HomeMy WebLinkAbout10296336 - Permitq
Project Address: 3624 S Main St
Assessor's Parcelr 932-910-3r Lot: NA
Unit: A Bldg Address Range: 3620-3640
Historic: No
Suite Range:
Zoning: C4Block: NA Tract: NA
city of santa Ana 20 Civic Center Plaza (M-19), Santa.Ana, CA,27O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: i714],667-2738 lnspector Section: (714) 647-5853
Permit #: 10296336
Pin #: l{OBl
Building Use:
Job Type:
Nature of Worki
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Alteration
Alter - n/v
Sfd Watt garage
R-3, U
VB
cBc 2016
x-0602320278J
,|
Patio:
T I Area:
Yards Req'd:
Valuation: $1,000.00
Description of Work: Seal door between garage & bedroom
Planning Conditions:
Judith Alvarez
3624 S Main Street, Unit A
Santa Ana, CA 92707
(714) s88-10s6
Owner-Builder
:hi: +J.'ly / - ".r/,5/21-tt$
i{e | (:l.YH lrRn5:r $r:l
;+r(!25632(r - i/3/2llg
rsq,:t i0n lotol
lD! 6
Owner:
Address:
Phone:
Tenant;
Contractor
Address:
Engineer;
Address:
li rd ith Al v(tr.ez
1rildin9
_rl I l6rlr:r2- 516r1lr:rUt]-,lde Stds RevoIv ine
rl I 16ur:r2- il6l2rJUr_r-
!!i ernl F1(tn [Jpd(lte
rl t 16r-fl12.. 516rr_t[Ur:r-
Architect /
Desiqner;
Address:
laE
Planning Approval By
Plan Checked By
Permit lssued By
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Guevara, Jerry
Amsden, Julie
Date: 05103/2018
Date:
Date: 05/03/2018
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receapt
07776002
o7776002
07776002
07776002
07776002
07776002
5760 7
s760 7
s760 7
57672
57600
5760 7
Permit Fee
lnvestigation
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
$154.26
$93.17
$234.08
$1.00
$21.25
$52.98
No
No
No
No
Fire lnsp. Req'd; No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01116002 51600
01116002 51601
01116002 51612
Account#Total
$21 .25
$s34.49
$1.00
lnspector It/lD#: 20'18-143165
Fee Total:
Paid to Date:
Balance Due:
$s56.74
$0.00
$556.74
Occupancy:
Constr Type:
Code;
Flood Zone:
# of Stories:
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
NOTICE OF VIOLATION
Phone:
Stale Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Phone:
License #:
Phonel
License #:T
Every pennit issued shall becone invalid unless the work on the site authodzed by
such permit is commenced wilhin 180 days aftet its issuance,or if lhe work aulhorized
on the site by such permit is suspended ot abandoned fot a peiod o1180 days aftet
lhe time the wotu is commenced.
BUILDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNEf, BUTLDER DELCARATION
I hc,.by utlirnr undcr l,cnolly oI Frjury rhal I d .kmpl rion rhc conl,scio$ Liccns. l)w r(tr rhc rorhwiry E8$n (sN 7011.5
Businc$ aril Profcssion Codc): Any Cily or Counly which tcluircs a pcrmn ro $nsrucr. altcr. inlPmvc. dcmri\h or Eron rnv
sdcrurq rn)t k, ns hsuaftc. .ho rcqunc\ rhc {p,}ltanr l'or su.h lrrmn r. ilc r siSncd shlcmnl rhd hc or sh. t li.ctrtd plruonr
r. rhc pmvisions ofth. G,nta.ktrt Liccnsd tir (Ch!flcr 9- Conrmen.inB wirh Scclion ?uD of Divtion :l .r $c ausinc$ ond
Pofc$io.s Cod.) or rhnr hcorshc tcrem ficeftonandrht bask ror rh. altscdcxcnPri.n Aiy vntrlionofs€liotr?{)ll 5l,yaiy
. 0mhcrnrrhrrncrmrr\ul"J.(r.rh altnl,cJrr ro rctrrlNrrlryor r rrrc rh,n rtrc huiJn'ldollJ'\r'lr or.
1 0 1,' ,'" ".,,,r,* o.""y. n, ml cmrrrn)cc\ r h *!BDsxs rhct srd comrcnsorion. *illd(, rhc w.* 0'ld rhc imrurc h Rn
04 cnacd m n rcE l lo! {h i Scr ?0.14 Bulnr( J d Pmrcssion( Codc Thc Conlts.roi s Licus Law docs not lnlly h xn .*mr iir
rhcptuFny *lt, hikls or nnFturcs lhcNn. and who des $ch Md( hinr\.lr.r h.r$llor rlu.ush hi\ or hcr o*tr.nlloyccs-
providcd rhlr such impmrcmnls ar mr inrcndcd oroffercd forsk.ll h(,Rcvcr, lh. huiklinE ot impmrcftd k bkl qilhi.onc rd
oIo,q,lcrion. r'lcOmr 8ui)dq $illhf,( rhcbonlcnoftbving rld hcorsh.dil , huih or in{,mrc thc pqtny for rhc rlrlr* or
-l.
rs owncr oi llE prDcnt. rncr.lunlclyconiracrirg wirh liccnscd conrrut,R r, ..nnrud lhc Pmjcr rsc. T(}14 Buqncs\
iM lt lbsin ('.dc Thc CoDtnclols Liccnrc l-aw dacs nor apply b n o$ n$ ol proFny who bu ikh or nnprots rhc.con-
aa{l who codlacr for such pnrccc wirh ! Conhrbn, li.cn\cd ,utrua rorh.Conidcroir l-iccnsc tje)
-l
rmcrrDnr undcr Sccto0 .11 &f( lnrr[nrcnlr]
/^,",9 31y ,ry*
Dt.( t,lt{,\ I t(rN
I hc'clry rilinr und$ rcnilrv.t Eriu.yonc ofrhc nnlosin! d..hrxrnnr
I hrv. mdwill minroin iCcnilEarc.fCon\cnl b Sclaln\u'. n)r wor kcs' conFcosal ion- 0s pmvidcd fd hySccrionlT0Oolrhc
I ibor Codc. lor I hc pcrto@n.c .l rh. sork r'or rnich rhc Frnril is issuql
Ih"!crdwillmi'nriisorkcriconrpcnsrrionin\umE..rsrcqoncdhySNriur:l?0(rotrhcl-ah,rGdd.fotthcPoli)rnu'nccol
rhc work for *hi.h rhis pcmir is hsucd. M!wortcA co'npcnsrri{rn insrh0.c.rnicr rftllx,lic, numb$dc
Policy NuniE!
-Eroircr:
w ccniiyrhar in rhel.rf.rman.col rhc work lor shich rhi\ pcflnil ir i\ cd.l shnlltrol cnrploynnt P.non i ant minDcr
su lirom suhrcct to thc wor*cs co'npcnsdn,n hw! olCrlifornid. Md lercc thol if I should ttconr subl$r to thc
wo*cr{ onllrcnqriotr lrovhion\ .l sc.rio. :17ff) of ihc Lh, codc. I shrll. i)nhr irh co.ll)ly wirh rlr)* lrovisions
$ARNING Fuilure b $.urc qorrcr .!m|En\(tr covcnsc i\ unlrRru!. rid shirl suhicr arr cmPloyer t, siinirrl F*Drlric\ tnd
civil liors uI k, oru huidr.'l rhou{.nd d.llnn (!100.00)). in ltdiii(,n ro rhc.o$ ofconrPcn$ri{,n. drnrFcs rs Providcd lor rh.
Sccrim.1076.rrhc ltrhn Codc. i crc{rndr onryi ti..
w,.s- \-/ r
rlt.( I \R\rl()\
I hcEhy riltm undcr pcnalryor,.rjury rhd I om liccnsn undcr rovision orCh.t'rci 9(co.nEmins wirh Scdn,n 70(x)) ofDivision:l
of rhc Busin.ssand PofcssionsCodc. dd nryli..n\c ir in rull lns md clltcr
Liccnsc Nrn$.r
-
Corl.{clo.:
CONSTRUC'I'ION LFNN!N{i A(iENCY
I hcdhydmr u,rdn r.n.llyolpcrjuryrhtrr rh.E n a.o.d crbn lc.dinS a8ctrcy ror ihc Pcnormm..lthc wotk itr*hi.hrhn Pcnnil h
hsucd (Sec. 1097. Civ c.)
kndcr'!Na,E:-
APIIII]ANIDECIAAA.I]ON
I lElt y lrm !od( penalry br p.rjury onc ollhc folb*n!8 declmrions:
Dcmlilion Pcrmirs'AslEsros Norin ation Frdc.alR.Bularions (Tille 40- Pan6)
-Rcquircd
Lcucr nr Nor'rf, drhn
_l!.d,lJrhdrhcl.d.mlrcguhonnsreF{dinpJrhc{nUcm,.lrtno'0n cahk ro rhi. n",Jnr
trLt.dnv tut tta\c tcsd thN JnrlKar'. rnd {ir. rharrh. abovc intorrorion is.od.cr IsErNroomPl,w h arr cny snd cou.rv
E,lri6nines;trd Srlrc L!w\ rclarrry to bx,ldre .onsru.hotr o hcrc6y ollhorizc eprsenrttiv.s otlhh City ond Co$ryio cnrs u,lon ltr
rh^c nrnr,trrd t),nN:r\
rlppri.,,r "" aB",r si,:n,ru*
$n*,u." *-.,,.u,,,+b 44
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Set Backs
Forms/Steel/Holdowns
Erection Pads
SLAB Floor
Rool Sheathinq
Shear Wall I
Framino t8 ,.y-*
lnsu lation/Energy
Drywall
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif .
FINAL K77-1
Certilicate of Occupancy
Notes, Remarks, Etc.
UFER Ground
Subf loor/Vent/l nsu lation
Ext./lnt. Lath
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MAYOR
Miguel A. Pulido
I\,4AYOR PRO TEM
[,4ichele lvlartinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas CITY OF SANTA ANA
PLANNING & BUILDING ACENCY
20 Civic Center Plaza
P.O. 8ox 1988 . Santa Ana, California 92702
www.5anta- 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 sp ecified at t 2
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 ln 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 INF ORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
l./ ft 1 . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
guilding 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.
0 k , , understand building permits are not required to be signed by property owners unless they are responsible for
d1e-cbnstruction and are not hiring a licensed Contractor to assume this responsibility.
Q/L ,. , understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may
,Trotect 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
um bers on permits and contracts
Ql-5. I understand if I em ploy or otherwise engage any persons, otherthan California licensed Contractors, and the
,7ola*Ivalue 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.
94-A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and
YedEral 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.
7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
ES ential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
moulido@ssnla-a.a.oro
Mayor Pro Ten, Wa.d 2
m mart nezAsanla-ana ora
Vicenle Sarmienlo
vsarmieolo@sanla-6na.oro soloro@sanra a.a.oro
P Oavid Benavides
dbenavides@santa-ana.ora villeoas@santa'ana oro strna ero@sanla-ana oro
ACTING CITY I\,4ANAGER
Gerardo N4ouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
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.
t)/l A. t understand as an Owner-Builder if lsell the property for which this permit is issued, I may be held liable for any
,f,n"ai'cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
0 ,/ g. lunderstand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue
'3e?Vce, 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.oov for more information about licensed contractors.
04,0
'the party
address:
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
le and tnanc ly re nsible for p op cons n activ ity at lhe fo tng
0 / f .I agree that, as the party legalty and financially responsible for this proposed construction activity, I will abide by
cdlfYpplicable laws and requirements that govern Owner-Builders as well as employers.
0tl lZ. t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
{nfo"rmation 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. /Votej A coDv of the DroDertv owner's driver's license-
form notarization, or other verification a cceptable to the aqency is required to be presented when the permit is
rssued (o verify the owner's sionature.
Signature of Property o*n", 0,*-/,'7/ z /r r-,+---2
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 file the documents necessary to obtain an Owner-Builder Permit for my
project.
Scope of Construction Pro (or Description of Work)
Project Location or Add
Name of Authorized nt
Address of Authoriz Agent
Phone Number of A orized Agent:
alty of perjury that I am the prope owner for the address I above and I personally fll.)ed out the above
rtify its accuracy
Property Owne Signature Date
Print Name er:
Note: A y of lhe owner's driver's form notarization, or Yerification accepta to the agency is required to
be when the permit is issued Yerify the property signature.
Pliil('!n'P5iiCo!.ieiAc!vily:Assenb lRtirsrN.r.e t. Pr.F€ry
SANTA ANA C COUNCIL
mo!lido@sanla-ana oro
Michete Ma.l nez
Mayor Pro Tem Ward 2
mimaa{inez@santa-ana.o.o
V.ente Sarmenlo
vsarm e.loasa.la a.a ors rsolonorosanla-a.a oro ivl eoas@santa'ana.oro sl naiero@santa ana.oro
Date:
I declare under
information and
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