HomeMy WebLinkAbout10196619 - Permitry
Project Address: 1002 S Araoaho Dr
Assessor's Parcel:109-701-08 Lot: 130
Unit Bldg: Address Range
Block: NA Tract: 3937 Historicr No
City of Santa Ana 20 civic center Plaza (M-19), Santa Ana, cAg27o2 Building
Permit Counter: (714\ 647-5800 lnspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853
Permit #: {0196619
Pin #: 58244
Building Use: Single Family Dwelling Occupancy: R-3, U 1st FL Area Patio:
Job Type: Reroof Constr Type: V B 2nd FL Area T.l.Area:
Nature ofwork: Reroof Code: CBC 2016 Other Areas: yards Req,d
Existing Bldg. & use: sFD w att garage Flood zone: x-0602320256J carage Area: vatuation: $7,ooo.o0
Proposed Use: # of Stories: Totat
Description of Work: T/O existing roof and install new comp shingle to SFO with attached garage. Replace sheathing as needed. Hand out given. Auth on
file-
Planning conditions:
Owner:
Address
Phone:
Tenant
Bertha Maximo Salgado
1002 S Arapaho Dr
Santa Ana, CA 927042405
(714) 5s2-0180 Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Ber!hn llnx ih0 r-r I "r.l
,;enProl Plon UpdotE F
r:r1 1 1 6t:l(r2- 51 _1r,''ri'r:,4'.
gu i ld ine
es t.h +:
0fl ice:
Fi.ptiru
41!17 - L11.,
CTYH Trqr
!?975e4 - :
Contractor:
Address:
Owner-Builder
Engineer
Address:
ronso,:t ion Tofni
t:1
e 1r I
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Fire lnsp. Req'd:
Police lnsp. Req'd
Gomez, Pedro
Zuniga, Allissa
Date: 06/04/2018 Misc. Receipt
Date: Misc. Receipt
Date: 06/04/2018 Misc Receipt
Subject to Field:
No
No Account#
01'116002 51601
01116002 51612
515'ot Permit Fee
51672 Bldg Stds. Revolving
5L500 Genetal Plan Update
51601 lssuance
Fee Totat
Paid to Date:
Balance Due:
017 7600 2
0 77760 0 2
01716002
0 77750 02
$308.52
$1.00
$21.25
$52.98
Total
Flood Zone Cert. Req'd: No Ol116002 51600
Every pemit issued shall become invalid unless the work on the site autho zed by
such permit is commenced v,/ilhin 180 days after its issuance,or il the work authoized
on the site by such pemit is suspended ot abandoned fot a peiod of180 days after
the time the wo* is commenced.
lnspector MtD#. 2018-143737
$21.25
$361 .50
$1.00
$383.75
$0.00
$383.75
Suite Range:
Zoning; Rl
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
BUILDING. INSPECTOR BECORD
SITE-WORK DATE ID/SIG.COMMENTS oWNER B(III-DI'R DI]LCARATION
I hcrchy rtfirn u .r Fnrhy ,,r pdrjury lh l Mr cxcmrr ftuD rhc colltrNon l-iccnsc li* tur rh. r.l).win8 rcasn (Scc.70ll.5
Bu\nr\\ r Pnrcssion O,lc) Any Ciry or Counry which rcqut \ r Ilcrmir k, or{tu.r, axcr, nn|,o!c. demlirh or Eplt 3ny
$ru.Iurc. piorlo ils hsuancc.nkolcquteslhctrpplicanli,,\!chrcrinirronbanSncd$jtnEnrrh.rhcor+ctliccnsc.lNrsuatrr
t, rh. tmvni.n\ of rhc Conta.r.ls Li.ctrscn bw (Chsrrcr 9. (tnrmcncing *irh Sccrnm lfitr of Divnion I ol rhc ausinc$ and
ProLsionsCodc) orlhar hcor\hc isqcnlrr Ihcrcfronud rhc basi\ in rhcnllc8cd.rcnulotr AnyviolalionolSc.rhnT0.ll 5hyrny
rl]plic!trriurllennirslbjc.hrhcappli.dtrrrciviltcnlry.ltror.rorcrhlnlivchuDdrcddollaB(t5())
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n c .urpcns0r ion. will do lhe work !d rhc ntulm L\ nur
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|iuvidcd thrl such nnpmlcnrnt\ m ml inrcndql r oftFl f{n !h lf, howdcr, ttE huillio3 or irymtrmnr i\ v'U snhin .nc ,td
of conDbri{nl rhc Owncr BriU.r will h,vc llf hoftlcn or pmvi g ilan hc or shc did mr huitl or iq,ov. rh. F,Fny ior r}r lluqD* of
l.sso*ndrofrhrnmp.ny.a cr.lusivcly.otrhr.rinB wirh Ircnscd conrradon ro connrud rlt InJjccr (SN 71}14, Busirrc.s
r Lhf!*chnCodc: l hc Conrrucxn s l-iccnsc l-!* docs nor apply b nnown.i orFopc y who l,uilds or impnnts rhcrcon.
and who cunra.rs ror \uh proi.ts wirh. conrBtuns) liccnsc{ Dunur n',hc G,nrrrcroi\ Li.cn{ ta*)
Z" lZ
I hcrchy !llirm trnd.r pcnxl!y oln.tury om olr[c n)]k)ai',! d.(lrrrri(rr\
I hnvc,rkl*ill nEir airrCcnra(trrcofConscnltoScli.lnsurclor$orkcr'c.nDcnsdioi.A provi'lcd lor bySdion 3?fiJ ollhc
Lalnr C.xlc. ltr r hc F f.flMn.c oi rhc wo.* for Nhich rhc p.mil n issucd.
I hrvc lnn willnri rir sorkcs compensrri{,D insoraE_c. &s rcqrncd bys(rnrn:lTtDolrhc l-lhorCodc.lbrrhc Pc'fodin.c of
rhc work l'or *li.h lhirpciinil is is$cd My wolkcr'(,nrp.tr\,rnrn nr(urai.c.rricr and !olicy nunhcr rc:
P.,la r t\u'ih
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ofcompcns"ri(,n,lrnn'!.s rs trovid.d tur lhccivil finc\ ut b on. htrndr.d rh.trsrirl dollrs (Sl(X
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t il,,( 1,\lt\ll()N
Ihcruby116r unddr p.ndlryof,rrlury rhJl I om licctrr{ undct tovi\ion
ol lhc Busircs lnd ftorcsion\Codc. aM nyiic.trsc h ir tull lirr.c ond
rrtr l.onnrf, rtrrs $irlr S..1Dtr TlrroL ol I)nisi,r l
Liccnsc Cllsr-Liansc Noml,€r:
D.l.: Contmclor:
CINiIBIIEII!]NIINDIIC.AGIIIjI
I hc(b, notd und.r Fnallyofpcrjury thol rhcrc h 0 cotrstrucltin kndins lscncy for rnc !.rfortun.. orrhc wor* Lr whi.h thir lErnil is
hsucd ( ss. 1097. ci!. c )
AITUCANLDECI.AEAIII]N
I hdtny altim undcr Fnaliy of pcrjury orc ol rhc follovi.E dalarrr ionsl
DcnDlirion Pcrnir\ A\bcstx Norifi.rrio. F.dcrrl R.guhrnns (Tnh40, Pan6)
R.qun d Lcnfi of Norificarion
I.cd'ryih,r lhrvc rcdd rhisaDDli{lirn d (alclhnr rhcltDvc inlntrHlim h.orc.r LlrelocomPlrwirhallCiryandCoonr,
oftlinamcs rNl Srrlc tjws rhrin8 ro rurhori7c rcprc\cnrrinc\ .frhis City ud Counly h cnr.r uI)nrk'
xh.Y. nrnrntrr.d fn)N,rr lor
^*--efqfsug,lppli(nnl or Allcnl SiaBl n
d AXidt;-
t].
Set Backs
Forms/Steel/Holdowns
UFER Ground
SLAB Floor
Subf loor/VenVl nsulation
Flool Sheathing
Framino
lnsulation/Eneroy
Drywall
Ext./lnt. Lath
Brown Coal
l\/asonry
Pool Fence
T-Bar
Handicap Req.
Depuly Final Report
Enqineer Final Report
Flood Zone Certif .
I
toltl lt*irir..r..,<nre u\t
Certilicate of Occupancy I {fJ
Notgs, Bemarhs, Etc
Erection Pads
Shear Wall
FINAL
L.h,lcr s Na'E
-
knCci\ AddE$
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ccnily rhur rhc ltdsaldsuLrn,n\ rcSddine asb.sos rcnrrvrllrc nol oppliclhlc ro rhi\ !n,jccr.
?P
I
I\4AYOR
Miguel A. Pulido
[,4AYOR PRO TEM
l\,4ichele Martinez
COUNCILMEI,4BERS
P. David Benavides
Vlcente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
ACTING CIIY iiIANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNINC & BUILDING ACENCY
20 Civic Center Plaza
P.O. Box I 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
ecified
9
We are providing you with an Owner-Builder Acknowledqment and lnformatlon 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
D/RECI/OA/S: Read and initial each statement below to signify you understand or verify this information.
O"4 I . 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.
Q{r. tunderstand building permits are not requared to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
n.,,'.h,t-\. 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.
h4 q. I understand Contractors are required by law to be licensed and bonded in California and to list their license
n"umbers on permits and contracts.
/-,tl s. t understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
idtal'value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
"employef' under state and federal law.
Apl A. 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.
@ ,. ,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, uniess a/,/ work is performed by
SANTA ANA CITY COUNCIL
moulido@santa-ana oro
Mayor Pro Tem, Ward 2
mimarlrnez@santa-ana.oro
Vrcenle Samlento
vsarmienlo@santa-ana oro isolono@san1a-ana.oro
P. David Benavdes
dbenavrdes@sanla-ana.oro iville!as@sanla-ana.oro sti.aiero@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.
BUa. I understand as an OwnerBuilder if I sell the property for which this perm it is issued, I may be held liable for any
fi6ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
r2,v19. 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 conlractors.
aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the party I and financial responsr for propos construction activ at the llowin
address o
4 t4ll. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by
afl applicable laws and requirements that govern Owner-Builders as well as employers.
btllZ.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 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 perm it. Nofe.' A coDv of the DroDertv owner's driver's license.
form notarization, or other verification acceotable to the a oencv is reouired to he Dresented when the Dermil is
7
issued to the
Signature of Property Owner
ownert s
Date: tr L//,+"t//r
Print name of Ow ner -'l €)e .<\raV i '.,-',.---
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 flle the documents necessary to obtain an Owner-Builder Permit for my
prolect.
Scope of Construction Project (or Description of Work)
Name of Authorized Aoent
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:
Nole: A copy ofthe owner's driver's license, form notarization, or other verification acceptable to the agency is required lo
be presented when lhe permit is issued to yerify the propefty owner's signature.
SANTA ANA ClIY COUNClL
moulldo@santB-ana oro
Mayor Prc Tem, Ward 2
m marllnez@santa-ana oro lsolono@sanla'a.a.oro
P Oavd B€navides
dbenavrdes@santa aoa.ora N eoas@sanla ana ora sli.alero@sanla-ana.orovsa'hienro@sanla-ana $o
$nl rct
Project Location or Address; _
Address of Authorized Agent:_