HomeMy WebLinkAbout30341892 - Permit (2)Project Address: 4906 W First St
Assessor'sParcel: 108-741-04 Lot NA
Unit:
Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range;
Zoning: Ml
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA}27O2 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) d47-5853
Permit #: 30341892
Pin #: 94552
Owner:
Address:
Contractor
Address:
P hone
Tenant Name
Thoai Tang
14541 Bushard St
Westminster, CA 92683
(714) 936-2803
Oiscount Spa & Salon Furnlture
Owner-Builder
01116002 51602
0'1 116002 51602
01116002 51600
01116002 51602
01 1 16002 57770
Fs6 Type
Water Closet
Min Fee Adj
General Plan Update
lssuance
Microfilm Records
Amount
14.78
57 .57
22.95
57 .20
3.9't
Qt!
1 .00
100
100
100
100
Fee
$ 14.78
$57.57
$22.95
$57.20
$3.91
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Botchi:5{200 - 2/3/2O2O I0: ororolesls
Office: CTYH Trqlsf : 78 2 of 2Accti: Refi: 303{189?
RcDt+:02887095 ' 2/3/?O?O ll:50 All
Tronsoct ion Touol l3l2 ' S2
Thoo i T6ns
Commercial
Alteration
Toilet
Occupancy:
Constr Type
Code:
B
V B, SPK
cPc 2019
t??.98
t3.91
t129. s5
t3?0.00(t7,18)
Notes Replace toilct
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By
Permit lssued By:
subjecl to Field;
Bualding Permit #:
Date:
Date;
Date:
Misc. Receipt:
lvlisc. Recelpt:
Misc Receipt
Total
Amsden, Julie
Every pennil issued shall become invalid unless lhe wo* on the site
aulhotized by such petmit is commencod vtithin 360 days attot ils
,ssuance. ot il the wo* authoized on the site by such pemil is suspondod
ot abdndoned to. a pedod of360 days after the tine tho worl< is
commelged.
lnspector Mto# 2020-157526
oao3t2020
Account#
01 1 16002 51600
01 1 16002 51602
01 116002 57770
Fee Total:
Paid to Oale:
Balance Due:
$22.95
$129.55
$3 91
$156.41
$0 00
$156.41
PLUMBING-INSPECTOR RECORD
APPROVALS DATE tD/slG.COMMENTS
UNDER GROUND
Waste & Vent
Water-Under f loor
Gas-Underlloor
Buildino Sewer
Area,/Storm Drain
lnterceptor/ Clarilier
TOP OUT
Waste & Vent
Water Pipino
Gas Pipino
Rool Drain
Tub/Shower Test
Rough Water Heater
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rouqh Plumbinq
Final Gas Test
Meter Release
FINAL 7-lo'zo"'fL< tr/t ert Z7
Notes, Remarks, Etc
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POOUSPA
I
APP-13 CBC 2016
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 improvements
specified at 1).1 L c'-t^/ FtPat 1/14./\,4 a *,J4 . A-Z1O LO.\
We are providing you with an Owner-Builder Acknowledqment and lnformation Veriflcation 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
LE MENT AND VERIFICATION OF INFO T
DIRECTIONS: Read and initial each statement below to signify you underctand or verify this information.
')/: L I 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 flnancial 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 prop-
erty.
'" 1' 2. 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.
:/ 3. I understand as an 'owner-8uilder" I am the responsible party of record on the permit. I understand that I may protect
rhyself from potential flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
_a7_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.
) I S. t understand if I employ or otherwise engage any persons, other than Califomia 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.
J_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' 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 financial risk.
) / l. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
{tructures cannot legally build them with the intent to ofter 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
wilh a licensed general building Conkactor.
,?1 a. 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-
bial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
www.santa-ana.org
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 offlcial address indicated. An agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
1/ g I understand I may obtain more information regarding my obligations as an "employef from the lnternal Revenue Ser-
vice, the United States Small Business Administration, the California Department of Benefit Payments, and the Californaa Divi-
sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-
321-CSLB (27 52)or www.cslb.ca.qov for more information about licensed contractors
JlulO I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
dary legally and financially responsible for proposed construction activity at the following ad-
dress:
t'y' ll.lagree that, asthe party legally and flnancially responsible forthis proposed construction activity, lwill abidebyall
dpplicable laws and requirements that govern Owner-Builders as well as employers.
1l'lZ.tagreetonotifytheissuerofthisformimmediatelyofanyadditions,deletions,orchangestoanyoftheinformationI
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 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
laable 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. /Vofe : A coDv of the DroDerTv owner's driver's license, form notariza-
tion, or other verification acceptable to the aqencv is reduired to be presented when the permit is rssued to verifv the
property owner's siqnatu re
Signature of Property Owner Date: l_ -3 -la>D
Print name of Ownet I uoat ;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 project.
Scope of Construction Pro.iect (or Description of Work)
Project Location or Address
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 fllled out the above
information and certify its accuracy.
Property Ownef 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 re-
quired to be presented when the permit is rssued to verify the property owner's signature.
aZ---a-rt'