HomeMy WebLinkAbout104103093 - Permit (2)Project Address: 2434 S Broadwav Unrt Eldg: Address Range Suite Range:
Zoning: MlAssessor's Parcel 410-381-03 Lot NA Block NA Tract NA Hisloflc: No
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: 1714) 667-?738 lnspector Section: (714) 647-5853
Permit #: {O4lO3O93
Pin #: 854s3\l
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
lndustrial
Tenant lmprovement
N/V - Bathroom
lndustrial
Occupancy:
Constr Type
Code;
Flood Zone
# of Stories:
B
VB
cBc 2019
x-0602320278J
'l st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
Patio:
T.l.Area:
Yards Req'd
Valuation:$1,500.00
Description of Work: Remove unpermitted bathroom facility and restore back to point of origin
Planning Conditions:
Owner.
Address
Phone
Tenanl:
GENE L FELLING
2220 S LOARA ST
Anaheim, CA 928023914
l'7141775-7735
Contractor
Address:
Owner-Builder
Engineer
Address
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
P hone
License #
Architect /
Desiqner:
Address:
Phone:
License #
;t60 tr:r0t.r
ievol v ine
i 1.( l ?r'liflr.-
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPOES lnsp. Req'dr
PWA lnsp. Req'd:
Planning lnsp. Req'd.
Landscaping lnsp. Req'd
lnspector
Graham, Jeffery
Chavez. Da
Dale: 0211112020
Date
Dale: O2l1'll2O2O
Subject to Field
Misc. Receipt
Misc. Receipt
Misc. Receipt*o,
$166.53
$3.91
$100.57
$252.69
$1 .00
$22.95
$57.20
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
MID#: 2020-157688
No
No Account#
Every pemil issued shallbecome tnvalid unlossthe wo*on tho site authorized by
such pormlt is comfienced within 360 days altet its issuance.ot i lhe wo* authonzed
on the sile by such peml ts suspended ot abandoned fot a period ol 360 daysaftet
lhe tifie lhe woi< is commenced.
01 1 16002 51600
0'1 1 't 6002 5'1 60'1
01 1 16002 5'1612
01 116002 57770
$22.95
$576 99
$1 00
$3.91 $604 8s
s0 00
$604.85
07776002 5.1601 Permit Fee
07776002 57770 Microfilm Records
07776002 5I60I lnvestigation
07776002 57607 Penally
07775002 s7512 Bldg Stds. Revolving
07775002 sl600 General Plan Update
07776002 51601 lssuance
Fee Total.
Paid lo Date
Balance Due:
Total
BUILDING- INSPECTOR RECORD
SITE.WORK DATE tD/stG.COMMENTS OWNER BI]II-DI]II DI'LC I' TION
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srrudu.. r's ro ils suffiq algr rqpc rh. la,r,lrtut fs ruch p6m h 6L ! 3i8.ai ndffil thd tE or 3lE it lKoa.d li@d
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mrdi.d or oE6.d for d. (Sa 704,1. DBi"d ed Prcl<io6 ('on : Th. conlEcloa! Licru t s d.d not tpgly ro 0*6of
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DECIJSAIIq!
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tib.r ( od., lD. fic DdnhMcc o f lhc $orr for *hich :h. Fn i! isu.d
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rh. $ML lor shth lhn Fnn i ileEd. My*orld ooFar.Dn i6uffc (4i, -d policy nunb.r sc.
PolKr_ Nlmb.r - E\pm
-l c€nify thrr i. rh. dforon.c.flh. worl for shich lhi! p6,nil is isu.d.l shlu not dploy any rrsn ir lhy mmnd
b 6 to tEoft iubid io rlE ftrt6'mnFBlion bB of Cilifomi4 !,ri isE !h, ill Jhuld bd.rc sbicl lo llE r.s.rta <omFdbn F!\ iim of Sdbn l70O of rlE L.tu ('o<k, I itl!. tdh$nh Nstt * nh rbr FlrEioE
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D}:CI.ABAIIO!
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of lh. uunB 6nd Phf6b6 ( od.. d nr lt.e 6 in full f!y.. rn cfldr
rallrBucuollElDr!(i-acllcr
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N!.d (5€ 1097,Civ ( )
L.nd6 s \e.
AIILICAILDECJ.ASAIIA!
I ho*y arm uodd p.n.lry of pojury o.. of rh. lollowinS ddla.t ions:
l).mlilr. PcTnr'ArtBt6 Nonti.alon F.d.rrl R.8uhrio.r ( riE 40. PM6)
- R.quftd t 116 orNdiadio.
I (dify rhd rh. tun(d r.gul{nrN rqadina sb€los r{Nvrl &c &rr arpl'r.6lc b (hit prcjal.
?,f*l,mmr*rppncahn arj nir.rh.r thc ah'v. 'iromnxr 6..dd l.r|ia'o comoly trIh lllCnylnd Counry
r.,..ddi!6of thn( y dd Cou.ry ro dr6 upo. rh.tr! r' lI'lJtr,t c.nsi,rrrk)n. in
,'luc nrctrrkft1t pn)t).nl lt,
,lpplicrrl or ,\Bol Shn.lox*L,N6
.s -rr-7a
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loorA/enUl nsulation
Roof Sheathing
Shear Wall
Framinq
ln su lation/Energ y
Drpvall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
De y Final Report
Enqineer Final Report
Flood Zone Certif
FINAL ) ltLl?)Dffvtl n Jt51
Certificate of Occupancy '10
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Notes, Remarks, Etc.
Planning & Building Agency
Buildlng Safety Division
20 Clvlc Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-s800
www.santa{na.org
APP.t3 CBC 2016
Dear Property Owner:
An application for a building pe ,flt
^
ha been "t mitted i
NOTICE TO PROPERTY OWNER
y9{r-name
t.0 /+/)
listin yo urself as the builder of the property im ments
specified at rr+ *NA
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 understanding of each provision, signed, and returned this
form to us atourotflcial address indicated. An agent of the owner cannot execute this notice unless you, the property owne r,
obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT ANO VERIFICAT ION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you underctand or verify this information., Bt+L{f I t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder build-
ing 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 llmits of my insurance coverage for in1uries to workers on my prop-
erty.6lt
ZID 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.?t*
-Lrt , 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 havrng the permit flled in his or her name instead of my
own.!?3
(!ta. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.let
4!fS. t understand if I employ or otherwise engage any persons, other than Callfornia 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
"employe/ under state and federal law.
3t_e
/ t['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' compensation disability insurance, and contribute to unemployment com-
pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious flnancial risk.
ZLtu
3-
. I understand under Califomia 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 subcontrac-
tors 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.
,1s s
4lltsA. I understand as an owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
.fn.g
0:,b ,understand I may obtain more information regarding my obligations as an "employe/ from the lnternal Revenue Ser-
vice, the United States Small Business Administration, the Californa Department of Benefit Payments, and the California Divi-
sion 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..3t t'
'l'LlO.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
legally and fi n anct pon le for activity rng 4J4-e
Zu--11.1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
ap6licable laws and requirements that govern Owner-Builders as well as employers.
,4ts_
f<-ghZ 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 flnancial loss you may sustain as a result of
a complaint. Your only remedy against unlicensed Contractors may be in civll 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
Iiable 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. A/ofe:A coov of the DroDertv owner's driver's license. form notariza-
tion, or other verification acceotable to the aoencv is reouired to be Dresented when the permit is issued to verifv the
Dropertv owner's siqnature
party
dress:
,4+
Signature of Property Owner
Print name of owner L t
ns
l-f -?o
@U BZo? oQd
qav L. ilt\NO .,b
1
AUTHORIZATION OF AGENT TO ACT ON PROPERW 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 prolect.
Scope of Construction Project (or Description of Work)
AqSq J B€omuto"l /Prolect Location or Address
Name of Authorized Agent
---------------^
Ka*Lkz^ A - Nu o( 6-
Address of Authorized Agent )3zq S B.oaol--
Phone Number of Authorized Agent:1lLl-o-t'71 (
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 7-T-20
print Name of own"r, 6a h b-r-1c 8c,
verification acceptable to the agency is re-Note: A copy of the owner's driver's license, form nota zation, or other
quired to be prcsented when the permit is issued to verify the Property owner's signature
-2*