HomeMy WebLinkAbout10197100 - PermitProject Address:4 WEI rAv
Assessor's Parcel 109-123-01 Lot.84
Bldg: Address Range Suite Range:
Zoning: RlBlock: NA Tract: 1346
city of santa Ana 20 civic center Plaza (M-19), santa Ana, cAg27o2 Building
PermitCounter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Permit#: lO{97lOO
Pin #:4{ { 2FJ
Building Use:
Job Typel
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Occupancy:
Constr Type
Code:
FIood Zone:
# of Stories:
R-3
VB
cBc 2016
x-0602320257J
1
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
ncbP Patio:
T.l.Area:
Yards Req'd:
Valuation:
Single Family Dwelling
Addition
Addn & Convert Garage
Sfd w/att garage
Sfd Wdet garage & det ADU
223
0@0
$38,600.00#tY tr
Description of Work: Add laundry room, bathroom, & closet. Convert attached garage (223 s0 to bedroom. SAUSD #3803
Planning Conditions:
Owner:
Address
Phone:
Tenant:
Martin Gonzalez
2430 W Elder Avenue
Santa Ana, CA 92704
(949) 544-9901
Contractor
Address:
Engineer
Address:
Donald J lnman & A3sociates
Donald J lnman
5'131 Fox Hills Avenue
Buena Park, CA 90621
(714) s21-0554
11888
C&CDrattingDesiqn
Edgar Cortez
1651 Raymond Ave., 190-G
Anaheim, CA 92801
(714) 813-6555
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensalion lnsurance:
Carrier:
Polacy #:
Expires:
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #
Planning Approval
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'
Byl
PWA lnsp. Req'd: No
Planning lnsp. Req'd: Yes
van
S azekas & Assoc.
rodowski, Teri
07775002
07776002
08907007
07175002
0 77760 0 2
07776002
5760L
53600
24000
51672
5760 0
5760 7
o
Dale: O7l2Ol201B Misc. Receipt
Dale 1212812018 Misc. Receipt
Date: O21OS/2019 Misc. Receipt
Subject to Field:
No
No Account#Total
$352 08
$440 10
$5 02
$2.00
$22.08
$s5.04Fire lnsp. Req'd:
Police lnsp. Req'd
Landscaping lnsp. Req'd; No Flood Zone Cert. Req'd: No
Every permit issued shall become invalid unless lhe wotu on the site authonzed by
such permit is commenced within 180 days after its issuance,ot if the wofu authoized
on lhe slte by such pefinil is suspended or abandoned fot a peiod af180 days after
the time the wotk is commenced
lnspector lVlD#: 2017-135399
01 1 16002
01 1 16002
0'1 1 16002
0'1 't 1 6002
08901001
51600
51601
51612
53600
24000
$22.08
$4O7 .12
$2.00
$27.00
$5.02
$876.32
$413 iu
i463.22
Fee Total:
Paid to Date:
Balance Due:
U nit:
Historic. No
1/t:;/ ltti7 I0; Lflrl5r\l
11 ol
Owner-Builder r-1'l'i ,'
li. U:
Permit Fee, rl
Plan Chedk',Fee
SIIlP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
71267
COMMENTSSITE-WORK DATE ID/SIG.
Set Backs
dlxh,t 1t W\*radl 'D)Forms/Steel/Holdowns
Erection Pads I
UFER Ground
SLAB Floor
SubfloorA/enUl nsulation )h lt4 lq,ttxt
Roof Sheathina itglLtrtrtl^
,, -)Shear Wall ;tlvilll rP-a
Framing 4ltlrot W
+)rll^ qw \1__.,lnsulation/Energy e,47ilt4 ',t 4 7r)Drywall
t/Ext./lnt. Lath d.zulla n
Brown Coat $\
Masonry
Pool Fence
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
lvY(K tlle;li\ululr4 'it /^
pq44.sltln fi 'rr,EuaHJ
FINAL ,/"a-^>I
Certificate of Occupancy
Notes, Remarks, Etc
OlVNIJR I}UII,DI'T DI:I,(' RA'I]ON
I hercb amid undd p$alry oa rEiury rhal I a. c\eD to rhc ('ontaclor' l-ic.nse l as fin rh. rdl vins
Busings a d ,lofsion Codc): Any Ciry oi Cotr rt shrh rcquts a p6mn ro consrtu.l, alld. inptpvc. denolGh .r
srrudu,e. prior ro irs isudc.. also r€rtun6 lhc applic l lor sucn p.mir ro tild . siSncd {aldft tha lt ot
ro rfie prcvisions ofrht Contrartor s Licensed Lr* (chsrler 9. Comm.ncins rvirh s.ction 70m of Division 3 o
Prcf*ions Codc) o. rhar h. or 3hc t B.mpl thgcfroE od lhc bs6 fot lh. alL8.n smplion Any violdion oasllidn
.pplicer aor a pdnir subjars rhc agplicanr ro , civil p@lry o f iot morc Ibtr nv. hun&cd dolles ($5001
l. 6 o$n6 ofrhc ptup.ny, or .ry oployG wilh wa-!6 6 thcn eb conpcNlion. sill & lh. so* and $c sME G nol
iNdd.d or oilded aor slc (SE.?0,14. Busin6s od Prol6sions Cod€ Th. Conlr'clor s t-i.cB. tlw do6 nol apply to d oM.r oa
lhc Fopdry rho bilds tu impmrs tlso6. rnd \vh. do6 sucfi Nlt hioself or h.*lf or lnNusn tis ot hq os'. mploy.6.
plovided thar such ioprovoNnrs e. nor intdddl oi oild.d aor sl.. Ii hoNdq. lhc ttrildins or inpr.\mdr is $ld Nittin on€ ,Er
oacolnpl€lion. lhc Oqn6 BujB6 Nill ha* rhc hrdd orpmvi.! ihd lE ot sfi€ did rcl build or improe. th. lmFy for lhc plrFE or
-1.
ar ownd olrhc rropsly. dn .xclusiv.ly controcl irs rvilh lic€ccd contadoN ro cotrnrud lhc prciel (Sd ?044. au5i.6
and Potusion Co&: rhc cotrrtdol s Lic.m. tjr doB .ot apply io an o\rn6 orprorfiy who bu ilds or imptovG rhden,
and rvho conraft lor su.h pmjEls wnh a Co nclo(s) lt€.s.d ttruuMl lo rlE aontracrors l.icd* La{).
-l
ancr rpt under Sation-. R & P c aor ibis r€aotr
lloRxl,lLs' col\tPENsaTtoN
DEC!.4!{IIA!
I hcr.5t amnn unJd pd.hyofpquryoneoIlhe aolkNir! ddhralions:
I ha\. dd $ ill mainlain a C.nifical€ orcotudl ro self-lBurc aor rrcrk.rs cdfrr&s,(ion, 6 pmid.d foi by S6rion :1700 o lthc
bLlr cod., for rh. pdlomancc olln€ *o,k lor whi.h rh. p.nnil is ia{ed.
I haveand willdaimain workerr co'np€malion insurflnce, d requircd[yS(rion ]?00 otlh€ lnb1rr(odc aor lhc psfonldce or
r h€ sork lor lvhich rhb p.mn is issu€d My *orkrt compa@l io. iBurmc€ caEis ud Fli.y numbs tr :
I'dicy Nurh.r:-FrPnes:
I ccniay lnar in rh€ psronnanc. ofrh. work ior \rhich rhis p.m't is itru.( I shall not dnploy any p.6on in tn, mannd
e a r. b..on. subjd lo thc qorl6 enp.nsatiod latrs ol Califomi{ dd asr thll ia l sh.uld beom. subj..l lo thc
$ork6 .ompeffariofl proisions ofS.dion 3700ollh. Lat r cod..I shnll. forlhwith .ompl, wnh lhos provisios.
WARNINC: rzifurc lo ecu. \ork6 co,npos.tion covmsc is unlaNiul. dd sha]l subjd mtloycr ro cimiMl l)<oalti6 ed
civit lina up to one hundEd rhousdd dolls ($100,0010). in addilion lo rh. con olconDmsalion. ddag6 6 p.ovided lor thc
sorion 1076ofrfi.IiborCod.,inrd6rmd.norn y sfG
ppliont_
ITCEISED.(]ANIIAqIAB
IIECI,AAAIIO!
I hmbv amm unda pc.alryoapdilrylhal I an [.dsl undd proision olChaPra 9 (commcins with Sdion 7000) olDivision ]
of lhc au!i.6 6d PrcfsiomCodc. and nylicse isin tull forc. md ctfsl.
q)NiIAUCIIQII.IIDIIIICENCI
I hs€by alimr undg !.nahy ofp€rjury lhol lt6c is a conntuclion le in8 aSmcy lor lh€ priomanc. of th. ro* lor *nich rni! pdmt is
issu.d {Se 1097. Civ. C.).
Affu(ANr.llcLAaauor
I lElby afim undo pdairy of perjory o.. ol lhc follorviar decldaiio.s
Demolirion P6ins asbGros Norificrlior r€d6alRcsuldiotu Gnl.40, Pd6)
Rqlun.i L.lrd of Nolificalion
-l
c6r ily lhar the Ld6al r.tularios cgedinS sbeslos rmoval de nol eplictblc lo thu Drcj{l
-r.cnilyrhat
I har.rqdrhisrpplicationd slatr that lhc aU,\c inlomaion itcotrd I asre to.o,npl, Nilh aU Cily dd Cou.ry
ordind.6 dd sratc Laws r€lalins lo buildins coNrtudio., tnd lHcbyotrlhodzc ler.*nrarivd oflhis Cily and Coumyto.md upon lhc
au,ve froriondl pmpdly lor insp€.lion pu,F66.
ApDli.r r or,{genr Sig rltrre
P€rmilft nin'e(pnn():
BUILDING. INSPECTOR RECORD
T-Bar
Lic.ns. Clds:-l-icdse Nu,nbd:
-
Dele ('onlr.clo.:
L.n,l.r ! Add6:-
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
APP-13 CBC 2016
Dear Property Owner
lication ra bu itdt4 pe rmit has be
LUr
en
NOTICE TO PROPERTY OWNER
rn yo ur name listi yo urself as the builder of the prope improvementsAn app n
specified
We are providing you with an OwnerBuilder 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 offlcial 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.
" lt
-YS ,understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builded' build-
ing peimit 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 flnancial 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.
^A t
Yi, \ ( iZ. 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.
^lt /^
JII-S t 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.
-[].l[o.
'
understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
.ll
(V( h s. f understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
valud of my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an
"employel' under state and federal law.
^t I
tllh_6 I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal
govdrnment, 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.
['\'lk I I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
stiu"dtures 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.
ffi8. 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-
personal inluries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials
d
ilI,
W\tDg I understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser-
'vice,fhe United States Small Business Administration, the Califonlia Department of Benefit Payments, and the California Divi-
sion of lndustrial Accidents. lalso understand I may contact the California Contractors' State License Board (CSLB) at1-800-
321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors.
0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
pa ally and financially responsible for proposed construction activity at the following ad-
SS
_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.
_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 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 p ermit. /Vofe.' A copv of the propertv owner's driyer's /rcense, form notariza-
tion. or other verification acqeptable to the agencv is required to be presented when the permit is issued to verifv the
propertv owne r's si(l natu re.
Signature of Property Owner
Print name of Owner V
)D"t", ll-ZG-l
r'llvfl)<-'
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)
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 Ownef s Signature Date
Print Name of Owner
Note: A copy ol the owner's driver's license, form notarization, or other ve fication acceptable to the agency is re-
quired to be presented when the permit is issued to verify the property owner's signature.