other Areas: yards Req,d
Existing Bldg. & Use: Sfd w/det garage Flood Zoner X-0602320276J Garage Area: Valuation:
Proposed Use: # of Stories: , ,o,", O
Description of Work: Legalize repairs to (e) front porch including some floor joists, blocking, & columns. like for like. Auth on file.
Planning Conditions: Roof to remain the same.
$5,000.00
Owner:
Address
Phone:
Tenant
Contractor:
Address:
Owner-Bualder
Address:
Gustavo Martinez
827 S Broadway
Santa Ana, CA 9270'15645
(714) 8784692
gotch+!{3968 - 1/24 '/2t118off ice: CTYH Trnns+; IAc,:ti: RE + !
Fcpti:02?70281 - :,'?i /ltri?
Tronssct ion TotolGUSTAVO IIAI{T iNI. A
Genenal plon Upd(ti: Fpe
r11 1 1600?- il6r:r(r(rtr -
Bu i ld ins
fil 1 1600?- 516r:r10r:'!:r-
ll icrof ilr & oocurent:
01116002- i7770(rtrr.r-
IDi PZun issI o{' 1
I r.r294532
3t 4? Pr
*56 /.25
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Architect /
Desiqner:
Address:
Phone:
License #
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
Soto, Ricardo
lfHll;fl\v,
arg9frl arfl | - ?4i[ rfrfrr-,r-l-
0 7 7 7 6 0 P e sfr7 601 Freift it-Fee
077760Q4|r6,9600 Plan Check Fee
07776002 57770 Microfilm Records
07776002 51601 lnvestigation
07776002 57607 Penally
08901007 2c000 Sl/lP - Categorl
07776002 57672 Bld9. Stds. Revolving
07776002 51600 General Plan Update
07776002 51601 lssuance
$I Q€?Q,:S
$2f866 '-'r..r r
$10.86
$93.17
$234.08
$0.65
$0.00
$21.25
$52.98
70263
Total
No
No
Yes
No
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#
Flood Zone Cert. Req'd: No
Every pernit issued shall become invalid unloss the work on the site authonzed by
such pemit is commenced within 180 days aftet its issuance,or if lhe wo* authoized
on the site by such pemil is suspended or abandoned for a penod of180 days after
the time the work is commenced
$21 .25
$534.49
$10.86
$0.65 $78'1.1 1
$213.86
$s67.25
lnspector MtD#. 2017-139509
01 1 16002 51600
01 1 '16002 51601
o 1116002 57770
08901001 24000
Suite Range:
Zoning: SD40Historic: No
Engineerl
$21. ?E
$534 .49
tl(r.s6
tl] rq
Dale:1012412017
Date: 05/1712018
Dale: 0512412018
Subject to Field:
Misc. Receipt:
Misc. Receipl:
Misc. Receipt:
Fee Total
Paid to Date:
Balance Due:
BUILDING- INSPECTOR RECORD
SITE.WORK DATE OWNEtr BUIt,DER DEt,CARATI0N
I h.r.by rllhn unil$ Ptnilry or p.rlury rhdr I m cr.mpr rrcn rh€ Conrdo6 Ltcn* L3$ rb, lhe followins eN,n ( S( ?0:l l 5
3urin.\s ind Profc$io. Codc): Any Ciry o. Coutrty rhi.h rcquics ! tcrmil t' c.nndd. ,lrcl im[ovc, iL'mlkh ,{ rcnrn ,ny
nrucrurc. I,itrn' irs issuamc- ako rqut i rhc spplicor for such Frnir ro lilc r si8kd sarcmni (hrt lE or shc is licenrd purulnl
ro rhc novnions of lhc Conhcroa\ l-iccn{d liw (Chaprcr 9. Conmcming wirh Sc.rio. 7000 of Division I of rhc Busincss and
ProfcrsionsCodc)urrharh.orsh.iscxcmprrhcrcfromrndrhcha\iJfitrrhc!llcsly.lcrcnrption.AnyviohlionolSccr[,n?03l5byany
lDpli(n fo! a lcrnril subjcch thc arpliconr lo acivilpenlllyoinot morclnon fivc hulldad d.lla^ ls5m)
l- trs ownu.fihc poltny, oi ry.nlroyccs wirh wrgcs ai lh.ir \olc .onDun\{riotr. will do rhc m.k:ud r1_. srBruE is nol
i.tctrdcd or oflarcd ror elc r 5(.7()44. snslnc$ ,nd Pmlcsions codc: l hc Co radoi\l,ice.scli$doesnorapnlyn,aiownfor
rhe pmpcny *ho hildsoi nrrrov.s rh.dr. dnd wlb d*\ \!ch *b* him{lror hclscll or IhouBh his or hc, own .mpk,yccs.
proviJcd rlur such i'nprovcEnh m nor inrcftkd or onLrrl lff srlc ltl how.Rr. rh, hoildir8 or inqorcmnr is sold wirhin oE
'wof.ompldtr rhc Owncr suild.r vill turc lt* turdcn oI povin8 rh,l he o! rhe Jil [n tuili or inqD!. rhc ptu,rit ror ItE pu{r{ .f
-1.
!\ o*rcr oi rhc pmp.ny. am ciclu\ilcl, conrrlcr ins *irh liccnscd conk(tr\ t, co {tu.r rrr pr,i{ (se 7t}14. Buiirc\\
and trD,tsi)n Codc: Thc Cdnr,a.kr'rl-i..ns. Lrq docs nor aprlyk, ano*ncr offl.pcnysho builds or n.froves rhcrcon.
,nd wh. coNn B loi such tmj.ck wnh 0 Od Bdon t licctrsd puNrnnr ro rhc Conrrackn\ Liccnsc li$)
l, n.\c 'rr u (Lrr S..ri(rr
,"r.,-5-2a::1Lo"Ad
UI!I.!B]TIIQ!
I h.rchy rflnn undcr Fnrlyol pdjury orc ofrhc Iolk,sir8 dccharions
Ihrvtdndwilltuintainaccnifr.rcor(ronr.lrosclllnsurcfn*orkcn.omnnsalion-a\pmlid.dfttrhySccrio..u00ofrhc
Ltrtxtr Cdrq f(x rhc p.rf.rm. ol rhc work lor rhth lhc |)cmn ( issucd
I hntt itrd rill.mi rin polkcri conrD.trsrlion insurancc.0s rcquircd htSc.rnr.lT(X)ofrlt l-tbor Codc. fn th. Frlomuncc o{
rhc sork hr which lhis pcrmilis hsucd. My *orter' comlcnsal ion insurln.ccxdcrr Fni.y.rmhd ml
PolicyNumb.r-
_l cenily rh3r in rh. pcrfortun.. olrh. qork rrr whi.h rhis l).rnir is i$ncd. I shall nor cmtloy lny Frv,n in rny tunNr
b s ro h.(,m suhFr rorhc qoircs' comFns.lion laws of Crli'omi.. andu8rccrtarirI stxrlld t comsubj.crrorh.
q ork.ri ...rp.trs,ion pmvisiotrs ol Sdiotr 3?fti of rhc tjho. Codc. I sh.ll. lhrl h$ilh unnnl, wirh rhos pn,*n,n!
W]\nNlNC Frilurc ro Burc workcn'conEnsalion colcnse is unhwt!|. md \hrll sxbjd an cmploitr lo aimnrl lcullics and
civil fitrcs uf r. otrc hundrcd
'housand
doll ).00Or. in a(liiri,nr b rhc .oi oI co rN ns,Lon. dmu8.s ns prcvidcd tu lhc
s..rn, llrT6ol rh.ltrhoraod. lnr.rc(u{lrr
"",",-5 -2 t/ - / I
I hcrcby alfird undcr lculr, of Frjury lhrt I rn li.cn*l undcr ptuvisdn nf chlprcr 9 (.on mncin8 wirh S<i hn 7fix)) of Division ]
.f lhc tlusirc\s md Pmlcsion\ Codc. dd hylircns is in fullfor-_ axl clla.r.
SI,N5IAI&NONIENI]NI,i.AIiENI:I
I hcrchy afinn ulrdcr Fnllryofp.rjuryrhd rhcrc is,..nstuclion Lidin8 a8ctrcy rb. thc l).dbrmncc of llNork r.r which rhis rrnrn ir
nsucd (Scc.1097. Civ C )
ATTIIIAIIDECLABAIION
I h.E-hy:'flinn undc! Fnally of pcrjur, o.c olrhc fdlo*ins dcclaralion\
D.nblirion PcrnirlAsb.slos Norific0rion FL{cral Rc8uldions (1irlc.l0. P 16)
Rc{tuircd lrirn of Norifi.ario.
-l.crlilylh
rhc lcdcrulrcguhrions rc8 dinstrsh.no\rcm.vrlrrcnor"ttli.rhlchrhitfrolL\l
I (cnil.v rhrr l havc rcxdrhn rmlicr!otr dnd { rc rhd rh. ahovc iitunnnri,n il..nccl I rgra l.c.mply!irhrllCiryr dC.unly
onLnxnr.\ xn,lSr31.I r\s rc arn,g r hu'ldtrrr cotr{nr.hotr. ud hcroh! rurho rizc rcrcscnrarilcs olrhh Ciry and Counry tJ cdd ulbn rhc
rtxtrc rntoNrl fo|{ny
,\ppli( nr or \[ul Sirnrl
6*/r fo-va /? a" h t, " z.
^" -5 .-2/-79,
Sel Backs
Forms/Steel/Holdowns
Erection Pads
SLAB Floor
Subf loor/VenVlnsulation
Rool Sheathinq
Shear Wall
Framing
lnsu lation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Beq.
Deputy Final Report
Enqineer Final Report
ll ,t
FINAL ///o// v .LM.
Certilicate of Occupancy
Notes, Remarks, Etc.
ID/SIG.COMMENTS
kndcf ( Addr$
UFER Ground
Flood Zone Certif .
MAYOR
MiguelA. Pu!ido
I4AYOR PRO TEM
Michele L4artinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
imorovementsff9i"oS. (r^^o[^ ^4T
We are providing you with an Owner-Builder 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 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.
6rrl l. 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.
6-42. 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.
6LZS 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 permit filed in his or her name
instead of my own.
6-lu q I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
6t*. I understand if I employ or otherwise 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
"employer" under state and federal law.
GLS. I understand if I am considered an "employer' under state and Federal law, I must register with the state and
federal government, withhoid payroll taxes, provide workers' com pensation 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.
Gfl, . I understand under California Conlractors' 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 CITY COUNCIL
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
IMaria D. Huizar
moulido@s6nla ana oro
May.)t Prc len Watd2
mrmartr.eracrsa.la-ana oro
Vrcenle Sarmiento
vsa m enro@sanra-a.a o.o soio. o@sania-ana.oro
P. Oavid Benavdes
dbenavides@sa.la-ana.oro villeoas@santa-ana oro slinaieroOsa.ra-ana oro
CITY OF SANTA ANA
PLANNING & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, California 92702
www.santa-ana.org/pba
NOTICE TO PROPERTY OWNER
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 C\ontractor.
4Ug I understand as an Owner-Builder if lsell 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.
6M.5. I understand I may obtain more jnformation regarding my obligations as an "employel'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 www.cslb.ca.oov for more information about licensed contractors.
6ta rc.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the [arty lega]ly-alq fieancia|ly responqtble for g(oposed construction activity at the following
address: 72- I > Y-., YU-l C,\t-rt-'V
6lrdl .l agree that, as the party legally and
T
trna ncially responsible for this proposed construction activity, I will abide by
all applicable laws and requirements that govern Owner-Builders as well as employers.
Glg,Z. t 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.
form notarization, or other verification acceptable to aoencv is reouired to be Dresented when the Dermit is
Signature of Property Owner Date 5.zq-/F
Print name of Owner Gv sfa,v o 11 or \.i rr e >- ----a
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 POect (or Description of Work)
Project Location or Address
Name of Authorized Agent
Address 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 verification acceptable to the agency is required to
be presented when the permit is issued to verify the propefty owner's signature.
SANTA ANA CITY COUNCIL
soloriolasanla-ana oro dbenavrdes@santaana.oro N eoas@sanla-anaoro stinarero@sanlaana.oro
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. Ivote-' A copv of the propertv owner's driver's license,
issued to verifu the propertv owner's siqnature.
Migue A Pulido Mr.heeMartinez Vcentesamento
Mayor Mayor Pro Tem, Ward 2 Ward 1
mpudolosanta-ana.oro nimartirez@sanla-a.aoro vsamie.to@sa.ta-ana.o.a