HomeMy WebLinkAbout10196491 - PermitCity of Santa Ana 20 civic Center PIaza (M-19), Santa Ana, cA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O{9649{
Pin #: 55852
q
Project Address: 2017 S Forest Ave
Assessor's Parcel 408{48-02 Lot: 45
Unit Bldg: Address Range Suite Range;
Zoning: R'lBlock NA Tract: 4606 Historic: No
Building Use: Single Family Owelling Occupancy: R-3, U 1st FL Area:
Job Type: Reroof Constr Type: V B 2nd FL Area:
Nature of Work: Reroof Code: CBC 2016 Other Areas:
Existing Bldg. & Use: SFD w/att garage Flood Zone: X-0602320257J Garage Area
Proposed User # of Stories:
Total:
Oescription of Work: Reroof Wt.o.-Remove and apply comp shingles/sheathing to remain/handout given
Planning Conditions:
Patiol
T.l.Area:
Yards Req'd:
Valuation: $7,924.00
Owner:
Address:
Phone:
Tenant:
Adelfo De Los Angeles
2017 S Forest Ave
Santa Ana, CA 927044722
(714) 437-1609
Bstrh+:43ggl - 5/21
Off ice: CTYH Tr'i1r,
R.ptf:tu267311 - 'l
fronsort i on tot (l IADEI.FO CL I
'ienenol Plon UpdotP
rr11 160r-r?- 5l llrl[:trir-
8u ild ine
r:r1I I6r:10:r- 51r'!:r 10fl,r-glde Stds Revolv ine
(r11160r:r?- 5111?0r l
Contractor
Address:
Owner-Builder
Address
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #
,t
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
N/ar, Escarlel
Hernandez, Kathy
Date: OSl2'll2O18
Date:
Dale:0512112018
Subject to Field.
Misc Receipt:
Misc Receipt;
Misc. Receiptl
$308.52
$1.00
$21 .25
$52.98
o tt t ddd[t' tfs o t Permit Fee
07776002 57672 Bldg. Stds. Revolving
07776002 57600 Gene?l Plan Update
07776002 51501 lssuance$
No
No
No
Fire lnsp. Req'd;
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
il: Accounr#
Every pemit issued shall becofie invalid unless the wo* on the sile authoized by
such pemit is commenced wilhin 180 days afler its issuance ot if the wo* aulhotizecl
on lhe site by such peftnit is suspended or abandoned for a period of180 days after
the time the work is commenced
$383.75
$0.00
$383.75
lnspector Mto#. 2018-143447
$21.25
$361 .50
$1 .00
Fee Total:
Paid to Date:
Balance Due
Engineer:lt
Total
01 1 16002 51600
01 '116002 51601
01 '1 16002 5'!612
SITE-WORK ID/SIG.COMMENTS OWNOR BUIt,DFJR T'EI-CARATION
I hcrchy llftm lndcr pcmlty or p.rjlry rh,r L'n cxrmrr ri(,n rhc Cork.ct,i Liccn{ l,sw f(tr rhc tull,)wirrA rcisoD (Scc.?trll.5
Ausircs rnl Pdasn, Cod.) Aoy Ciiy o. Counry which r(tuir$ r pcnnir k, drnnru.r. ilrcr. nnProrc. dcmolnh or rcPrn 3ny
{rxc(c. prir nr ns isurnc.. rln, rcquncs rlr lpflicrnr lor srh Fnnn tu ik . sisnci n cn..r rhar ht or shc L\ licci{d N^urtrr
ro rhc ,)l,li\iotrs oi rh. contrctoil t,i.cnscd ljw (Chiltcr 9- CommcBin! *irh s.cllun 7(xD of Divisi()n I olllE B,\incs\ rnd
Proicssi(nrsCodc)orrhrr hcorshc hc\cnrfl rhcrefro lnd rhc hr\is f lhc lloSddcxcnrlriotr.Atryvnnnrn,nols(lihT0.ll5bydiy
!pplicanr rbrrrE mirsul,jcchihc rmlicrnr u r .ivil tcnrlry or n.r xtrcrhrtrlivclrndrcddoll$($5lr))
I. as o*nciorrhc ptutEdy. !r nrt cnflorccs *ilh w0S6 $ lhcir sk omp(n\xrion. ailldo rh. *o* dx, tl'. stndm n mr
inrctrden or oficred lor slc (Sa ?04.r. Burin * rid Profcs\n,ns Cdlc: Th. Crn mdois t.tcnsc l-rw docs nor arlly ro rn owncr or
rhc nn)II rt wlh huilds or inprovcs rlENn, oM wh. do.s su.h wn k him\clf.r hc!\clf or rht,lBh hi\ or h* oqn cnDloycc\.
F)vidcd thar su.h inllrow'mnh r. nor imcndcd or offcr.d I(r salc Il hnscv.r. lhc buildirS or imProtcnEnr h $ld *irhi" 'f, ]tr
oaconpLrion. lh. owncr Buildcr $ill hlr rh. hunlcn .l pmvin8 rhli hc or qhc did ,xn boild or inlmtt lhc pmocny ,or rhc purlx,r of
-1.
ns o\rncr ol rlrc Jn)Dcn y. rr cx.lusivcl, ro rrmr i',9 *irh liccNctl ..ntrrttrs ro con\Ncr rhc Pmjccr (S( 7Or4. 3 \in(\
rtol Pnni:\\inCodc'lhcConricktr'sLiccnscLi*docsnollnDlyto0no$ncrolpnp.ny*hobuild\.rinuovcslhocon.
and who c.nrm.r\ Iorxuch pmj$rs wirh a contrcrons ) liccn\.d r r. rh. Contr 0-s Liccn\c lr*)
-l
rrrc\cnr uD(lcr S..rior . B & I'c
D[rLt8trullN
I lrrcby rliirm undf p.nrlry orn rjxry onc ofrhc lnllowirg d.cl rdri.rs
-lh!!cudwillrui
ain!Ccnificrr.otCoi*nrt,sdltlnsur.r.rworkLyJconurnsnlion.$ povidcdli,rhrSccrionlTOroirhc
bli* Qric. rorrhcl)cnornunccoflhc work ao.*hich lhcpennil ir hst.d.
lhrvc rtd sillmrnrrrin *orkcrr cotrPtisrrnr in\!rrncc. r\ rc!!ncd bySc.riqr l7(Xrolrlt l,ihtC{dr. trrh{ PdnrDrr.col
lhc work lnrwhichrhi\ pcnnir is i\\!cd Mywork.'J co r)^..n\rriirr i'sunf... rlcr od Frll., nunh.rnR
-l
ccniryrilr in rhc |xrfortu..c orrh. *or* for whichthis pcirni n hsuc . lshallnor cn,fl,)yany Fs.n in.nyflunrcr
$ as r. trco'tu \ubjc.t k) lhc workcs onpctrernu hwroacllinrmia. and 4rc rhd iil \hould hcconE sl'Fr ro rlt
sulr'\ .,r trtr\nr o t)'!,vr\io N rl s..ri. r.liln)ol 1h. l.xhtr (i . I \l tunhq h coDrrly *iih rh.r niixisn,ns
WARNIN(i Frihrd k, \c.urc vorkcr conrprn{(iotr orcrngc i\ nnla itr cnri oycr ri cri inrl |In ht\ tr d
.ivil fitrc\ ur t, otrc hu|drcd thotrsrtrd doll0r (Sl(x).O0o). io Mdil Dctrsitnn. drnrilcs r\ oridd ntr r[.
S.crnnr 1076 ofrhc tjtxtr Co'lc. idcrc{ lnd ronry s
DECIAXAIION
I h!rchy oinmu crI].nahr.r!.rrur!rh,r I rn liNns.d undn rmvis,otr of Chaptcr 9 ($mrEkiog qnh sccrion 7ur0rolDivhin:l
ol lhc ausincss md l'rsfc$ions Codc. ard my ltcosc t in full ttr c ll cffc.r
caxfff,uuuNrENDac-dliEN{.:x
I hcEhy lnnm undcr lcnaltyofpcrJurr rhd rhdc h r Lvsrru.ri,n hMin8.8ctrcy for lhe Pclrom,n.T orrh work lo. nhich lhis pcrmir is
h{.d (Scc 1097. Civ C ).
AELIAANLDECI./IS{IIAN
I tf,rcb,dlinnundcr pcnnhyolpcrjory on or rhc r(rbwinA dcclr ions
DctrblInr Pcfltri(sAsbr(os Norificrrion Ftdcrul Rcarhnlx ('f irb.r0. PM6)
Rcquied btr(.f NolifE ion
I lcnilyrhli rh.lldcrrlrcSul i(i rrc8 difg \hnos rcnrivrl rrc n.r 'mliuhlc r, rlri( p' ojlrl
-l
c$liiyrhrr I hrlc rcad rhnattli.dl'r url srrc I r l rgr( r).onrdy\ [rllCiryrnd((]unry
ordinlmcsnnd srarc lrss rclding h burldir.e.otr{rcp'csc rrri\r\ ofrhi\ ciry rtrd counly n, rnr.r trFn r)f,
lwc trrnridrcd |(,rcny ihr iD
,\ppli.nnl o./\E.nl SiAmturc v
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
A\,
Roof Sheathinq q-2J1y V.W{tr,)
Shear Wall
Framinq
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
lVlasonry
Pool Fence
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
A
FINAL 5"9-lr Y.W;A)
Certilicate of Occupancy u_-/
Notes, Remarks, Etclt
t14-
BUILDING. INSPECTOR HECORD
DATE
Sublloor/Venti I nsulation
T-Bar
kn'lcf { Addr\(
-
t---+---
*,$ANIA
.ANAffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1938 (l'I-19)
Santa Ana. CA 92702
(714) M7.5300
u?'ra,v. s a n ta-a i a. o r:l
rNSP-02 2or3 CRa
This document mqy be lound ot
(check one\
h t1o://,,v.,,r,,r. sa n ia-a na.orq 'pbai
(Please use a black or blue ink ball-point pen)
Project Address:2017 ], Frr>{tf
lanl,qxl
Contractor:
W tot P"1flrl
License #
Pe rm it N umber:
Property Owner:
State of California requires that smoke and carbon monoxjde (CO) alarms are installed in residential
bu ildings.
California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define
the requ ired locations.
4\ ,o,n boxes below must be checked:
d Crrbonmonoxide atarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each level of the dwelling. Alarms are requlred in bedrooms with gas-fired
apylaoces (i.e. hot water heater, cooktop, furnace) or a fireplace.
E Smoke alarms: Are installed in each room used for sleeping, in each hallway outside ot a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved
by the State Fire Marshall (SFM). Battery life must be 10 years.
I hereby certify that I am the contractor or the property owner of the above project. I further certify
that smoke alarms and carbon monoxide alarms ha're been installed in compliance with the governrng
Codes and have been tested to be functional. I, also, hereby certjfy that I will retest the alarms per the
manufacturer's instructions.
tr Licensed Contractor Property Owner
N 'tlxJ 4do J" finklerSignoture:Dat e:5 -3o-Zd',
Have this completed form and the job-card readily available on final inspection!
Smoke & CO
Alarm Affidavit
NoTE: rh6 self-certification is only used lor projects thot afJect the ErTERI9R of the stucture. This
process is applicable ONLY to projects where dccess to the interior of the dwelling by d Sdntq Ana
lnspector is not required.
MAYOR
MiguelA. Pulido
MAYOR PRO TEIV]
Michele Martinez
COUNCILMEI\,4BERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
INTERIM CITY I\,4ANAGER
Cynthia J. KurE
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNINC & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, California 92702
www.santa-ana.orq/ pba
NOTICE TO PROPERTY OWNER
An application for a building permit has been submitted i nlv name listing yourself as the builder of the property
improvements specjfi ed at
We are providing you with an Owner-Builder Acknowledoment 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.
ili.r.,understandafrequentpracticeofunlicensedpersonsistohavethepropertyownerobtainan"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. l\ry 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.
fi A r. ,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.
fl L, tunderstand as an "Owner-Builded 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 llled in his or her name instead of my own.
/ $0. , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
/ 0 a. , understand if I employ or otheMise engage any persons, other than California licensed Contractors, and the total value of
my construction is at least flve hundred dollars ($500), including labor and materials, I may be consadered an "employer" under state
and federal law.
fl-LU. , understand if I am 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 ofeach "employee." lalso understand my failure to abide by these laws may subject me to serious financial risk.
fl D , , 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 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.
"/l 'r'll Ug. tunderstand asan Owner-Builder if lsell the property forwhich this permitis issued, I may be held liable for any flnancial or
personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
mouIdo@sanla-ana oro
Mayor Pio Tem, Wa.d 2
mrmart'nez6sanla-an. oro
Vcenre Samrento
vsam ento@sanla-ana oro lEgbr!9@s4la=a!a
P. David Benavides
dbenavds@s6oia ana.oro rvilleoas@santa ana.oro stna ero@sanla ana.oro
Dear Property Owner:
h
ff-NS. f understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the
United States Small Business Administration, the Califomia Department of Benefit Payments, and the Califomia Division of lndustrial
Accidents. lalso understand lmay contact the California Contractors' State License Board (CSLB) at 'l -800-321-CSLB (2752) or
www.cslb.ca.oov for more information about licensed contractors.
A [ ,0. tam aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party
legally a
address
nd fi nct res construction activity at the following
X D f ',. f agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
epplicable laws and requirements that govem Owner-Builders as well as employers.
[\t Z. t ugr"" ,o 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 llnancial loss you may sustain as a result of a com plaint.
Youronly remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand that if an u nlicensed
Contractor or employee ofthat individual or firm is injured while working on your property, you maybeheld liable for damag es. 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 ovyner and returned to the
agency responsible for issuing the permit. Nore;A coDv of the Drooertv owner's license, form notarization, or other
,s to be ted when the ,s ,s
sionature.
Signature of Property
Pdnt name of Owner
Owner Date
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 file the documents necessary to obtain an Owner-Builder Permit for my
project
Scope of Construction Project (or Description of Work):
Address 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
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 signaturc.
PL ink:Vr' P51 lCou nlerActl\,l1y.rAssem blyB ilis,'Notice io Property Form
SANTA ANA CITY COUNCIL
mo!ildo@sanla-ana.oro
Mayor Pro Tem, Ward 2
m hanrnez@sa.ta ana oro
Vicente Samienlo
Earmienlo@sanle-ana.oro isoronorosanla-zna.oro
P. David Benavdes
dbenav des@'sa.ta-ana oro
Project Location or Address:
Name of Authorized Agent:
Phone Number of Authorized Agent,
Print Name of Owner:
Jlan Mllegas SalTinaierc
Ward 5 Wa.d 6
ivilleoas@sanla-anaoro stinalerolasanra-ana.oro