HomeMy WebLinkAbout10296788 - Permit&-l
Proiect Address: 1121 S Golden West Ave
Lotr POR 2
Unit Bldg: Address Range Suite Range:
Zoning; R2Assessor's Parcel:109-09't -05 Block: B Tract 504 Historic: No
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA\27O2 Building
PermitCounter (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 10296788
Pin #: 60715
Single Family Dwelling
Alteration
Remove Garage Alterations
Sfd Wdet garage
Other Areas: 0 Yards Req'd:
80tchi:{{397 - 6/m/2018 I0: ccuEr.t.AR
Garage Afeare: CTYH IH aUorEt $1,000.QO IAccti: Refi: I rl2967tt8rotar: Rcetir02299s92 - 6/20/2018 zzii pn
Description of work: Remove unpermitted partition watls, kitchen, & bathroom facilities in garage. Return galSgg EtictS il9\ftlenoea use. tt3fte?2of autn
U
VB
cBc 2016
x-0602320257J
Patio:
T.l.Area
1st FL Area: 0
2nd FL Area: 0
At|Jrer 0'ooon file.
Planning Conditions: Garage to be used for its intended use of parking & storage.
Owner:
Address:
Phone:
Tenant:
Contractor
Addressl
Owner-Builder
Engineer
Address.
ts34.19
,1 ,00
,77n.92
Andrew Dao
1121 S Golden west Ave
Santa Ana, cA 927043203
(714l.7',t6-6201
Euildinr
0r116002- sr60t0(n-
Bld! Std6 Reyolvine0lll6m2- 51612m0-
ICL fieck ??19
NOTIcE oF Vlot.Arlfrhl;"1;"',o""sation rnsurance:
Policy #:
Expires:
Phone:
State Lic #
Lic Typel
Phone:
License #
Architect /
Desiqner:
Addressl
Phone:
License #:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd
Kelaher, Selena
Amsden, Julie
Date: 06/20/20'18
Date:
Date: 05/20/20'18
Subject to Field:
Misc Receipt
Misc. Receipt
Misc. Receipt
No
077750 0 2
077760 0 2
017160 0 2
0 71160 0 2
0 777600 2
011160 0 2
$154.26
$93.17
$234.08
$1.00
$2',t.25
$52.98
57601
57607
51601
57672
57600
57607
Permit Fee
lnvesligation
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuancePWA lnsp. Req'd: No
Planning lnsp Req'd: No
Landscaping lnsp. Req'd No
ffi Account#Total
Flood Zone Cert. Req'd: No
Every permil issued shall become invalid unless the work on the srte authoized by
such pemil is commenced within180 days aftet its issuance.ot il the wotu authoized
on the site by such petmit is suspended or abandoned for a period of180 days after
lhe lime the wo* is commenced.
lnspector MtD#. 2018-144117
0'1 1 16002 51600
01 1 16002 5160'1
0'1 'r 1 6002 5 1 6'r 2
$21 .25
$534 49
$1 00
Fee Total
Paid to Date.
Balance Due:
$556 74
$0 00
$5s6.74
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Storiesl
Planning Approval By:
(
Fire lnsp. Req'd:
Police lnsp. Req'd:
BUILDING. INSPECTOB RECORD
COMMENTSSITE-WORK DATE IDiSIG.
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Sublloor/VenVl nsulation
Roof Sheathinq
Shear Wall
Framinq
lnsulationi Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
lt/asonry
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Ceftif
[.o> )4lt7 lg-ru,tr'€r/FINAL
Certif icate of Occu n
Notes, Remarks, Etc
OWNF]R BTI!LDER D}X-CAR 'NON
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BxsinN\ r Pro,cst,n C.dc) Any Ciry or C.umy qhi.h rcquitcs I P.nnir ro onsltucr. alrfi. imnrovc d'nmlnh or rcprn dy.
irucru,.. prior ro irs ksuarcc. ako rcqriE. lh. q,rlicant Ihr slchFnnit lo filc! siEncn {lrmnl rhar h'or shc h liccn{d Pusurnl
lo lhc Ptuvi.n rs of r,r ConrBck, l Licc.scd Llw (Chlnrd g ConDelring wn[ Sccl ion ?(xn ol Divhion ] or rh' Bus idcll rnd'
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$ owncr ollhc nrol(ny. or nry cnrlo)tc\ sirh w.8cs rs rhcit v,lc comlf,trsdrion. *illdo tlt qork drhtifl'Nrcnnol
irrdxlc{ orollcrd for srlc (SN70,11. Bxsincs d Bnlc$ioBC(ilc IhcConrEcttr\ Li.ctrk Lf,w (1..\ or rl,flvn)xtro$ .' fl
r lr pml.dy who huilds or in{fl,vcs rrEr@r. u who des ruch sn* him\clr or hcr*ll'or rhnrulh hh or hcr o*n 'mpbrccs'p","ia"a lr,or .,.t in,r,o\tft.b {c nol inrcd.rl or ollctd nn sb. lf. k,sdcr' rhe huitliu or ilnlmrcflEnr is v' withir' nnc Jtr
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r Pdc\ifl(hdc lhcConrra.ktr s Liccnsc Lawdot\ iorrl)Plyio nno{ncrofln)rcnv$h. hnrldsor imPtrrt\ihcrcotr'
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DECI.dSAITON
I h.r.hy !l6rm undcr pcn,xy of pcrju.y oN orrh. rollowins dslursri.trs
-lh3vc
dt $illnuinlaiouC-.din..rcolCons t) Sclrltrsur. io. *o,kc* conrycnslrt,n 0s folidcd forbvscclion lTlnofuhc
bho, Grlc. ibi rlE !q |orm(te .f rhc work for which rh. Frnir is issEtj
-lhorcandwillmrintai.workcn..rrF.Dsarioni.suBncc.rsrcquircdt'vSerio.lTtroolthclntDrCodc.Jirltcp'rr'n'Enccorrhc work tuwhichihistcmn i\ isacd My *o.kss dlmFtrs,iiotr in\ura&c.Micr {xlrolicvnnn$cr m:
-ExPnc':
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MAYOR
MiquelA. Pulido
MAYOR PRO TEN,1
l\4ichele Martinez
COUNCILIVEI\,lBERS
P. David Benavides
Vicente 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.orglpba
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 ECn J tf r/(
We are providing you with an 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
_r)@_,1 . t understand a frequent practice of unlicensed persons is to have the prope(y 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.
_[-l-2. t 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.
jl_3. I understand as an "Owner-Buildef' 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.
=]t9_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.
[ ,D 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
tbial 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.
,lD 6. Iunderstand if Iam considered an'employer" under state and Federal law, I must register with the state and
fedbral government, withhold payroll taxes, provide workers' compensation 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.
_IpZ. t understand under California Contractors' State License Law, an Owner-Builder who builds single-family
resfdential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
moulido@sa.ta-ana.oro
Mayor Pro Tem, Ward 2
mLmartinezrasanla ana.oro
Vicenle Sarmienlo
Eamiento@santa ana o.o isoiono@santa-a.a.oro rrr!.ca-a!@!a!E a!!gg slrnalero@sanla-ana.orodben.v'desdsa.ra a...ro
ACTING CITY MANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
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.
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.
__{O_A f understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any
findncial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
4 g. t understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue
Service, 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 Conlractors' State License Board
(CSLB) at 1 -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.
PO
the pa
10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
rty legally and financially responsible for pro osed construction activity at the following
address
It ! I t . 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.
tt lt t Z. t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
infdrmation 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'
com pensation 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 p ermit. Noter A copv of the propefiy owner's driver's license,
form notarization, or other verification acceptable to the aqencv is required to be sented when the Dermit is
Signature of Property Owner
Print name of owner ltl N ) tt;
Date v6
yA")
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 Project (or Description of Work)
t'1""'- '- <t-f
Project Location or Address 't*^r
tE r.tr"/Vi U ILP\ircD l<i 1c- lu* t \ c'U- t',.,-
*utl- 6
Name of Authorized Agent:&'ck.r."\ C-*t-'-'a ,??t'4
Address of Authorized Agent i.\q]. s !i (-trrto&t s trrulrr fyNo- q
Phone Number of Authorized Agent (t tt -,.2oC
I declare under penalty of perjury that I am the property owner for the address listed above and I personally lllled out the above
information and certify its accura
Property Owner's Signature
Print Name of Owner:
Date
Note: A copy ofthe owner's dri license, form notariz ation, or other verification acceptable to the agency is required to
be presented when lhe permit is issued to vefify the propedy owner's signature-
Plr.r yJ p5i ,C.r.le_A.!,.! A3.ei:,5 i:NJl.: ic P..;?ty F r.- a? ir:(,16
SANTA ANA CITY COUNCIL
MguelA. Pulido Mlchele Marlinez vicente Samle.to Jose Solorio P Oavid Benavides
Mayor MayorProTem, ward 2 ward 1 Wad 3 ward 4
-oJrroo@saita-a.a o.o - -ari 1ez@sanra a.a.o.o 6anre^to@ssrra.ana o,o 'sorolo@salra-ana orc doena oes@sarra dna o o ivilleoas@sanla-ana.oro sllnalero@sanla an6 oro
issued to verifu the propertv owner's sionature.
elrl,l\{t-A ^/ Dlto