HomeMy WebLinkAbout20165863 - PermitPermit #: 20165E63
Pin #: 74469
Project Address: 2605 W Hall Ave
Assessor'sParcel: 414-061-04 Lot: 2
Unit:
Block: NA
Bldg:
Tract: 8325
Address Range:
Historic: No
Suite Range:
Zoning: Rl
q
Owner:
Address
Phone:
Tenant Name:
Conlractor
Address:
Eugenio & Petra Medrano
2505 W Hall Ave
Santa Ana, CA 927045411
(714) 787-6093
Owner-Builder
Fee Type
Dedicated Circuit
Serv lvleler
General Plan Update
lssuance
Amount
23.87
51 .29
21 .25
52.98
Fee
$23.87
$s1.29
$21.25
$52.98
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
llnt rhi; rr:- /Irriifi i te: (:l Yli
o{t ron lotc!
L,19:n io I !-'.1,:.r r":
,:enerql PIqn l-lpdr,l:
trl 1 l6irf,r:-
$129.1{
$11!-ts
Building Use;
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Miscellaneous
Service Meter
R-3, U
VB
cEc 2016 Notes: handout given
\K 051141201a
Account#
Misc" Receipt:
Misc. Receipt:
Misc. Receipt:
Total
ernandez, Kathy
Every pormit issued sha become invalid unless lhe wo* on the site
authonzed by such pemit is commenced within 180 days aftet its
tssuance, or if the work authorized on the site by such pemil is suspended
or abandoned fot a peiod of180 days after the time the wotk is
cotnmenced
lnspector MID#: 2018-143324
01 1 16002 51600
01116002 51603
$21.25
$128.14
Fee Total:
Paid to Date
Balance Due:
$149.39
$0.00
$149.39
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA127O2 Electrical
Permit Counter: (714]-647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
01'1 16002 51603
01116002 51603
011 16002 51600
011 16002 51603
Qty
1 .00
1 .00
1 .00
1 .00
Phonel i
Occupancyl
Constr Type:
Code:
Date:
Date:
Date:
ELECTRICAL-INSPECTOR RECOHD
APPROVALS DATE COMMENTSID/SIG.
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Siqns (monument)
Life Salety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under Slab i Floor A
Bonding / Groundinq / UFER b-zz-l(k"wlu
Translormers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilings (Hard & Solfit Rouqh
Ceilings (T-Bar Bouqh)
Meter Release
Rouqh
Service l\/eter (,-t1 -lK Pr.Vm)
FINAL 6-27-lC y,\4w
Notes, Remarks, EtD. I
I
OWNER BUILDER DELCARATION
I hrrchy rf6'n uidcr Fnalty of pcrjury rh.l I mcrcnull ftonr lhc Co.rracn,n Lhctr* llw fd rht follosing rcr$n (S(r0ll.5
Srrincs lnt l,ron$io! C.dc): Aiy Ciry or Counry *hich Eqrndr a p.rn r to cotr{ruc], altcr, ilnpovc. dcnxni\h oi rcl^ir any
dncrnrc. prin ro irs issuancc.,lio.cqunc\ rh.,ppli.inr nrsu.h tEmit ro,ilcn risncd rlllcmnr lh,r hcor shc h li.ctrxcd Pursuanr
lo rhc ,x)!isn,ns ol thc Contmclols Liccnsed L(, (Cheplcr 9. Co nnch.i.! wirh Sc.(ion 7(x)O.f Divhion :l oflhc Butincls and
Pn'fc$i(nrsCodc)orrhatlrorshchcxcmpllhcrcfronrandlhchrnturrhcdltctcdcrc.ll)liotr.AnyviolalionofSsri.nT0.ll5byrny
!pplicsnrior ip.rnn su6rcccrhc spplicsnr ro acivilpcnrlrtotnor frncrhrn 6vc hutrdrcddollr\($5U)).
I.asow.croflhcproFfty,ornrycmployaswirhwascs!srhcirslccodp.nuri.n,willdolh.eorkad6c(rud@i\,
inrcndcn or oficrcd lor slc (Ss.7044. Blri.eri and Pmte$io.s Codc Th. clrnrmcrols Liccnsc tiw docs ml atplr 16,n oRncrof
rhc pmpcrly who brilti or irqm{s rh.mn. and who d@s skh mrk hi rcllorh.rsclforrhr,lBhhi\dh.rown.mnlorccs.
lmvidcd rha! such imprcrc,rcnkemr inrcnd3l oroitcrcJ finsab.li noscwi rhc hiBi'E or imfioromni issklwirhinonc )rd
oa compbtion. lhc Owrer Buildq *ill hrlc rhc bunle. of povitrg rtar he or shc did tut hoill or nrqe( rhc pmpcny for rh€ purlsk ol
-1.!\oencroithcpmpcnr.r'ncx.lu$vcly.onrr.rinA*irhli.ctrrcd.onticlonbconsrruclrhcpniF.r(S..7tB,l,Bu$m$afrl A L\sion Codc: TheCofiNrols Licctrse Lnw docs nor npDlyro !n o*rcr ol fn,F-nt *h{J build!.r im|rovcs rhcrcon.
r d *ho onktrdstor strch p(,jer\sithaco trn,(\) liccn\.d lu^u.nl ro rhc C.nk0ctois l-iccnE trw)
_lrrcicorpr undcr S.did .B & P.C. forrht rc$on.
Da,r ,,**. V 4" o€4 !(:,br6lc(ritENrAlea- lr[claraln]!
I h.rht lrfirm und.r rcn,hy of rcrjury o.c ofth! lbllowin8 dcclarntions
,Lr<e d I o{!(.9)
-lhsvcard!illnsinllinaCrnifi.arcolCon$nrroSclf-lnsuicfdworkcs
conqrcnsalion- as pnlvided tor by Sc.rion l70ij oflh.
Lrbor Codc. lor lhc D.rfoirMncc oflhc uork tor which lhc pcrmir i\ isilcd
-lhivc
sndNiU nrRintain wo,kcs co'nncrsari.tr irxurdh... as rcquncd hyScclion 3?(Doflhc lxbor Codc.Ior lh. rcfoflrttrcc oi
rhc $o for*hthrhtFrnir is ksucd. My wor*c6 .onD.ns.rbn insumre caris,nd plicy nrn$d ft:
l.cdily rh m rtu t rlornuncc ol lhc snrk lhr Bhi.h rhi\ I,c flrir is isskd, I shrll frn cnDby iny 0cB.n in rny montur
$ Nt, ti.com slbjcd b rhc *orlcE conll)cnlarirn hws urcdiror.i0, and tr8rec rhar il'I shotrld bc.ont suhjcct l. ttr
workcfi compcnsarion pmlisn,ns ofSdtnrn 1700ofrh. Lrhtr (1xlc, ! nrll lonh*ilh 6mpl, wirh rho* Pmvkio.s..
WARNINC: l:oilur.lo surc *orkcrs'compcn\lrion mKras. i! untswrxl, Md sholl nrhjccl an cnDbycr k, Lri'nitul,tcnnhic\ rnd
ciril fincs up lo om hundrcn lhoosand dollrs (S100.0G)). in Dddirbn tu th. co{ ol.omFns.lbn. nanuCcs as protidcd for rhc
c()NsTRlJC',rloN I FNnIN(i A(iFrtCY
, hcehy atfir undc. Ienohy of pdjury rhtrr rhcm h a .onsfl.ri,n lcndinS !8ercy fo, rhc l)crfontuft. .fthc work for shich rhn Fmir ir
issucd (Sc. 1097. Crv. C )
A?ILTCANLDECLAMIIAN
I tBEty afiim undcr I'cnrllyolt'crjtr, onc ot'tu tou.wing &cldariotrs:
Dc'mlniotr P.nnilr.Ash.sios Notification rcdcrul Recularins ('l'irlc 40. Pdl6)
Rcquircd kncr of Nolification
I ccnify rhar rh. fcdcral rcBularions Essdins arb.(ovcmvul uc not 0ppliclblc lo this prejcc!.
-l
ccairy rhar I hdc @d rni. lpplicdion {n sllc ltul rhc 0tnvc informlion iscoml.I agm lodrmplywitnlll Cirydnd Counry
od'ramc\ and Srare Lj*\ (ld,ne ro burlrhg con(ru.tmtr .d h.Eby auttnrie ,qvc{.hiiv.s olrhisCilyand Counly ro enrd ulsn l,r
obovc mnrioEi DrcEny r,r in.oc.lio,r{,n *"' l)i, (t13 aeeJ rrQr.c o.,. o9^ly-ltApDrionr or Asmr siEEruR' v 2D 9e\- .-
IIflIiIT
l1)Lict Nnn,h.r
*'T; '[ r"g et^\\ rHeqty (I \.)
LrGNsh.{oN rRActuR
DES.ABAIION
I hcrc'ty rliirm uoder p€nllry or p.rjory thar I am li.cnkrl un!.r pmvnion ofCh&lls 9lmnrEki',8 whh Scdhn 7{xD) ofDivision:i
ol lh. Busincssand Pmfcssk,rCodc. und h,li.cnsc h in tull fore ud.liNt.
t nd.i\ Addrccs:_
:
t---+---
MAYOR
MiguelA. Pulido
MAYOR PRO TEM
Michele l\-4artinez
COUNCILMEMBERS
P. David Benavides
\4cente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNClL
Maria D. Huizar
mou do@santa-a.a.oro
[,layor Pro Tem, Ward 2
m marl nez@sanla-an3.o.a
Vicente 56rmienlo
vsamrenlo@sanla'ana.oro isobno@sanla€.a.oro vilieoas@saola aoa.o.o slinaiero@sanla-ana oro
CITY OF SANTA ANA
PLANNINC & BUILDINC ACENCY
20 Civic Center Plaza
P.O. Box I 988 . Santa Ana, California 92702
www.santa-ana. org / pba
NOTICE TO 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
7 A o -<: ..^., t{ a.l\ l,A ut Sc'-t r \ c \D vr o Ctt q >2o.1
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 OwnerBuilder.
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.
Znl 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.
Er-r Z. t 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.
Zul 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 potentlal financial risk by hiring a licensed Contractor and having the permit filed in his or her name
instead of my own.
EU 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.
€n 5. I understand if I em ploy or otherwise engage any persons, otherthan California licensed Contractors, andthe
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.
_AE_6 I 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' 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.
tq t. 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
SANIA ANA CITY COUNCIL
dbenavrdes@sanla-ana oro
Dear 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 Contractor.
E.- L l 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.
Eq_5. I understand I may obtain 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 www.cslb.ca.qov for more information about licensed contractors.
2 z,+10.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the party
address:
leg a ly and financi
Os \A ally responsible for prop osed coL"rstruction activity at the following
aq C\OL oq
Signature of Property Owner c lro Date: 0f^ /\-,q
Print name of Owner E..rq e ra t o /F{ e d } a, Ld---------------_
AUTHORIZATION OF AGENT TO ACT ON PROPERry 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 Ille the documents necessary to obtain an Owner-Builder Permit for my
project.
Scope of Construction Project (or Description of Work)U f (eC Yr a(rt,e oo \A x Ps
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 lllled 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 lo verify the prope,Ty owner's signature,
pr -r rr'i!:: a:r..i..i- f_ r.:::-. rir .'(:... i. Pri.:i! Fr..- jIr r- ".
SANTA ANA CITY COUNCIL
mourido@sanla-ana.oro
Mayor Pro Tem, Ward 2
mrmaft nez@stsnta-ana oro
vrcenle samlento
vsamiento@santa-ana.oro iso oro@saita'ana o.o dbenavrdes@sa.ta.a.a oro i!ine93!@s4E:e!?.p!s silnaiero@sanla'ana.o.o
9+ ll.l agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by
all applicable laws and requirements that govern Owner-Builders as well as employers.
fu-.tlZ. 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
prope(y, 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 copv of the propertv owner's driver's license.
form notarization, or other verification acceDtable to the aqencv is required to be presented when the permit is
issued to verifu the Dropetu owner's sianature.
Project Location orAooress: 266 S us t\c^\\ V\tr< < "<ra (0'. \Ar,ru G,- t) >Or{