HomeMy WebLinkAbout10195219 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
I nspection Requests: \7 1 4i667 -27 38 lnspector Section: (71 4) 647-5853
Permit #: lO{952{9
Pin #: 84854
q
Project Address: 2208 N Main St Unit: C Bldg; Address Range
Tract: ROBINSON'SAssessor's Parcel:399-101-06 Historic: No
Suite Range:
Zoning: Cl
Building Use: Commercial Occupancy: B 1st FL Area:
Job Type: Alteration Constr Type: V B 2nd FL Area:
Nature of Work: Demising Wall Code: CBC 2016 other Areas:
Existing Bldg. & Use: Commercial Flood Zone: X-0602320163J Garage Area
Proposed Use: spec suite # of Stories: , ,o,r,,
Description of Work: Legalize d€mising wall to create Unit C and Unit B. Upgrade sxisting toilet room in Unit D.
Patio:
T.l.Area:
Yards Req'd
Valuation:$10,000.00
0
B(lIch+:4391-,tlfl ire: (:IYH
Planning Conditions:
Rebecca Sanchez
2208 N Main St
Santa Ana, CA 927062704
17141654-9748
vacant
neers 't/
Owner:
Address:
Contractor
Addressl
Owner-Builder
Engineer: AH Co
Armand
Address 2500 W Orangethorpe #121
Fullerton, CA 92833
(7141626-0720
72012
Jack DeRosas Oesiqn
Jack OeRosas
2404 E Kat€lla Avenue
orange, CA 92867
(714) 561-2059
s
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Archilect /
Desiqner.
Address:
Phone:
License #
Phone:
License #:I ) l|l|l']
Planning Approval By;
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Kelaher, Selena .
Mazatji, zac
Chavez. Dave
-..,4.No Y'
Date: 01/03/2018
Dale. 0512112018
Dale: 0512212018
Subject to Field:
01776002 5X-607
07716002 53600
07116002 57770
08907001 24000
07716002 57612
07776002 57600
07776002 57607
Misc. Receipt
Misc. Receipt
Misc. Receipt
70443
Total
$154.26
$213.86
$10.86
$2.80
$1.00
$2',1.25
$52.98
Fire lnsp. Req'd:
Police lnsp. Req'd
Noyes Account#
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every permit issued shall become invalid unless the work o, the site authoized by
such permit is conmenced within 180 days after ils issuance or il the wotk authoized
on the site by such permit is suspended or abandoned fot a pedod of 180 days after
the tifie the wo* is conmenced.
01 1 16002
01 1 '16002
01 1 '16002
01 1 16002
01 1 16002
08901001
51600
51601
5'1612
53600
57770
24000
$457.01
$ 1 53.58
$303.43
lnspector MID#: 2018-140715
$21.25
$2O7.24
$1.00
$60.28
$10.86
$2.80
Fee Total:
Paid to Date:
Balance Due
Lot: POR 5 & POR 6 Block: A
- 1/22/211I,3 IO: NGAI.
Phonel
Tenant:
nl
Permit Fee
Plan Check Fee
l\.4icrofilm Records
SMIP - Category 2
Bldg. Stds. Revolving
General Plan Update
lssuance
BUILDING.. INSPECTOR RECORD
SITE-WORK DATE COMMENTS OWNFJR BUII-DER DELCARATrcN
I h.rchy ofilfln und.r p.Mlry of rcrJury rhd I fl.x.'rp! fflrn h. Confuio* l-icnr uw for Ihc follosing rcason (Se?0.115
Businc$ and Pmfcsion Conc): Any Ciry or Coudy shi.h rquncs a pcnnn ro .onsrdcl, 3lrcr. im[ovc. d.nrlkh or rcn0n my
idcrlrc. dorlo ils t\unce, aho Equtcs rhc lpnlic l lor sucn rErmil io filc! si8ncd slurcnEnr rhot hcor shc h licensed pursuanl
Io lhc prcvnions ol d. Cotua.rols Li.c,rsd taw (Ch.ptcr 9. Com.ncin! wirh Sc.!io. ?0O0 ol Division I oflh. Busincls d
Pmfcsions Codc ) or lhar lrorshc hcxcrlpl rhcrcfrom and rhcblsis for rhc alLscd cxenDtion. Any violilionofSslionT0ll5 6] atry
rtplicanrrdrr.rmirsrhjehrh.,ptlica r.!.ivilpenalryolnorntrcthunfilchundrL{doll{\1:1500)
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of coq)htiotr, rlE Ownd Build$ will harr thc bxrd.n .f pbving rhnr h or +r did *, buiu or inpbk rh. ln p.iy fi, lhc ,urp.s ol
l. .r o*R. ol rhc pN|cny. am crlmnrly conr(rire wirh licc \cd .onr,croN n, .unnru.r rh. pmjcd (scc 7()'1,l. Busir'c$
md ftr,fssbi C.dc l'hcConractois!,iccnlcl,awdocsnotaDplylornowncrofpro|rnrelDhuild\orinrprolcsrhcrcon.
0nd who coff r.r s for such nml.cls wirh a Cofido(9 l'.cn\cd l)Usurnr ro rhc Cotrt..tor's Liccns Law)
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DIiCLAAATON
! hcrcby ollirnr undcr li(nilr, of Frjnry oN of lhc fdloqin! d..hblt N:
-lhuvc.
qilltruirti n Cenilicntc ol Consctrr to sclf. hsurc lnr solkcrl omtEnsdnnr. as providcd for Iry Sstion l7([ ol'rhc
Uhr Crodc. Ior th. r.rn)mn.c of th. Ro* lor which thc pcn ir is iskd
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rhc work turshichrhi\ pcrmii il nsud My workcrr con,p.nsrrion inslran..crRhr rd policynumb.rrc
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v' k' lE(mr \rhJ.d h lhcsorkcricon,p.nsrrion lawr oi Clli&nrir. n r8rcc rhrr ill \hould l.rom sul'j€r k,rtr
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ciril ln,.s ut i) onc hrn(lrcd rhou\lnd.tollar\ (S101).{ll)O). ir odnili,,n ro rhc con of co'nncnurion. dnnr4cs as tn)vidcd lnr rhc
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DICTJBAI]ON
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of rh Busincslnd Pbfdsi.nsCodc. nd,nyli.ri\c i! i[ lull hruc o]xl cl.f..r.
Liccnse Ch$:-
AITIICANLITII:IISTIIO!
I irrby aUm, ond.r pcnrhy ol pcrjrry otrc olthc n,lk,wing dc.larariotrs:
l)emnii.nPcn!ils AshcsrosNoriricarion ltncral kcBul{rion\(1irlc.l0. Pfi6)
R.qoncd lrrrcr,, Noii,i.diu,
-l.cniiyrhd
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orriDancc\ d Slnrc h*\ rchiing lo l,t ildirc connrud ion. dhcrchyaulhoriz.reFc\cnririrc\orrhnCny,ndCounrybcnrduF,nrhc
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Set Backs
Formsi Steel/Holdowns
Erectron Pads
SLAB Floor
Rool Sheathinq
Shear Wall
Fr amrng 6/t /l< ,., k,t:.r-rt$
lnsulation/Energy
Drywall l/,il|r sr\gk
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certil
FINAL t/t / lz 5b6y
Certificate ot Occu pancy
Notes, Remarks, Elc
--l}
ID/SIG.
ll)!$IAlcltONlJiNOlN(;iQllCr
I hcrchy rfltmund.r ncnilry oipcrjurr rhlr rhcrc is a con!ru.linr hndirs rscrcy lor lhc n.nomrmc olrhc Nork tr whi.h rhi\ tf,rnrii is
i\\ucd lScc.1097. Civ C )
I. trJ. ''. \rrr
lrndcis Ad&c\\:
UFER Ground
Subf loor/Vent/l nsulalion
MAYOR
N4iguelA. Pulido
MAYOR PRO TEI\,1
N4ichele Martinez
COUNCILMEMBERS
P. David Benavides
Vlcente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas CITY OF SANTA ANA
PLANNINC & BUILDINC AGENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, California 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
improvements sOecified at 2 2o:s N. \qC-N^ S aa C)-\cr ce\qa?d 6
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 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.
& o,1 , 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.
(-o-z 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.
(A- S. t 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.
/--' $-4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
((-F 5. I understand if I employ or otherwise engage any persons, olher than California licensed Contractors, and the
' total value of my construction is at least five hundred dollars ($500), jncluding labor and materials, I may be considered an
"employer" under state and federal law.
t (o U I understand if I am considered an "employer" under state and Federal law, I must register with the state and
federal gouernment, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to
unemployment compensation of each "employee." lalso understand myfailureto abide bythese laws may subject meto
serious financial risk.
7. 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
SANTA ANA CITY COUNCIL
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
N4aria D- Huizar
Mayor fto Tem, Ward 2
moulidoaAsanla-ana oro vsam enro@sanra ana oro s.ono@saila'ana oro
P David Benavides
db€navrdes@saola-ana.oro N eoas@sanla-a.a orq sti.aiero@sanla-a.a.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.
f'-Na. f understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any
flnancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the
workmanship or materials.
/^t ^
YJa g t understand I may obtain more information regarding my obligations as an 'em ployer' from the lnternal Revenue
S-ervice, 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.
(41 O. I am aware of and consent to an Owner-Builder building permit applied for an my name, and understand that I am
the party legally
address:
and financiall y responsible for proposed constructio ivity t the followi ng
L)\ h--)\--/\-o-\v'\G!
Signature of Property Owner )?*"*"rt*: s-2-lt'
Print name of Owner a
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
lollowing 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
project.
Scope of Construction Project (or Description of Work)
Project Location or Address
Name of Authorized Aqent:
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
Note: A copy of the owner's driver's license, form notarization, or other verif,cation acceptable to the agency is required to
be presented when the permit is issued to verify the propedy owner's signature.
!! .rr \'\'ta r a.,.i.r'Ar:1! At:.r4,!i ,. fLi....:. p.:i-.:: Ii_- ]r lri :r: -5
SANTA ANA CITY COUNCIL
moulido@santa-ana oro
Mayor Pro Tem, Wa.d 2
miman ne2@sanla-ana.oro
vicen!e Samiento
vsamrenbrosanla-ana oro iso oriorosanla-ana.oro
P Dav,d Benavides
dbenav des@sanla€na.oro ivilleoas@santa-ana.oro shnaero@santa ana oro
issued to verifu the Dropertv owner's sianature.
R,\U\L,
Print Name of Owner:
(Ar,1 I 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.
VD_irr.l 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 permit. Note; A, copv of the oropertv owner's driver's license,
form notarization. or other verification acceptable to the adencv is required to be presented when the oermit is