HomeMy WebLinkAbout10196723 - PermitoY
Project Address: 1416 W Hall Ave
Assessor's Parcel 140-234-O2 Lot.56
Unit Bldg: Address Range Suite Range:
Zoning: R'lBlock: NA Tract: 5952 Historic: No
City of Santa Ana 20 Cavic Center Plaza (M-19), Santa Ana, CAg27o2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Single Family Dwelling Occupancy: R-3, U 1st FL Area: 0 Patio
Job Type: Reroof Constr Type: V B 2nd FL Area: O T.l.Area:
Nature ofwork: Reroof codel cBc 2016 other Areas: o yards Req,d:
Exastjng Bldg. & Use: SFD Watt garage Flood Zone: X-0602320259J Garage Area: Valuation: $2,830.00
Proposed Use: # ol Stories: Total: 0
Description of Work: Tear off existing remaining roof materiat and install new comp shingle material. Handoutgiven. Owner-Builder form onfile.
I t,: :it .
l.rlf r,:q
Owner:
Address:
Phone:
Tenant:
Francisco D & Laura Delgado
1416 w Hall Ave
Santa Ana, CA 927045731
(71415744755
Contractor
Address:
Owner-Builder
Engineer
Address
f0t, o I
I Lflur0 oel
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Architect /
Designer:
Address:
Phone:
License #:
l6ultrfrtr..
cvo 1v ine
t 61?utro'
n Updote Fee
t6rr0r-r(ir-r*
i**rr(tI4, fiLrt.l
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
$308.52
$1.00
$21.25
$52.98
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
Evory pefinit issued sha become invalid unless tho work on the site authoized by
such permit is cofimenced within 180 days aftet its issuance.ot il the work authorizod
on the site by such pemit is suspended or abandoned fot a peiod of 180 days aftet
tho time the wo* is commenced.
lnspector MID#: 20'17-139909
H Account#Total
01 1 16002 5'1600
011'16002 51601
011'16002 5'1612
$21.2s
$361.50
$1 .00
Fee Total:
Paid to Date:
Balance Oue:
$383.75
$0.00
$383.75
Permit #: lO{96723
Pin #: 43738
Building Use:
Planning Conditions:
Phonel
License #:
b/ 1,!/ 1LtlE
Iuild ins
r i i 16u12-
Elds 5[dr
Lrll16tt(r2-,liener'rl I
r"{l116trr-r2-
( +: rr*r
Orozco, lvan Dale: 1111412017 Misc. Receipt:
Date: Misc. Receipt:
Chavez, Davega , Date: o$l12l2ola lvisc' Receipt'
Subject to Field:
01776002 51601 Permit Fee
07776002 51672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
07776002 51601 lssuance
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.owNER ltull-Dlifi DaLCARAI toN
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Ausincs nM Prof.\\ioi Culc): n, Ciry or Couiry which lcqutcs r Frnrir io .onq cr, rlrcr. i F)rc, d.'n hh .r rpair My
nru.rurc. nrnn ro its isnutre. also rcaut r th.,rdicrr f(tr su.h Fr.'ir n' ul. r siS cd idc.rc,r rhr heordr ir licciscd !u^u,nr
l. rhc ,hvisioN of rhc Cl.ftn !r's l-i.cn{d L'! (Chrprrr 9. Connn.ncing wnh S.crn r 7l[)0 of t)ivision .] of rhc Bu\i'lrs lnd
Pmic$ions Codc ) or rill hcorshc hcxcnfl rhcrcfro$ and rhcbrsi\ for rh. dlhlcd .xc'nprion Atryvt,lDrionotSc.riotrT0ll5hy.ny
applicur rbr a Frnril ruhjcct\ lhc lttlicunr lo ucivilncnrlryol trot mrcfion fivc hutrdrcddoll.r iS5($).
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i"rcndct rollcrcd for $k (S(.7O1-4. Au{rcss rtrd Profc$trN Codc Th. (btun ttr s Li.cnrc Lrw docs nor lPplyh o\rftr.f
rhc pbp.n! who hrikh or i'npr.ts rhc(r. dd who ,rc\ n'.h sork hinNcll o' hcrcllor lh(n'ai hir or hcr own cmpi)yccs.
proviJcd rhlr su.h imnnivcntrh nc rmr i .ftl.d or ollarcd {or sk ll hoMrd. rhc } ildin8 or ntmvc rnr is {,ld wirhir on. $
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rnd *ho conlmch {o! such pmJc.k wir[ icrM.dnnl) lic. \cd
I hcrcby rilnn trn .r p.ulryof Frjr'tnm.l rft ftn[Nirr dcclt
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hsvc ondwill mlinrain !Ccnific colconscnrroScli.lnsurcforso crl compctrsotion. as pmvidcdrorhySccrion3?O0ofthc
L,bor Codc.Ior lhc p.rfon mc oith. work i.r which rhc p.rnir h isucd
IhilcandwillFniniainworlc'! compcnsarinn insunncc. !\ rcqln.d h, Ssiio..i70O narlr Lzt*, Code, f.r rhc p.rformnc..f
th. rorl forwhi.hthk p.nnir is issNd Myworkc* .onrpcdqrioi insutunc.ariui rnd l.licynunrb.rr.:
Cuicr:-
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Eit hr rr rnr ,n rtrc rrr.rm{Nr,rl rhc s'trt ,nr lhtrh rhis pcrmir is issucd, I shallnor cnTk)y my pcrson in..y mnncr
\l'i7n ha, n c \uhtfl | r, rl. tr.4c'\, rn,|($ariotr |.,tr. oi( trlrf.iinJ.otrd rErcc rhr ri I "hnuld t("m \uhjccr r.r|i.
sorlc^ comnrnsari,nn()vi\i,,tr\olSrcri,nr.l?(lO.IrhclilxtrC,d.-l ll. hnhrirh.on,flv rvirI rln'{ Irrvi\i(tr,\
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I hcrchy rlrtnr undcr pcnihyoip.ryury rhd I rnr licctr{d uMcr taovhior oiCh.i'rcr I
of rlr Buenc* d Pturc$n sC.d.. dd.ry li..nsc n in fxll torc. r!]rlfccr
l-iccnsc Ch*
-Licctr\c
Numbcr:
-
D.l.: Contractor
C(INSTRU(:TI(IN I F\DIN(; A(;ENCY
I hcrct y irfirnundcr p.nrkyotll€rturyrhal thcrc h 0 consrucrhn lcndin8 r8ercy for lnc pcrfommc ollhc *ork tor which rhh lc nir is
issucd rSc..1097. Civ. C.)
aftrtc NrD[clll[auo!
I tEEby irlnn undcr lcnllry ol pcrjury om olrh,lollowirg dcclmrnnN
D.nslirrnPcnhirsAsh.{orNorifi.urbn Fcd.ral R.$ldions(Tnb4l), Pd6)
R.qurcd lrncrof Norifi.uhon
-l..nilyrhar
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H*r 'ly rhn 1 I'x\c 'cxd rh \ rft,li.rr(, r rnd rhar rh. ih,!d irloi,Mrion s conccr I +e lo comply wilh all Cil y and Counly
trtiDtr. d hcr$yrurlntrizc rcorcscnlarivcs olrhis cir,0nd Counrylo enrcr up.tr rhc\rfd Sr c ltrtr\s rhrirf r, hrildrtr!
trbort Nntoi.d pn,t. y f(n nisFari,nr
,,,,",, iltzt&Appli.ont or A*cnl SiSDrlua:
P.nnil.e nanP (pnnl): A
/-l1/,
a.--
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/Vent/l nsulation
Roof Sheathing
Shear Wall
Framing
lnsu lation/Enerqy
Drywall
Exl./lnt. Lath
Brown Coat
Ivlasonry
Pool Fence
T-Bar
Handicap Req.
De puly Final Report
Engineer Final Report
FINAL 7-2? -/€J/e!il ,-(O\
Certificate ol Occupancy
Notes Remarks Etc.
-{
COMMENTS
Set Backs
Flood Zone Certif .
*" 'E /tz I
%r - * *,,^ ^*, ",,,*,,^ ^,
MAYOR
Miguel A. Pulido
IVAYOR PRO TEM
Michele Martinez
COUNCILMEI,lBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
Sal Tanajero
Juan Villegas
ACTING CITY MANAGER
Gerardo lrouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNING & BUILDING ACENCY
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 you rself as the 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 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.
fr\f -U t . t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildefl
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. l,
as an OwnerBuilder, 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.
1,0 , , understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a Iicensed Contractor to assume this responsibility.
[,0 4 ,understand as an "Owner-Buildei' l am the responsible party of record on the permit. I understand that I may
plot6ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name
instead of my own.
f,Lo. , understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
[,I t ,understand if lemploy 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.
[.Lu.
'
understand if I am considered an "employer" under state and Federal law, I must register with the state and
lederal 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.
f ' [) Z f understand undei' 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 C]TY COUNCIL
moulido@sanla-ana oro
Mayor Pro Tem ward 2
m man .e2@sa.la-ana o.o
vi.e.re samienro
vsamienlo@sanla-ana oro soloao@sanla-ana oro
P Drvld Benavides
dbenavides@sanla-ana.oro ivilleoas@sanla-ana.oro sli.aierc@santa-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 Contraq2r. ,
8 I 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 su bsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
E-,\-n , 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 Contractors' State License Board
(CSLB) at 1-800-321-CSLB (2752) or wvvw.cslb.ca.oov for more information about Iicensed contractors.
[,\,0
the 0arty
address:
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am
legall and financiall y responsl le for pro construct activity at f lowi
-Eu 11. 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.
[ (\,l,
'
agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
ihfo/mation 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 jndividual or firm is injured while working on your
property, you may be held liable for damages. If 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'
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 permit. /Vote: A copv of the propertv owner's driver's license.
n anz or ven ation able to the IS ired be ,s
issued s,nat re
Signature of Property
Print name of Owner
Owner Date
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 llle 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 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 filled 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 property owner's signature.
i: .f i, ia' a:.r ^:r'i-,,.! r-,::-,-: ;il i r,l:r'. r. p 1;.rlL r': a-r :! ." .
SANTA ANA CITY COUNCIL
mpulido@sanla ana.oro
Mayor Pro Tem, Ward 2
mima.lrnez@santa-ana oro
V cente Sarmienro
vsamiento@sa.ta-ana.oro isolono@santa ana.ora
P Davrd Benavdes
dbenavrdeeosanta-ana o.o v eo.s@sz.ta ana oio sl'naie.oaosanta ana oro