HomeMy WebLinkAbout20172153 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, cAg27o2 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Permit #: 2(J172153
Pin #: 85753
Project Address: 715 S Hickory St Unit:
Block NA
Bldg
Tract 738
Address Range:
Historic. No
Suite Range.
Zoning: RlAssessor'sParcel: 011-095-04 Lot: I
Owner:
Address
Marcelino & Sandra Cruz
715 S Hickory St
Santa Ana, CA 92701
(7',t41262-2007
01 116002 51603
01 1 16002 5'1600
01116002 51603
o1116002 57770
Fee Type
Mrn. Fee - lnspection
General Plan Update
lssuance
Microfilm Records
Amount
172.64
23 79
59 30
4.05
Qty
1.00
100
100
1.00
Fee
$172.64
$23.79
$59 30
$4.05
Phoner
Tenant Name:
Contractor
Address.
Owner-Bualder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Building Use:
Job Type.
Nature of Work
Single Family Dwelling
Solar
Solar-re-energize
Occupancy
Constr Type
Code
R.3, U
VB
cBc 2019
Notes. Permit issued to re-energize existing solar system
(rel:20163634)
Planning Conditions
Planning Approval By Date
Date
Date
Misc
Misc
Misc
Receipt:
Receipt:
Receipt:
Total
$23.79
$231.94
$4.0s
Plan Checked By
Permit lssued By
Subject to Field:
Building Permit #
Amsden, Julie 10t22t2020
se DeSoto Account#
Evory permit issued shall become nvahcl unless the work on the sile
authoized by such permll ts commenced wtthn360 days aftet ils
issuanco ot t the wo* aulhoizec! on the sle by such permt ts suspended
ot abandoned for a penod of360 days after the ttfie lha wo* ts
commenced
$259.78
$0.00
$259.78
lnspector MtD#. 2020-162322
01 '1 16002 51600
01 1 16002 51603
01116002 57170
Fee Total:
Paid to Date:
Balance Due:
ELECTRTCAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS (IWNI.I' IT'[D}]R DEI,CAI'ATION
I tEEby llImr und.r p.'rrt of Friory rhd I an .r.nu nuD rh. cl,rreb^ tI.M L* lur th. lollo*i4 Een ls< ?031.5
Busin.ss aii Pnri*iJn C.dc): ny Cny or Coudy whth rcquiEs . Fnir h c..nrud, rlrs. ir{,rove. &mlis} or R?rn my
nrdur, ri,ib ns ksudr., sLv' Equirs lhc annliu lo. ruch !'.d oft.litEdst{.mnr rhltlEo.$cilic.Bal lu$dr
ro rh. Ftrvi$i.ns.t rhc Conl.eror'i l,t.n*d hv (chaAc.9. cDhmming wirh S.ction 7ux) of Divisbn ] olfic Bsims.nd
Prufdlions Cod.) or rh! h. or str is.r.n!i 6s.li!maJ nE bats tor tlE dkS.d .r.lIpri.n Any tiltLriotrofs6lbn,01L5 b) s,
applicmr ror 0IEnnil subj(h (hc dppli.rnr ro. ci!ilP.nnhyornor m..lhrn liv. hundEd dollrh (t500).
tl.!2. * **, ..r '* ""-.'. "r my c'nprnyFr * (h *.Bs 6 ,h.n sh mnpcnstioi. wirr do oEFurnL.l or oficE.l lor qL lsd.7o44. BueEs *J Pbf.$i.m Cod.: TIE Cod'&rDrs Lic.rE bw d@s not .pply ro r o*rcr or
rhr rn,Fny slr, b{ikh n inllruEs rlm[ a&l wl$ dB sh *)rt hitu.[ ot lE ellor lkou3,] hi! 6 her oM.n{'loF.r,
poviled tlEi such iDlYormdrd mi mrcrlddl.r.Ilcnn hr sL. l[ ho*.tr, tlE toildinS .r nryrowcnt knldw ri.oE ]td
oIconpUioq iE OwEr Build.r will h.w rh.b!rL,olp.oriU u h. or slE did mr hri! G inpo!. llE pDFry fc llE purPos of
l. rs o*rr of $. popdy. !m .rcltrsirly .ldrucrina *ith lic.i*l .onk&roR b &r{ruct rlE p$j.c( (S.c 7Ol'4. BusiBs
!,n PilfNio Cod. t h. Contnctn'r L&ns. uv d*. tur .tDly ro u owrw oI pnFny *ho boild! or inDDv.r rlEr.on.
.nd 'ho onreds ror such proi.k wilh r C(dkrrrls) licctrsd ru6ud lo 'h. Codrd.fs Li.cM bw)
_1m,.r.mni urdd S(tn
(!+u z\u*',1 a
DECLAEAIqN
I h. rcby atirn u ndc' !.nrX! ol pojury Dn. ol r hc inlhr og dcc lsd ions
-IlB*aidwill
6rr{in ! C.n rfi..r. of CnM ro S.lilNUE tor *or}.i. con{r,sdion, 6 nmvided ,.r hy Satiotr 1700 of rlt
tltu Codc. lor rhc Frlorlr4c of rb. *oIt ld whi.h rh. Pmni{ is ir5u.d.
_l lDve and *ill arnrah *orlr.is conltlsdrr.n nsurarc.. r\ EquiEd hy $d i(,n 17m of rh. ljbor Cod.. n, ih. FromBrt. or
$. $.rk io, wtrh rl,t rxrnii r issd. M, worldJ comp.Eiton intum.uiq nl lolicr.u,,h.L *.:
Polrcy Nun6.r:-lirpits
.LFrl..i'8 rhrr mrrr trrrd ur. rl
'
hu * urk fur ah'ch rhn p.rnir t issu€d, I sh8ll mt .mpby sy lusn in my ronn.I
-r ^ r. hcm'r.uhi.d 16rhc r nAca' (nnDcsd
'ntr hw\ or('rrromu, inJ.Arc rhr I lh.ud b.r^m \ubj.rr hrlr
$ortoi on,,.nsarion provnDrs of SdlDn 1700 o, rh. Llbor Cod.. I slull. funfi*irh oiply wirh rtDs l,rcvisioN
WAI{NING, Failur. b s-ur. *orl.n comr.niurion cov.agc i\ unla*Iul. md sh:ll subi.cr an .rnploycr ro ominul FMhis ud
uvrl tuEs un b oE htr' rd ilrusa*] dolln (tlo0.tl)ij). r addirDn to rlf .oi ol cotr{Ersiion, dlnsA.s s pDvid.J in rtE
(1i1..idcrN da ore'r_ \ lir\
tt /tt/zr,",.(
DEEIABAIIO!!
I lEEhylfrrDu er p.alry ol p.rjury rh.r I an! lienEJ und.r FovnDn oi Ch.ps iJ (conmNing *irr, Slirn 7000) o{ DivNon l
of (he Busi*ss d*l Ptuf.x\iotr\ Co!.. .rrl my lrc.n{ ir in full IorE lnd clTc(
CONSTRUC"lION LENDINC AGENCY
I hcftby.nlrmundcr p(nrhyofr.ruryrhd lhsc i! i.oniru.rhn kndii8 a8.ky r.r rhc Pc.L'rurc..rth. *ork rhi rhthrhk p.mii i.
nsu.d ls.c. loe?, ( n. C.).
AICUCT,ULDEELAA{I9!
I tfttryrlnnundcr l].n ry or p.r ju.y om ot rhc i,llowin8 &cl arins:
D.mn ion P.rnnk- s1lio! N(nfi. x)n F.dcral R+uhrbns ollc 4l).l'd6)
R.qurcd l-.n.'.1 N.ni.nron
45-;
rlythr lhc kdr.lrc!uhi()n\ r(lrdins Atr(,xr.irtrrl c D.r rr,tLrrhL hrhn tolar
rhrr I luvc,r&lrhnumlicario rl rliul'c uhr{ nfonrlnfl i! co,rcr , rSrcro.ongly wirh r[ cntand c.unty
Sra'c lj*s rchriq ro boildins ,rl h.rhy luh.rnc rcnrc*nuriver oithis City ind Cou y 6.nrcr up.,n 0E
/o ,.)
Site-Work
Underground
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Sions (monument)
Lile Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor I
Bondinq / Groundino / UFER ICffi/K d,ut/,k vat
Transformers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Faclory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilings (Hard & Soffit Rough
Ceilings (T-Bar Rouqh)
Ivt€ler Release
aI91a"'td/21Da U-.r"lr (6 4'
Rough
Service [/eter
FINAL lq4/dt.W-rtl/ai :zd
Notes, Remarks, Etc
Rev. 0B 07 201
a
Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 9?702
(7'14) 647-5800
www.santa-ana.org
APP-13 CBC 2016
Dear Property Owner
An application for a building
sp ecified at --7/ 5 9,
pqrmit has been _submitted in your name listing yourself as the builder of the property improvements
ekt ttv 5'l S*-, t A,t ,, Oa Q2 7t/ /
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 usatourofficial address indicated. An agentofthe owner cannot execute this notice unless you, the prope(y owner,
obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
ll-.L l. I 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 hisorherown laborand material personally. l, as an
Owner-Builder, may be held liable and subject to serious financaal risk for any injuries sustained by an unlicensed person and
hls or her employees whlle 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 prop-
erty.
N!-r. 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.
Ja-g. t understand as an "Owner-Builde/' I am the responsible pa(y of record on the permit. I understand that I may protect
''nryself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
lJ&-q. t understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts,
ILL-S. t understand if I employ or otheMise 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.
U.C 6. lunderstand if lam 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.
L L-1. I understand under California Contractors' State License Law, an Owner-Builder who builds singlejamily residential
structures cannot legally build them with the intent to offer them for sale, unless a/l work 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.
.l.ltl "_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 f inan-
cial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workman'
ship or materials.
NOTICE TO PROPERTY OWNER
l/,(--e I understand I may obtain more information regarding my obligations as an "employer" 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 -8OO-
321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors.
&:_10 I am aware of and consent to an Owner-Builder building permit applied for in my name. and understand that I am the
party legally and financially responsible for proposed construction activity at the following ad-
dress:
ll!-l I I agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by all
applicable laws and requirements that govern Owner-Builders as well as employers.
lJ.L ,, 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 unllcensed 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 responsibie for verifying
whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
oro verifi acc table to the enc is uired to be resented when the I issued
propertv owner's siqnatu re
Signature of Property Owner ,rt t,Date
Print name of Owner
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excludlng 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 pro.lect.
Scope of Construction Pro.iect (or Description of Work)
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 re-
quired to be presented when the permit is issued to verify the property owner's signature.
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. A/ote: A copv of the propertv owner's driver's license, form notariza-
/Zrr./,-,4ar,,z
Project Location or Address: