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Home My WebLink About103102326 - PermitProject Address: 2803 W Westminster Ave Address Range:Suite Range: Zoning: ClAssessor's Parcell 101-131-12 Lot: NA Block: NA Historic: No city of Santa Ana 20 civic center Plaza (M-19), santa Ana, cAg27o2 Building Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit #: {03{02326 Pin #: 96r4tr1 Building Use: Job Type: Nature of Workl Existing BIdg. & Use Proposed Use: Commercial Alteration Partition wall Commercial B VB cBc 201 6 x-0602320143J Occupancy: Constr Type Code: Flood Zone: # of Stories: 1st FL Areal 2nd FL Area: Other Areas: Garage Area: Total: i"ri. l Patio: T.l.Area: Yards Req'd: Valuation: $200.00 Description of Work: Reinstall partition wall separating suite 211 & 212. Planning Conditions Owner: Addressl Andrew Nguyen 2803 W Westminster Ave Santa Ana, CA 92705 (714) 249-8688 Conlractor Address: Owner-Builder Engineer Address Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance Carrier: Policy #: Expires: Archilect / Desiqner: Address: Phone: License # Planning Approval By Pezeshkpour, Ali Plan Checked By: Permit lssued By: NPDES lnsp. Req Dale 1112212019 i/isc. Receipt Oale: 1112212019 l\4isc. Receipt Date: 1112212019 lvlisc. Receipt Subject to Field: No No Account# /No So, Anson Amsden, Julie o11760 0 2 071160 0 2 017760 02 077760 0 2 071760 0 2 0 777600 2 57607 53 600 57770 57672 s7600 57601 Permit Fee Plan Check Fee Microfilm Records Bldg. Stds. Revolving General Plan Update lssuance $166.53 $115.44 $7.82 $1.00 $22.95 $57.20PWA lnsp. Req'd: No Planning lnsp Req'd: No Fire lnsp. Req'd: Police lnsp. Req'd Total Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No Every permit issued shall becomo invalid unless the wo* on the sito authoized by such pemit is commenced within360 days aftet its issuance,or if the wotu aulhotize.l on the sile by such permit is suspencled or abandoned for a period 01,360 days aftet the time the wo* iscommenced lnspector MID#: 2019-156013 01 1 16002 01 '1 16002 01 '1 16002 01 '1 16002 01116002 51600 51601 5161 2 53600 57770 $370.94 $0.00 $370.94 unit:211 Bldg: Tract: NA Phone; License #: 6errerql Plon Updqte Fee 01 I l6rlt:12- 5160r:luinl- P.u i ld ins 01 I I 6[x]?- 51 601 t-rrlril- tll ds Stds Revol v insU 161182- 5l6l2t:trl8- F,/t: Bu i ld ins 11I t I6(102- 5360(rlrlr.l- n i,: rof i 1,r A Docu ents r:r1 I 1 6t:tr:r2- 5777ri0r:lr1- Iloster (:ord (Ci: * xlx r x r I * * xx4:-i95 S I . t:r(l $11i,/r4 $37tr Phone: Tenant: $22.95 $223.73 $1 .00 $1 15.44 $7.82 Fee Total Paid to Date. Balance Due: BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS O\!NER BUILDEN DELCARAl'ION I h€reb! amnn undd pcnalty ol pdlury rh.r I m.xc6pl Foi rh. Co.r,adoR Lictrc l-aN for thc lollowios Een (Scc7011.5 Bus.6s qnj Prof*ion Code) Any City or Counly which reluts a p6nit ro coNrtuct. ah6, imptuve, danolish or Epair dy snlctue priorb ns isrum.e. al$ r.qun6 rhc applicMr fo! such F6mir io lilc a sisnen iat€mflt thar lE or she is licd&d pusutrl ro rhe poviiiont of tu Contracloas l-icds.d L.r (Ch.ple 9. Comh.nci.A lnh Se'ion 7000 of Diliiion I oarh. BBin* and ,'rcfNions cod.) or rhd h. or sh. is .r.mpr rh6cEon d rhc basis lor rhc all€sed eGnption Anyviol0tionoisdion7011.5byany {rr'\0d loripmnsub'd\rhc dppha rodcrv' r.nJk) "l.ur mr'.,ld n.c hundr.Jdclldsrlt00, r'll,L1a:l;I, is u(n.r or rhc propeny. or m) crnplnlc r irh oag6 a th.t $1. .onrprelion. \vill tlo th. $orl ud t mdE i! nol inird€d or olfd.d f.r el. (se 7044, B*i.ar &d llrofNions Codcr I hc Contraclois Licm La$ &16 nor .pply lo M o$ns ot rhc pbpeny \$o builds or iqr.v6 rh@r ad who do6 scn $i( hims.lf or hds.lf.r rhrotrgh hk or hd om mplotc. providcd rnal such impro\ondts e not imdded o. oll.rd for s.]. I f. how.vE rh. bildiry or improvdnol is sld wirhir onc y@ ofconplclion. lnc (\,nd Builda will h0!. the htrdd olFovitrs lhal h. or shc did lot h,ild or i'nprove the pmpsly aor lhc pulros ol l, {s o\T( ofrhc pmrmy. u .xclusivcly conrdints \nh $cdr*d ..nra.roN ro .onsnr' 'h. p6jd (Ss 701,1. &r'n6 and Pioldion c.d.: Th. co.r€croas t,icd.. LaN do6 not.pplylo anorno ofp.orEny sho builds o! nnprovB thod,n.and rho .oilracts lor such poj*ls qith 0 Contado(, li.Nd puBoanr to rhc ConiB.ro Li.ds LaN). I tuncxcdpt undrS.crion "X u/zzpor .Lr &f ( i!1lMosur. ""Y //J- ttl-,o,-/' sfrur:s'rrxrlrnstfrti( OC(IABATA! I hocbJ, amni uflrlLy poaxr- olpdjuryonc ottne rollo*ins dccltualionsl I n.!c dd \yill 'nai.rain 6 Cdlincerc olcoMr to S.lf-lBUre ao, s ork6 .o,nposlion. s Pro! ideJ aor by Sdion 1700 ol rhe t,bor Codc lor lhc pgtomece o llhc \ort lor shich rhc pdnh is irsuql lhrvc.nd $illnlai nn work6 .o'npc6axon insulancc. 6 reqtriredblSdionlT00oftheLabor(tdc.lorlhep6formnceof ihe Mrk ror$hichlhisp{ml G issu.rl. My workes' conrpqsatiofl insuruce snis.trd policy numbs Ee Caricr: (f1.o,'4,r'a,rr,.p-r,rm..orrhctr.rkrnrs.hichihispflnlisrsucd.Ishollnoldproyanyp.reonrnanynann6 e 6 kr b€.ome subJdt lo 'hc Rolte co,npsMion lass ofc,lif6m,a, dd asre rhd il I lhould b.$n. .ubj(t lo lh. $r(c compeGalion prorisioN oasdlion T00 of (h. bbor codq l slsll, fodhwirh.onply { ith rlk'e povilioN \TARNING: Failur. o ecu. s..l(m' compqsrnJn cordse it unlatr rul. ed shall subjd oplo]s to aininal pouhi6 ud civil lincs trp to one hundrcd lhoosmd dollm ($100,000), ii addnion io lhe cosr or crD!€oetion. d@as€s d provid€d ror th€ (odc. i(er€st a.J axornlrt Lrs //7d1 r r(l:\\til)( ()\rRl( toR DFCLARATI()N I hmby .mrm ullc6 p..rhv oa pdjury rh.r I d licns.d und6 proriion oi ClDpr6 I tumocios v h S.dion 7000) ol Division l oa rh. BBin* ed PDl*ions Codc, ud my lice6. is in tull force md €fld ( o r.c(or CO!$AUC TOT-IETOIIG-AEEIII I hqchy.alim und6 pe.ahy ol prjury ihar thd. is r.oslndnn k di.g !udc) hr rh.peaomdce otlhc wort lor \rhich lhB FDit is iso.d (S(.1097, civ. (.) APPLI'AN'T DECI ARA I ION I hod,y afim undd peahy of Frjur) o.eotthe fouoying declaBtions D€'nolilion Pmils-Asbcslos Nolificalion tcddal R.grldions (Tnk 40. Pd16) R.qut€d t..1rq ol Noliliation I c.niay thar rh. l'.d.61 i.luhrio rcsdding rsbsk's rcmo\ al ae rcr applicable 10 rht projecl. tC4-,'ry tr,r tt ^,,*arr,rs spplrar'on md srarcrhd rh..t{!. inro,rnaron is conecr l.grdrocor.plyrvirhrll(ny0nd(tuniy-i.i/mtic6 d Skk I i{ s rclnunA ro bu ldmS coErtud i.n. exl fitr b, aulho.ize rcPr6ard i\€ o f lhis (iir} ed colniy ro dra Wo! th! ab.\e m.nr.n.d t6FF) f.' iBrdli.n pqIF s6 / ,rDpricrnr or.rcm,sknrrV 4*-/? 4r..- r",n,rr*n","rp,trd, 2Lru<:at z l6u6t / ty'=/'*r Set Backs Forms/Steel/Holdowns Erection Pads SLAB Floor Roof Sheathing Shear Wall Framrng 7/nVz)ECZ 1 lnsu lation/Energy Dryvvall Ext./lnt. Lath Brown Coat Masonry Pool Fence Handicap Req Deputy Final Report Engineer Final Report FINAL 7/z*,/ea KZfir^tezzsSD Certificate of Occu p"icyT Notes Remarks, Etc \ UFER Ground Subf loor/VenUlnsulation T-Bar Flood Zone Certif. Planning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 (714) 647-5800 www.santa-ana.org NOTICE TO PROPERW OWNER Dear Property Owner: An application for a b u ild in s permit bas bpen1 U/a< rtn) submitted in yo ur n e listin n t ff :t * P yt o \{_ry x?"*t i m provem ents specified at o?o Ad-,Cf,^-/Q A WeareproVidingyouwithantomakeyouawareofyour responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or veify this information. -ffi I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builde/' build- ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an O\Mner-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 prop- erty. -W , 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. Y/ s. t understand as an "Owner-Buildei' I am the responsible party of record on the permit. I understand that I may protect myself from potential flnancial risk by hiring a licensed Contractor and having the permit flled in his or her name instead of my own. Xr/_K4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. / -W. , understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vSlue of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe/' under state and federal law. ^/,'K 6. I understand if lam considered an "employer" understate 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 sub.ject me to serious financial risk. K. t understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential struclures cannot legally build them with the intent to offer them for sale, unless a// 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. iK A. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- 6ial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workman- ship or materials. APP-13 CBC 2016 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 offlcial address indicated. An agent ofthe owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. -M/S 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- 32'l -CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. ,Y/ lO. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the pbrty legally and financially responsible for proposed construction activity at the following ad- d ress: 'I 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. I -&4. ,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 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 DroDertv owner's driver's license. form notariza- tion. or other verification acceDtable to the adencv is reouired to be presented when the permit is issued to verifv the proDertv ow ner's sion atu re. /t,/zz / zo, rSig nature of Property Owner Date Print name of Owner c 6/ 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. 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. 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 propetty owner's signature. ScopeofConstructionProject(orDeScriptionofWork): Project Location or Address: Name of Authorized Agent: Property Owner's Signature: