HomeMy WebLinkAbout10193944 - PermitCify of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, cAg27o2 Building
Permit Counter: (714\ 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (7141647-5853
Permit#: lO{93944
Pin #: 125lJ1
Project Address: 1921 E Garneqie Ave
Assessor's Parcel: 430-222-12 Lot: NA
Unit: G Bldg Address Range: 1901-1921.
Historic: No
Suite Range:
Zonang: MlBlockr NA Tract: NA
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Planning Conditions:
Commercial
Addition
Addn/Tl/Roof Mtd Equipment
lndustrial/Offices
Occupancy: B, S-1
Consk Type: V B
Code: CBC 2016
FloodZone: X-0602320279J
1st FL Area: Patio:
2nd FL Area: 1083 T.l.Area: 3374
Other Areas: Yards Req'd:
Garage Area: Valuation: $159,000.00
Proposed Use: # of Stories: Total: logg
Description of Work: Add 2nd floor mezzaninerstairs with offices, storage, & 1-restroom (1 ,083 sf). Tl to comblne Suite(s) G & l,l. Nely interior part
create offices & 1-restroom on 1st floor (3,374 sf). SAUSD #3904.
F(cpt+; l]2.15',
Trqn5q,.L i r'rn
I
4:
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PBr-; i
Owner:
Addressi
Owner-Builder
Engineer
Add ress
lvy Geng
1921 E Carnegie
Santa Ana, CA 92705
(949) 445-2435
UM Media
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance;
Carrier:
Policy #:
Expires:
AQX Engineering
Qiang Xiao
1520 Brookhollow, S45
Santa Ana, CA 92705
(714) 562{510
5289
AQX Engin€erinq
Qiang Xiao
1520 Brookhollow, #45
santa Anai cA s2705
(714) 662-0510
$J r151.,/q
$7. r:rr
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #
Planning Approval By:
Plan Checked By
Permit lssued By:
NPDES lnsp
PWA lnsp. Req'd
ezeshkp , Ati
07176002
07116002
07776002
0 890100 7
07776002
07776002
07776002
$1 ,210.47
$2,576.72
$36.20
$44.52
$7.00
$21.25
$141 32
$4,O37.48
$2,576.72
$1,460.76
o Date: 1011312017 Misc. Receipt; 7016'1
Oalet 0112412018 Misc. Receipt:
Date: 05/07/2018 Misc. Receipt:
Subject to Field:
Account#Total
51601 Permit Fee
si600 Plan Check Fee
57770 Microfllm Records
24000 SMIP - Category 2
57672 Bldg. Stds. Revolving
51600 General Plan Updale
51501 lssuance/New Structu
n
B ki, Teri
No
NoPlanning lnsp. Re
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every pennit issued shall become invalid unless the wo* on the site authotized by
6uch pemit is cofinenced wilhin 180 days after its tssuance,ot if the work authorized
on the site by such pormit is suspended ot abandoned lot a peiod of180 days aftet
the time the wotu is commenced.
lnspector MtD#. 2017-138228
01 1 16002 51600
01 I 16002 5160'1
01116002 51612
o1116002 57770
08901001 24000
$21 .25
$1,351.79
$7.00
$36.20
$44.52
Fee Total:
Paid to Date:
Balance Due:
Phonel
Tenant:
Contractor:
Address:
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
BUILDING. INSPECTOR RECORD
SITE-WOBK DATE IDiSIG.
Forms/Steel/Holdowns VMErection Pads ,/a
UFER Ground t- I t u?
SLAB Floor
Roof Sheathinq
^?4ry",{Shear Wall (l>11[E lr ll
,t I
IA.,L.iFramingtl)YIrB T ,Y t(.raf d^^uitl ',-"I{lnsulation/Energy I \)l
utapblt)Drywall I ?,
Ext./lnt. Lath /t L
Brown Coat
Masonry
Pool Fence
av4<,4-T-Bar r$I .)/
Handicap Req uv
Deputy Final Report
Engineer Final Report
Flood Zone Certif
'^tqer'J,FINAL t6ltq 1i ?9./
Certific ate of Occupancy yl
Notes, Remarks, Etc
(,WNER ITUILDER I)EI,('ARA'IIoN
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slrucrurc. lmrlo i* (surrcc, rho rcquiic\ thc rffli.rnr r(r\u.h lf inil t,lilc. siSrrd starcnrnl lhrr lror shc is liccn{d Phuxnr
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CA!fl8I]qT9!I,ENUINC.AGINI:I
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AITUCINLIEIIIIBAUqN
I hcrc{ry llinn undcr rcnslry ofpcrj'ny nrc ol ihc ldlk,winr dcckrdrn,ns:
Dcnmlirion PcrnrirsAstE(os Notificorion [cdc(l Rcsulurions (rirlc 40. Plna,r
-Rcquncn
l.ttcr ol Nolilic.rion
l.ral i.Suhrion! rcB&din8 ishc{or rctrxx.l rrc nor ryplico6l.
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cl0riry to huildiu cotr{rucrioo. rrd hcrcnynurhorizc rcrcw
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COMMENTS
Set Backs
Sublloor/VenVl nsulation
Lc crs Addcs
-121rc
-T------
MAYOR
MiguelA. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILMEI\4BERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan \4llegas CITY OF SANTA ANA
PLANNING & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box 1 988 . Santa Ana, Califo-nia 92702
www.santa-ana.org /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
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
l\,4aria D. Huizar
improvements specified ^, l(Zt €2 ,s
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.
- 4 I I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
builifing 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.
442 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.
71q5. 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.
ZAC. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numUers on permits and contracts.
71lS I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total \ialue 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.
1/l/-q 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and
fedetal 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.
f47 . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residbntial structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
mouirdo@sa.ta-ana.oro
Mayo. Pro Tem, Ward 2
mimarlinez@santa ana.oro
vcenle Samiento
vsamienlo@sanla-ana.oro isolonc@sa.la.ana or0 dbenavrds@santa ana.ora ivilleoas@sanla-ana.oro slinaiero@sanla-ana oro
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.
Z
fi na ncta
. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any
I or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
f/t /z.rr
workmanship or materials.
/ LrB. I understand lmayobtain more information regarding myobligations as an "employer'' from the Internal Revenue
S6rVide, 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.qov for more informalion about licensed contractors.
),GlO 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:
2 {^ll I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by
all apblicable laws and requirements that govern Owner-Builders as well as employers.
=hlZ.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
ii-forniation 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.
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. Nofe.' A copv of the propertv owner's driver's license.
notarization or other verification table to the en ts when the it is
th owner's natu
Signature of Property
Print name of Owner ,,h c:Lt t 6€4^4
Owner Date
-JAUTHORIZATION 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)
POect 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 ,illed out the above
information and certify its accuracy.
Property Owner's Signature Date
Print Name of Owner:
Note: A copy of the owner's driyer's license, form notarization, or other verification acceptable to the agency is required to
be presented when the permit is issued to verify the propeiy owner's signature.
. i-,r,!: t,-i:i :1-, ly !.:j.,:.: _i:: .. r.-. -. i. rr :r',_ | . - : :' ;..' a
SANTA ANA CITY COUNCIL
moulido@sants-ana oro
Mayor Prc Teh. ward 2
mimarlrnez@santa-a.a o.o
V cente Sam ento
vsam ento@santa aoa.oro isoloriolosanta-ana.oro
P. DBvrd Be.avides
dbe.avides@sanla ana oro srnarero@sa.la-ana orovrl eoasiasa.la-ana oro
Address of Authorized Agent: