HomeMy WebLinkAbout101103382 - PermitProject Address: 850 E Bishop St
Assessor's Pa;cel 011-231-02 Lot 33
Unit Bldg. Address Range Suile Range:
Zoning: R1Blockr NA Tracl 3113 Hrsloflc No
City of Santa Ana 20 civic center Plaza (M-19), Santa Ana, cA92702
Permit Counter: (714) 647-5800 lnspectron Requests t714) 667-2738 lnspector Sectron: (714) 647-5853
Building Permit #: I Ol { 03382
Pin #: 83137?X
Building Usel
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Addition
Addition
SFD w/att garage
Occupancy
Constr Type
Code:
Flood Zone:
# of Stories
R.3, U
VB
cBc 2019
x-0602320276J
1st FLArea: 475 Patio:
2nd FL Area: T.l.Area:
Other Areas: Yards Req'd:
Garage Area: Valuation: $50,000-00
Description of Work: Room addition at rear to existing SFD
Total: 475
New Master bedroom with closet, new bathroom, and new dining room.
Planning Conditions
Ownerl
Address
Phone:
Tenant
Conlractor
Address:
Engineer
Address
HAI M VO
850 E BISHOP ST
Santa Ana, CA 9270'15206
(7141 788-7 087
Ovrner-Builder
Phone:
Stale Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensalion lnsurance
Carrier:
Policy #;
Expires:
Donald J. lnman & Associates
Donald J. lnman
5131 Fox Hills Avenue
Buena Park, CA 906211408
(714) 521-0554
c-'t 1888
Architect /
Desiqner:
Address:
Phone:
License #
Planning Approval 8y:Graham, Jeffery
Plan Checked By.
Permit lssued By:
NPDES lnsp. Req'd
Wayne
Amsden. Julie
PWA lnsp. Req'd: No
Planning lnsp Req'dr No
No
Dale: 0811112020 Mrsc. Recerpt
Date: 0712312020 Misc. Receipt
Date; 08/19/2020 Misc. Receipt
Subject to Field:
No
No Account#
01'l 16002
01 1 16002
01116002
011 16002
01116002
08901001
Total
57 607
5i 600
57?70
24 000
5 7672
s7600
57607
$55'r.00
$688.75
$52.65
$6.50
$2.00
$23.79
$59.30
$1,383.99
$625.00
$758.99
0777600 2
0777600 2
07776002
08907001
077760 0 2
07776002
0 717600 2
Permit Fee
Plan Check Fee
Microlilm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
Fire lnsp. Req'd:
Police lnsp. Req'd
Landscaping lnsp. Req'd. No Flood Zone Cert. Req'd: No
Every pemil issued shall become nvahd unless the wod< on the stte authonzed by
such pemit is cornmenced within360 days after its lssuance or if the wot* authonzed
on the site by such permtt is suspended ot abancloned lot a penod o1360 days after
the rime the wofu is commenced.
lnspector MID#: 2020-158155
51600
51601
51612
53600
57770
24000
$23.79
$610.30
$2.00
$63.75
$52.65
$6.50
Fee Total:
Paid to Date:
Balance Due
Phone:
Llcense #:
BUILDING- INSPECTOR RECORD
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Certificate ot Occupancy I
Notes, Remarks, Etc.
Hev.08-D/-2015
c0!sll!c1!N'Ilur!!.acEx(I,
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$ued (Sec ll,9?. civ C),
lrd.rs N.mr
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Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-s800
www.santa-ana.org
APP-13 CBC 2016
NOTICE TO PROPERW 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 e ST A c+l zH
We are providing you with an Owner-Builder Acknowledqment 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 permitling authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
IS f. t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build-
ing 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 rask 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 an.iuries to workers on my prop-
erty.
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. I understand as an "Owner-Builde/' I am the responslble party of record on the permit. I understand that I may protect
myself from potential Iinancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own_
_d_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
,/5. I understand if I employ or otheMise engage any persons, other than California llcensed 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.
--t
-AO. f 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' compensation disability insurance, and contribute to unemployment com-
pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
W' Z. f 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/rwork is performed by licensed subcontrac-
tors 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.
$' 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 finan-
&ii? personal injuries sustained by any subsequent owne(sj that result from any latent construction defects in the workman-
ship or materials.
9. I understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser- '
vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi-
sion 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.
J,_
party I
dress:
10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
egally and financially responsible for proposed construction acti at the following ad-gT.
1 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
r/12. 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 flnancial 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 flrm 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. ,Vote.' A copv of the prooeftv owner's driver's license, form notariza-
tion, or other verification acceplable to the agency is required to be presented when the oellnrl rs issued to verify the
4 Oate: OB \4 .ZD?-DSignature of Property Owner
Print name of Owner HAt VD
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 Descriptaon of Work)
Project Location or Address
(^0
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 fllled 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 verilication acceptable to the agency is re-
quired to be presented when the permit is issued to veify the property owner's signature.
proDertv owne r's sionatu re.
Clty ol 5.tzr,* furf
Los Angeles Uniform Code Program
Uniform Procedure I-7: Special Inspections
Speclal lnspectlon Report
.DISCREPANCY 'CONFORMANCE
hou b $a irmodid. atlndon of lf i'/st to approvad end cldg reqliEfiEnB, submitAJi
ti6 Confacu b. ccrec{orl tf correciodt art mt m$a in e
&rely rnenoer, trIs regort shd De used al I dagegarEy nolce
Submn Urc cdglnd b Buidflg oeprfiEnt aod cophs b
Confactor
fiis repod b Bulldog ocprtrrat ad gog;es b Contab( Engineer/
Arc|'itect d rrc€.d and Ornlr no l@ t lal fre business day blior..llr4
60 c!fldulion dhr spclC lnrprlon, For inspccdons greater than 5
a d leasl o veeh-
fiorxr ffdIlsrgs>a. ,ksd q'
Pc"mlt NunrE:
/e / tD)t8 Z /r9h t/o
Owna:l^liltEvtngh!.r d R.@rd:*>s712 .D-ry,b1)
Fu[ Nama a, SpacLl Lrrpctbfl:
l{uan Van Bul
CJty Ragfficr flurDbcr: -
POf 3049 <zt t'-'.ft
lD2 2-^/ 4 ,/./- z-
Arnpny:
VanBul Insp€cdon
ThlsEa:..P Final
Tlpc of Irupcdon:
o Relnforccd Concrete o Stsudrd Maonry
o ftesessedPost-Enshnd o MB h Coocret{Masonry
o Shotcrrg&r{tc o StrucE ral WrHh,
o IneJbE)g CoocntCcypo.t! o tttsh SUt'tgt,t BoehgTlma TtmrData A}trttd D.p.rtsd
7/,r/u ( zrt 4' u4
Remarksr I
o Piflng, Pla6 & Calsrons a Snpke @ttrd
o 6@rat on and n[s : Encrgy Cornplianc€
o SprafApglGd FII! honrE o TestirE Reports
c Qlhs &>e/s ,u/ 7--
Dcrcrlpdor and todoa olWorklnopected ,724/.ffi.a-7 .
#,+ adtt--t5, gq- " b1+, z-tz-c=;177/7g ,^, t/'*
/-7a5, c'/-r.zo ar-, e.-4 cz.oz-zz.< z*=-L,
2H4 z-*a@ zb-+<osz4 t<-,/+1>_t, 2..4L
G .CZfr aED.,c: /s * / g=- - // .ru_
No.
Wpbtd
s.E Ptoizt/.bW_-.at
e No.lof I
Numbar':
7t+34U8266
*+-
2
I I'IEREBY DECI.AR! Ill T IHE Fotto'ivlllo IS IRUE IO IHE SESr 0f lft KHoWIEDG&
:. :A:t CR !{YCOrllP rl.1/IE REIIJHED BY IHE OWIIER 0R IHE AFC}ITIEEIIEHG|iiEER 0F REcoRD l0 PROVIDE sPEcrAL
IiSPECTiCX FoR TlrE !19R ( CoVERID Iil tHtS REPoiT,
L I HAYE PERFORT{ED IHE REqUIRED IilSPECIIOi DIJRI'IG fiE TlitE PER,OO A8 STATEO AEOYE
3. IHE!YCnXCO\TEREDttaIUSREPORTtSfiCoIIFORA'tC!tOIHEAPPSoIEOPt.AilgSPEClEcAnoNsAt{0APPi.lcAncx
,,voRKltllrsHrP pRo\4stoli8 0F tltt cooe ErcEPrts txotcATED oTH ERlllsE.
*--* zv"- .,:&--:.,Signature:
Huan Van 8ui, Ceguty InrE€<tor
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