HomeMy WebLinkAbout30139413 - Permitcity of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702 Plumbing
PermitCounter: (71q A47-5800 lnspection Requesls: (714) 667-2738 lnspector Section: (714],647-5853
Permit #: 30{ 39413
Pin #: 85079
Project Address: 2045 W Martha Ln
Assessor's Parcel: 004-'163-02 Lot 5
Unit:
Block: NA
Btdg:
Tract: 1458
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address
Phone:
Tenant Name:
Contractor
Address:
Arthur Hoffman
2045 W Martha Ln
Santa Ana, CA 927063219
(714) 34s-9498
Owner-Builder
Foe Type Amount
01116002 51602 Tankless Waler Heater 63.12
01116002 51600 General Plan Update 21.25
01'116002 51602 Issuance 52.98
Qty
'1.00
1.00
1.00
Fee
$63.12
$21.25
$52.98
Batch*r436,12 - 1/g/2t11!)
0f f icer (:TYH TronE+: ,41Acct+i Peff!
R(p ti: t12260(t41 -:,,/P/3r.tl!
Tronsoct ion Tota IPhone
State Lic #:
Lic Type:
Bus. Lic #:
workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
lcl
Lt?4 rJr f'fl
Arthur Hof f finn
Genenal Pldn Updqt e Frc
01 I 160t-l?- 51 60r1':fi1!:r-
Plul.b ine
0l I l6tl02- 5l6tl?r.rttJ-
lloster (ord
CC+: **r****r***I3J9U
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permjt #:
Single Family Dwelling
Alteration
Tankless water heater
Occupancy:
Constr Type
Code:
sden Julie
Every pemit issued shall become invalid unless the work on the site
aulhodzed by such perfiit is commenced within 1 80 days dfter its
issudnce, or it the work authorized on the site by such permit is suspended
ot abandoned for a peiod ol 1 80 days aftet the time the work is
commencod.
R-3
VB
cPc 2016
05/08/2018
Account#
Notes: Replace regular water heater with tankless. Located in
laundry room. Handout given.
$137.35
$0.00
$137.35
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
$21.25
$116.10
lnspector MID#: 2018-143242
01116002 51600
01116002 51602
Fee Total:
Paid to Date:
Balance Due:
Date:
Date:
Date:
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Waste & Vent
Water-Under floor
Gas-Underfloor
Buildinq Sewer
Area/Storm Drain
lnterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Pipinq
Rool Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipino
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
tl
FINAL -7ltglt9 1)
Notes, Remarks, Etc.tl
,
OWNFJR I}UII,DER DEI-CANATll)N
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ro rhc pmrisions ol rh( Conrn.l{tr's Li..n\cil Ijw (Chaprcr 9. Conrnrn.in8 wnh Se.li,'n 70(n of Divi\k'n I ol rh. Rusincs lid
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rhc ForEdy who hr & 6r inpiD6 tlE@n. o,n who dG sh w* hid\clt or h.rklf or rhmu8h nG ot h.. oM cr'rloyccs,
provid.d rllll such impmErnr: e mr 'ni.nd.d or orcdl fo, $lc. lt, lk,w.w. rh. l,uitin-q or ir{mwmm B $Id wnhm onc ,w
or coqlclion, ltE Owrcr Builir will hsrc lhc bshn ofltrolins lhd lE ot shc dil ml build ot iryrcw the nopgly ftr rlt r tlDs of
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Pnf.s\irn codc: ThcConticlor's Liccnsc Lis docs nor dpnly r. ,n osncr ofltopcny *ho h!ild\ or imporcs rhctsn.
and who onrEcts lor $.n t,DjGk wirh r liccn*d puBu ro rhc C6ntel6, s L@N tjwl.
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DEITAEAIIJTN
I ncrcby afrtrm undcr Dcnalry of psj!ry oic of rhc followiig d(hruiors:
-lhr\clklNillnui
triniCcniturrcof Cons n)srllldluicarr$o!kcr'conrFn\rri,)n. pn,vidcd l(n hrSNrion llTll()olrhc
ljhor (itrlc.li)rrhcJxrLnr!$ccolihcw.rkf(trwhichrhclcnnir ni\{rd
_I h6!. lnd qill mi.ldn wort6 mmpe Balior insuEmc. as rcaoir{ by Sel io. :1700 of lh. l,hor Codc. for tlE df(rur of
rhc wo.k for qhict $n pcmir is bscd My wtrt6 comFnsalio, inslrane .ohr and rblty ,unh.r el
-t
anify rhll in rlrc ,.rfortuG ot rh. worl( tor which thh p.rmn is is$.d. I shlll not crllloy ey posn in any mnncr
s ai h heom *lhjccr ro rhc worlrcs compcNrliotr hvs of Crlifornis. &d ase lhd if I should b.com subjd lo llE
w*ol codpcnsrion Imvlrions of SRtion 3100 of lhc bn,r Cod., I rlell. tonhwilh .omply wilh lts$ ,mliiiotr ..
WARNING I',ilurc ro {curc workcn cor,tti\dnnr co lawtul. and shau suhirr d cmplorlr ro ai'ninal lEmhis and
ion. d.@gcs .s providcd tor lhccavil lir.i up to oE hundrcd thols.nd doll.6 (t100
I)t:( 1. \R,\ rll,1
I h@by arud !ndc! Fnllr, of Frrury lhd I m liensd hdcr Folirion of Cn piq 9 (onftminS Filh Selb. 7@0) of Division 3
of rhc B$ircss and Pmfcssions Codc, ad my liccne h in tult fom &n eff61,
CONIIAICII!]NIENDINGJGIICT
I ncEby aff"m udcr pcelry of lcrjury ih,t rh6. is o sinrudbn lcnding es.rcy tor lh. pc.foru. of llE uort fo, whhh rhk Fmn is
i{sucd (Scc.l0i)7, Civ C.).
AITUCANfDECITIXAII9N
It Nhyamnnxndcr |fnllrt ol pcrjry om oflhc folloNins dcchfurnrn\
t).trx,lirt'n Pcrmir\ A\b.{.s Nolifi.ntion lcdcr!l Rcs!lalioN (lirl.l0, Pd6)
Rcquird h ft ulN.rificdi'n
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fcdcral r.Culari,,ns mg,.di.E nstEslos rcrmval orc nor lppli.abl. 6 rhir Pru,..l.
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onlinrtrcs md Sr.rc kws rcUl aurho.rc rcrcsnhrirc\ ofrhis CnFnd Counlyro cnrcr !F. rhc
trtx,rc 'ft.ri.rd prcncny fo.
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UNDER GROUND
Meter Release
Polic, Nlnbcr-Exllncs:
-
Cotlrrclor
N4AYOR
Miguel A. Pulido
I,iIAYOR PRO TE[,4
Michele Martinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas CITY OF SANTA ANA
PLANNING & BUILDING ACENCY
20 Civic Center Plaza
P.O. Box I 988 . Santa Ana. Calilornia 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 s ed at AIJ+QZzo6
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.
(Lk' , 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.
/^ lfW_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. lunderstand as an -Owner-Builder" Iam the responsible party of record on the permit. I understand that I may
rotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name
instead of mv own.
^f( d#- O I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
d'r.lunderstandiflemployorotherwiseengageanypersons,otherthanCalifornialicensedContractors,andthe
iotal 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.
({Nz 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' 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.
W-l lunderstand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential slructures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
eM
Mayu Pro Tem, Ward 2
mrmarl nez@santa-aoa.oro vsarmienlo@santa-ara oro isolorio@sanla ana.do
P. tuvrd Benavdes
dbenav des@sanla-a.a oro ivireoas@santa ana oro sl.ae'o6sa.la-a.a oro
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
moulido@sanla-ana 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.
OEa f understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
worknnanship or materials.
MU. , understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Smatl 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
4k r.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the oartv leoallv and financiallv res
aaaiesi,J€45 lNfrT oonsible for orooosed constru'tY1HZ7++ 1A^l€"ltf'ffi*"#flff in.b qT7 6A
W_l-l.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.
.( f(KlZ 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 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 Iicensed and the status of their workers'
compensataon 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 coov of the Drooertv np.r's driver's ti cen e_
rization or other table to the enc ,s u ented when the it
issued
Signature of Property Own C:^*Date I /tr
Print name of Owner L A.J
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 flle the documents necessary to obtain an Owner-Builder Permit for my
project.
Project Location or Address
Name of Authorized Agent:
Address of Authorized nti
Phone Number of A orized Agent
mpulidorasanta-ana oro
Mayor Pro Tem Ward 2
m marlrnez@s6nl. ana.oro
Vcente Samrenlo
vsamre.to@sa.ta ana oro so oro@santa ana oro
P o6vid Benavdes
dbenavldes@sanla'ana.oro v,lleoas@saila-a.a oro srrnaEro@sanla-ana oro
ScooeofconStructionProiect(oIDeScriptionofWork):
/
I declare under penalty of perjury that I am the prope(y owner for the address listed above and'l personally lllled out the above
information and certify its accuracy .," Dara-Property Owner's Signature:
Print Name of Owner .
Note: A copy of the owner's driver's l'lrense, form notarization, or other yerification acceptable to the agency is required to
be presented when the permit is issued to verify the property owner's.slgnature.
;'', i.'i,: :-..,':.jl'r. . r A.j.!':,a !'..r.. i:t'. i,':, "- a' 1: :/. :'
SANTA ANA qTY COUNCIL