HomeMy WebLinkAbout10296873 - Permit\
Project Address: 2010 S Cypress Ave
Assessor's Parcel 403-164-O2 Lot. POR 18
Unit Bldg: Address Range Suite Rangel
Zoning: R2Blockr B f?d 284 Histoflc: No
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA'27O2 Building
Permit Counter: (714],647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (7'l'4) 647-5853
Permit #: {0296873
Pin #: 15262
Building User Single Family Owelling Occupancy: R-3, U 'l st FL Area: Patio: 425
Job Type: Patio Covor Constr Type: V B 2nd FL Area: T.tArea:
Nature of Work: PatioMindows Code: CBC 2016 other Areas: yards Req,d:
Existing Bldg. & Use: SFD w/det garage Flood Zone: X-060232O276J carage Area: Valuation: $9,887.00
Proposed Use: # of Stories:
Total:
Description of Work: Remove walls from unpermitted patio enclosure & legalize as an attached open wooden patio cover; legalize windows changed
out.
Planning Conditions:
Contractor
Address:
Moises Cabrera
20'10 S Cypress Avenue
Santa Ana, CA 927072448
(714) 833-8400
Owner-Builder
Phone:
License #:
Architect /
Desiqner:
Address:
rJt-tl]r- J
u I r-r[0!
01116002 57607 Petmtl Fee $315.76
$93.17
$234.08
$1.00
$21.25
$s2.98
Plan Checked By
Permit lssued By
NPDES lnsp. Re
PWA lnsp. Req'd
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Date: 06/2712018
Date:
Date: 0612712018
Subject to Field:
07176002 57607
07776002 s7607
07776002 57672
07116002 51600
01776002 57607
lnvestigation
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
Fregoso, Vince
Amsden, Julie
lVisc. Receipt
l\4isc. Receipt
NIisc. Receipt
o
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#Total
Flood Zone Cert. Req'd: No
Every pennit issued shall bocome invalid unless the wo* on the site aulhoized by
such permit is commenced within 140 days aftet its issuance,ot if the wo* aulhoized
on the site by such pemit is suspended ot abahdohed fot a period of180 days after
the time the wo* is commenced.
lnspector MtD# 2018-144328
01 1 16002 51600
01 1 16002 51601
01116002 51612
$21.25
$695.99
$'l .00
Fee Tolall
Paid to Date:
Balance Due
$7 18.24
$0 00
97',tg.24
Owner:
Address:
Phone:
Tenant:
Engineer:
Address:
Phone:
License #:
Phone:
State Lic #:
Lic Typei
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Eotrh+:44:;r-r9 - 6/27 /2t:.t1p,0ff icer i Ii'H Trons*: iuri':ct+ ' Rel+:li',:pt+: [l?3r-r4c;4ri - 6/Z? /Zuliltflnso,:t ion TotqI
I0r Jc
1r:t?' i.
Iio rgEs trnhr{.rr.fl
rr FT
Planning Approval By:
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDAR DET,CARATION
I hcr.by r0nnr uNlcr pcMltyolFrjury lhlr I am cxcnrpl fronr rhe Conrr!.t,. Li.cnrc tjw r.r rhc r'ollowiry rc{en (Sa?0.11.5
Br\incs\ r l Prcfcssn,n Codc): Any Cny or Curnry shi.h rcquncj , lrnnt lo construct. ahcr. inDrovc. dc.x,[\h or ftPrn nny
srru.rurc, prbr h ns k\umcc. oho rcauircs thc omlica hr such [tmir lo filc r sisncd duretunr rhai r. .r sh. i\ li.cn{d Pursuonr
b rhc pn,vi\tuls ol rh. Conrra.ktr s Li.c.*d u* (Chnt'dr 9, Co,nmcminS with Scclion 70(x).f Divhion I orrhc au\i".* md
PmrcsidN codc)orrhrr hcorshc iscrempt rhcr.linrand rhc hasn ior ihc ullcscdcicnDridl Anyvi.l ionors(lim?0315hy0try
antl'!Jnrlor!p.rnrir.uhj(r.thcanlrdnrrnrc\rlncndhy.lnnrni".rhadl^rhdtul'rdJcJr\'(\tro'
'ft!.'',"**,"r,*,.*,ry.orn,ycnplorrcs*hsrg.\ssrhcnebcotr,pctrstion.w,ud.rh€wortu{,rhcsrrd@r,
"
irtcndcd oroflarcd lor $lc{Se.7014. Businc$ and lt ltssions Codc lhc(irrracroisl,icensctisdocsn.ril,tlyro,nownfiof
rhc pmlf,ny who huild\ or impro*s rlrmn. ud wtx' dks su.h *\)* hnnscl, or hcscllor lhrcugh his or hcr o*nc'nnk,rccs.
lovidcdihorsuch impmvcnEnls m frn inrcndol orollercd ir sE Il hrwchr, rh. hiklinSo! i.rpr.lcm h sok eirhin onc )cu
orconpkru rh. O*ftr Buiklcr will haK thc t rdcnofpmvir8 rh,r tr or sic dd ml l{ir.l or improrc lhc poFn, ror rhc rurrFs or
L $ owncr of rhc pmncny. !fl .rclusivcly conrod ir8 *ilh liccnEd conrrucroF to con(dd rhe pmFcr (Sft 7lx4, Brshcss
and PnrissiDCodc:TtcConrlrtr\Li.cnscLawdffsnor,ptlykJr.!sn.rorpii,pc ywho build!or impmves rh.rcon.
rnd who .ommrs for such lsrccls qilh . Contlcro(s) lnrnscd pusua lo thc Conlrack" \ licn$ hw).
>""F,er
lrrLtaat!(D
I ho'.hl xlltrm unn.r |[trrLry olp.rru'j_ oDc of rl[ ln IN tr,! (lrrlnrrrii, I
I hrvc r willnuinrai'rrC.n'li.rrcorCon\.nrk)Sclilhurcr(nworlds.ompcnsnrion.B\ ptr)vnhdartrbySc.r'or:l70Oorr1r
l.ohorOnlc.lnrlhcncri.rmanccofrhc"brtforwhirhrhcp.nnir i\i$u.d
_l hrvc rnJ sill trri' ni'r *orkcr' conprnsrri(n, i'rurancc. r\ rcquncd hySccriotr:lT0Oollhc hi.r Ordc. forrhc n rr.rnwr'. r
rhc *ork l,n Nhich rhis pcrmir i\ nlrLrl My *ork.^ .o'q{tr$tun nr'uran.c .rrid $ trnicy nunrhcr m:
l-J%inny thn n t6. t1!turtuRc.l rhc u'orl nr *h,ch rhi\ p.rn n isu.d. I shall nol cnpioy any pt(o. in any nrnncr
$ as to 6com suhjecr lo rhc Boikcn compcnssrion la's ol Culili,rii,. 6d rg@ ihr irl shuld tEconE subrc.r lolhc
uolkcn' cotnp.nstiotr pmvisions oa Secrion :17u) of lllc Lah, Codc. I shall. fonhwfh LsnDly *ith lhn* !n!isn,n\
WARNING: Failxrc k, ecurc workc( ompcnssrion covcmSc rs unhsiul. ond shlll suhi*r a. cnpbrtr to riflIinll lEmhics d
! 'l finr\ ut h .nc hun4rcd r
sc.trotr 1,76 oL,lfrc tibolcodc.
x"",..424r
housrtrd dollars (Sl()o.m0). i. Mdirioo ro :ffin,r drnD8cs is provided i({ rlE
iricrcsl !nddrorncy s lccs
DECI,ANAIIa!
I herchy aalth udcr p.ndlry of pcijurr rhar I lien{d und.r povkhn ol Chrptcr 9 (commmin8 sith Sdcri.n 7{xx)) .r Division 3
of thc Busimss and Pmfcssions Code. arn m, lt.nr t in flll tue lrl cflatr.
C()NSTRUC'I'!oN I FNOIN(; ACENCY
I h.mby rfiirnund.r Fnihyofpcuuryrhar thcrc h a con(ruction lcnding lscnct f.r rhc p.rloi,nmcc ofrh. work li,r $hi.h rhis lf,nnn t
i\\!cd isrc .]m7,Civ C )
APIIICAIIDIiCLAEAII!}N
I heby drtrm u.dcr lEnnll y or pcrjury onc olthc rollnsin8 dcclarari,ns
Dcfrnirnr P.nnirs A*hc(oc Noliil.0riotr Fcdcr!l Rcsulorions ('lirlc4l). Pln6)
Rcquircd hrlc. uf Norifi carhn
ilyrhi rhc ltJcrJlruguhri(nN r.Eirding r\h.rrsto tr,vrlarcfornl]pi.{hlct,rIi\pxijo.r'#*:y rh,r I hiv. rcld rhn amhalion ud (drc rh|( lhc ahorc irfonurion n corc.r Lere ro..mPlt wirh all Cil y r Counry
dd Srrrc ljas rcldiD! k)bui consrru.lion. drl hcrcbyaulhoriT. rc!rc\cnrrriv.s.rrhn ciy.nd Counr
rh.rc trEtrri{) r,l nr)n.'ry l(tr i,,\|r..ri,tr/
\ppliunr or As.nt slsmluF c7 //4*
4184zzz
x
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground )
SLAB Floor
Sublloor/VenVl nsulation
Roof Sheathinq
Shear Wall
Framrng
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coal
lVasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
En gineer Final Report
Flood Zone Certif
FINAL PlalR n '-?s)
Certilicate ol Occupancy IIUV (_-,,'
Notes, Remarks, Etc
\
I
City ofS4nta Ana
Planning & Building Agency
Code Entbrcement Division
20 Civic Centcr Plaza M l9
Santa Ana, CA 92701
#AC 073412 a
Page 2 of 2
AD}IINISTR{TI\-E CITATION
ADDENDUNI
.\ddress/Locntion:2010 s. c vo ress Ave.Santa Ana, CA, Zip 92707
An inspection of the above premises revealed the follorving code violations:
As of 05/08/2018 rt 72:48 P,Nl., you are in violation of:
CURE THE DEFICIENCIES BY RENIO!'L\G THE CONDITION/S AS DESCRJBED A.\D/OR NIAKING REPAIRS TO THE
BUILDI\G (THIS WILL REQUIRE SECURI.\G PERNIITS).
l. Patio cover was enclosed without the benefit of permits and inspection. SANIC 8-94, SANIC 8-43/ CEC
105.1
. Obtain a permit to remove or legalize patio and/ or enclosure rrithin 30 days.
o Building permit required and must be obtained.
2. lVindows were changed out on the dwelling without the benefit of a permit. SAMC 8-94, SAMC 8-43/
cEC 105.1
. Obtain a permit to remove or legalize within 30 days.
I}IP()R'I.\\TI CORRECTIONS MUST BE COMPLETED AS NOTED ABOVE
The inspector may conduct a drive-by inspection to verily compliance. You will be notified in writing with the Notice of Administratiye
f ine if you are not in compliance (see section below). You will then be tiable for a fine in the amount of $100, $200, $500, or $1000.
[These lines are subject to cllange pursuunt to Califomia Gotertnent Code Section 36900.]
[n addilil)n to the flne(s). you ma1 be cited each da) that thc \iL)lati()n erisls belond the co[ectidr date. Other enlbrcemcnt action and
penalties nray also result ifcompliance is not achiered by the correction date.
OFFICIR: R. Hernandez PrtoNE #: (711) 667 -2730 NI0N-FRI. rhernandezl0@santa-ana.org
7-r-ll ER
{ll 11ork nrttst be completed in a uorkmitnlike manncr and rcpairs,i\rork conrpleted rlithin the specificd tinrefranre.
![!!!ff!!Q!!![. Building
ffi
,
I
\;
I
t
a
C)
o
cl
5
dOo
u.
C\
ryJ\<vvr \) R\1/v tl Ys l)\ \uo
)
I
?,rl
u)U 0l 1 E
I .)A zl 5 |,0 A L{/))'
\,)
3L t [},1"tl 'i\t4L )I
-)S8 3;.3l\,l u '=>t-
5 c*5L
T I
,.8
J t-Jr
i )Q,
-1
I t
-6
^.t (4 IA
\I o ^t 'lu )at (,q
c
aO )T +l
'4 a /'i, U t t 'r,)€,\rrr t ./l
I r\.\t 0^:l ())6 IA
4
l.-\la t\
I \x {lc \"'W:(),1 6 4 I 0 (j
l(+I\s fl v t.,t
I (6'b l@ t VI oo I t/(l :)
tI I H
I v {(\v +e ?)\')\t ')I ._\
tj rI \{v a vl
-1
I
n FI Cf (--1 r .,..1r-I
i-"Co .n
I a /i L (,/.:)II l(L C,'9 / ('.
F
a i<:-
t4
l)
.:Z
U)n-,\
I D ll 4 ra '')l -t
CI
Itr 'te a lt v lt
/1
V
rl .I mo i_i u hlr h t t0 t, z t,h b
,o
I \to 1 IH o lt t 4 ()
n D^I i E T
I
(L
n !
?6 N
I I
(i ,4,
L)a-
I
I \)s
!Cz -n nm
I J I o r o rri
a )
)I -tTI
--4
m \{('l-q \
F I c \.cl I JI L,)
r Jof\
\\
C(/,
(D
fo
(.o
(UE
=E
OJ!(D
uo
€
f(D
E
o_
o.,€
(U
ln.
o
3
o
p_
OJf
=(D
o
o!o
U\o
o_
!
s.(D
a!
I
s
J
o
N)
o
!J
2."(fl-
7
zqA{
7
"ali\\za
;si{
o
L
A
c I)
,r
C
(
i..:\
GALVANIZEO 2i2 x r2'x 7 GAGE THICK
SIEEL STFAP w/4,5/8'O LAGS
4 x aEAM
i
2'
5-80 NAILS.
EACH END
4'x4' KNEE
BAACE
2'12'O r 5'LONG laGS SCBEWS
ErcH ENO
{sEE OETATT'€')
4'x BEAr,l
1'x6'KNEE
BFACE
DETAIL "8" ALTERNATE
t2'
4'x4'POST M NIMUM
DETAIL'8"
POST
BASE \
ANCHON
BOLT
-__t8'3 tn'I
1j
EMBEO
ANCHOFS IN
CONCBETE I
l
itt
OETAIL "C"
NOTES
1. ALL MATEBIALS: LUMBER, HAFDWARE, PLYWOOD, ROOFING, EIC. SHALL BE NEW
AND BEAR MANUFACTUBER'S OR CERTIFIED AGENCY'S GRADE MARK.
2. ALL CONSTRUCTION SHALL CONFORM TO THE CALIFORNIA BUILDING
CODE CUBRENTLY IN EFFECI.3, CONCBETE SLAB TO BE MINIMUM 3 1/2' THICK.4. POSTS SHALL BE MINIMUM 4'x4'.5, BOTTOM OF POSTS SHALL BE ONE INCH (1') ABOVE SLAB.6, ROOF SHEATING SHALL BE:
a. 1/2' PLYWOOD, CDX. 5 PLY EXTERIOR GLUE, WITH INDEX 3216, T & G
STRUCTUBAL I. WITH 1O d AT 6' O/C AT SUPPORTED ENDS, AND12' O/C ALONG
INTEBMEDIATE FRAMING MEMBERS, OR
b. 1' BOARD SPAN 32': 2' SOLID T&G SPAN 8 -0'; 2'x2' SELF"SPACED SPAN 6'-0'.7. ROOFTNG SHALL BE MlN. CLASS ',C', ROOF COVEBTNG (CBC TABLE 1505.r) OF:
a. WOOD SHAKES: 4/12 PITCH
b. WOOD SHINGLES: 3/12 PIICH
c. BUILT-UP ROOF SLOPE IO ORAIN (MINIMUM 1/4'lFT.)
d. CLAY AND CONCRETE BOOF TILES INSTALLED IN ACCORDANCE WITH
MANUFACTUREE'S INSTRUCTIONS.8. MAXIMUM HEIGHT FOR A PATIO COVER IS TWELVE FEET.9. PATIO COVEB SHALL BE USED ONLY FOR RECREATIONAL OUTDOOF LIVING
PURPOSE AND NOTAS CARPORT, GARAGE, STORAGE ROOM OR HABITABLE ROOM.
10, ENCLOSURE WALLS IUAY HAVEANY CONFIGURATION, PROVIDED THE OPEN AHEA
OF THE LONGER WALLAND ONE ADDITIONAL WALL IS EOUALTOAT LEAST SIXTY.
FIVE PERCENT OF THE AREA BELOW A MINIMUM OF 618'OF EACH WALL,
MEASURED FROM THE FLOOR.
,l 1. OPENINGS MAY BE ENCLOSED WITH INSECI SCREENING OR PLASTIC THAT IS
READILY ffEMOVABLE. TRANSLUCENT, OB TRANSPABENT PLASTIC NOT MORE THAN
1E INCH IN THICKNESS.
12. EMERGENCY EGRESS OR BESCUE WINDOWS FBOM SLEEPING ROOMS MAY OPEN
INTO AN ABEA OF AN UNENCLOSED PATIO COVER..I3- PATIO COVER MI.,ST BE AT LEAST 5 FEET FFOM PROPERW LINES.
PERSON RESPONSIBLE FOB DESIGN AND CONSTRUCTION OF PATIO COVEB:
GAIVANIZEO
r2'r1?'x7 GAGE'r' wr'0.!8' o LnGs
DETAIL "D'
4'x4'KNEE BRACE
2 ID'O x5'LOI\IG IAG SCREWS
reErtll
DATE
tev:07/19/2A11
PRINT NAME SIGNAIURE
Page 2 ol2
I
t
DETAIL ''E'
POST
"
CTIOI SAI\IIA
l rr l PI.l\\l\0
Al\A-'!','il.N
Planning & Euilding Agency
Building Safety Oivision
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647.5800
www.aanta-ana,org
sTD.02 CAC mr0
IMPORTANT NOTE TO PERMIT APPLICANT
Prio.lo expending lime, money or effort in plan preparation, lh6 applicanl should conlacl the Planning Division al (714) 647-5804
rogarding zoning, solbacks, landscape. aeslhelics and olher requtemenls. A fully dimen$loned SITE PLAN shall be required on a
separate8l/? x'll"sheetolpaper. Ask tor handout on BesidenlialSite Plan lnlormation (paliocover ls not pe.minsd wlthin
5 feet ol s property lino).
SEE ROOFING NOTE
SPECIFY AOOFING & SHEATHING OBOPEN LATTICE
RAFTER SIZE A SPACING
SEE TABLE "A'
12-'l
DETAIL
-"
OVEBHANG
6'
MIN
6'
MIN
r= t=
25OOPSICONCBETE.'
END VIEW
SIDE VIEW
3/8" O X 5'LONG LAG SCnEWS
INTO STUOS AT I6'O C,
FOOTINGS:
CBC APPENDIX I, A PATIOCOVER MAY AE SUPPORTEO ONACONCRETE SLABON
GRAOE WTHOUT FOOTINGS. PROVIDED THE SLAA ls NO LESS THAN 3 1/2'THICKAND
FURTHEN PROVIOED THAT THE COLUMNS OO NOT SUPPORT LIVEAND DEAD LOAOS IN
AN EXCESS OF 750 POUNDS PER COLUMN.
2X CONTINUOUS LEOGEB TAALE A
TAALE A USE:
1 DETEBMINE BOOF SLOP€
2 SETECT BAFIEB SPAN
3. SETECT RAFTEA CENTER
TO CENTEB SPACING
1. SEI.ECT RAFIER SIZE
NOOF RAFTER SPAN
stzE
SPACING
c. To c.
12'
t8.
BOOF SLOPE
<4 t2
B@F SLOPE
24:t2
8'..6'
1',-8'2X4
810'
7',-O'
a"^\L'l,
11:6'
10-o'10',6'
2Xa
12'
t6'
24'
17,0'
15:6'
17-6',
1610'
14:O'
JOIST HANGEB OB SOLIO BIOCKING
NAIL BAFTEB IO ALOCKING
DETAIL'A'
PATIO SIZE
POST SIZE
SPAN OF P.)SI SPACING / HFANFN qITF
!tt{v ua_13{'1416',5:0'810',10 -6
1G0 12rO'
18',-o'7.0'9-6 11 .6'
POST SPACING
HEADEB SIZE X
RAFTEB SPAN
RAFTEF SIZE
& SPACING
ROOF PITCH
@ 'o.c
POST SPACING / FOOTING SIZE
10'-0'516115" s
816 /20'so 11.O'm".,t\
ls!]?{sc.
14',.0726'so.t2!0"516116' sq.
14',-6'5 0'l16's4.810-/20'sq 1310'r6', s
r6',0'
1810'.
/-6'121'sq 1010724' sq 't2ro')27" e
7'-0'121'sa 9 0726' s{l1 -6',28'sq
ROOFING I,{ATERIAL
GRADE OF LUMAER:
12"
X
:
n
CONIINUOUS LEOGEB
RAFTER SPAN
-'-
DETAIL 'C'
SLOPE TO OFAI ).
SEE TAALE 'B'
EXISTING
HOUSE
(
z
a
z
,!- oetetL "8" t.
DETAIL'D'
OVERALL LENGTH
LONG SIDE MUSI BE 65'10 OPEN
FOOTING 12'
AELOW GRADE
SEE T'€!E-'c' Fo8 slzE
-,-.
FOST SPACING
I
)
rcvi 07 /19 /201 1
! D.F. No.1
D D.F. No.2
TABLE C USE:
1 SELECI SPAN OF FAFTEB
2 SELECT POST SPACING
3, SELECT FOOTING SIZ€
IAALE C
PATIO COVER FOR ONE AND
TWO FAMILY DWELLINGS
TAALE A
rABLE A USE:
1, SELECT SPAN OF FAFTEB
2 SElECT POSTSPACING
3. SELECTHEADEF SIZE
lt.
@
Page I ol2
(]
-.- !-),il o
.. H6, rilF/,1:--v-nn\{ .-l- lr)
a,oIoo
:,i
_q
m
P
=-l
-E
m
)t,tt
3
?-,
A
3l
I
0 .s )l o
I
2
I _s
)'
-1
,:l
{\,
JI :1
\4\
t^
oo
tf,
'0
I
5
0 (,,1
\4\'
l t
I
',1
zrr
7)
mx
.,s t
)t,
\
Irl
/1
L,/
a
t
I
ZJA
:J
?
le h
ll
/r L
e
tr ?
1
,o
l/
tr
lt
,
C
o
=o
(O
o,El-
!
TDE(D
(,oo€
o
f
rD
!a
OJ€
(U
(n
=(D
=
p_
o,f
=o
E
dE
oo-
.0o.)
(-)
B
l>
-)
o
t.l
o
tJ
o
OAtl
zl53
I
C'
\
-0
/:,/ J I <'d t,l..^ \_-:,1rlru'-fi ./\A l)\ \ UO
)
L^
8.
)
o
I
l)
+
1
t-- | t
MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILMEIVBERS
P. David Benavides
\4cente Sarmiento
Jose Solorio
Sal Tinajero
Juan Villegas
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNING & BUILDINC ACENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana. California 92702
lwwv.santa ana.org,i Pba
NOTICE TO PROPERTY OWNER
An application for a building permit has been submitted in your name listing yourse as th builder of the property
improvements specified 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 understanding of each provision, signed, and returned
this form to us at our official address indicated. An agentofthe owner cannot execute this notice unless you, the property
owner, obtain the praor 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.
lr./l:Z_1 . 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.
Ae2. 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.
ZZ-S 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.
L-LO t understand Contractors are required by law to be licensed and bonded in California and to list their license
ffim-Oers on permits and contracts.
/ZZs. I understand if I employ or otherwise engage any persons, other than California 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
"employer" under state and federal law.'/
//1:Z-A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and
federal government, wjthhold payroll taxes, provide workers' compensation disability insurance, and contribule to
unemployment compensallon of each 'employee." I also understand my failure to abide by these laws may subject me to
serious financial risk.
/Z_L7. I 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
mpulido@santa-ana.orc
Mayor P.o Teh, Ward 2
mimart ne2@sanla-ana oro
SANTA ANA CIry COUNCIL
Vicente Sar.iienro Jose Solo.io P Oavid Benavdes Juanvillegas SalI]najerc
WBrd 1 ward 3 ward 4 ward 5 ward 6
vsamiento@sanla-ana.oro isobno@santa€na.oro db€navides@sanla-ana.o.o ivilleo3s@sanl8-ana.oro stinaierorassnla-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.
/l f .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
'tinaicial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the
workmanship or materials.
ff f.g. I understand I may obtain more information regarding my obligations as an "employef from the lnternal Revenue
'Service, the Unrted States Small Business Administration, the California Department of Benefil 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.
,lt .
//1_/:'10. I am aware of and consent to an Owner-Builder building rmit applied for in my name, and understand that lam
the party leg and finan ponsible proposed st on ivity at the owrng
address
issued to veri the ow
Signature of Property Owner Date
Print name of Owner
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 Project (or Description of Work)
POect 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 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 to verify the propefty owner's signature.
P ^r'!r,,Pa,r)i.rrr.ri. r.tr 1..!!"r! ln s \.. :. 1. p.i._it; t."- (]l I a :liia
SANTA ANA CITY COUNCIL
rnpulido@sanla-ana.oro
Mayor Pro Tem. Ward 2
m man nez@sa.ta ana.oro vs3rm'enlo@sa.la-ana oro lsolorio@sanla'aM oro
P David Ben6vid*
dbenav desaosa.ta-ana oro ivirreoas@sanra-ana.o.o srinaie.o@santz ana.oro
/ttZ. ll .l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by
all applicable laws and requirements that govern Owner-Builders as well as employers.
n
//L t 12.1 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 \Mill
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. Note: A copv of the propertv owner's driver's license.
form notarization. or other verification acceptable to the aqencv is required to be presented when the Dermit is