HomeMy WebLinkAbout102102442 - Permitcity of santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA127O2 Building
Permit Counter: (714J 647-5800 lnspection Requestsr (714),667-2738 lnspector Section: (714) 647-5853
Permit #: 1o.21o2442
Pin #: 3oBsX{
Project Address: 1827 W Seventeenth St
Assessor's Parcel: 001.033-40 Lot: 94
Unit:Bldg: Address Range:Suite Range:
Zoning: ClBlockr NA T,act 1478 Hisloric: No
Building Use:
Job Type:
Nature of Work:
Existing BIdg. & Use
Proposed Use:
Single Family Dwelling
Alteration
Demo Addn(s)/Alterations
Sfd Watt garage
1st FL Areal
2nd FL Area:
Other Areas:
Garage Area
Total:
Description of Work: Remove unpermitted additions to include (2) bedroom(s) @ rear of sfd, side patio cover, outdoo, kitchen laundry, sleeping quarters
& bodroom in garage. Legalize (7) windows & (2) sliding glass doors changed with samo size/style.
planning conditions: Removo addn & patio. Return garage to its intended use. unseal garage door. g-t _,r^..=Jla lt,,-/t!_rME r lli-tr_ i,fEngineer: tri I r,:Et iTYH Trn,r!,+i 52 1 eri ,iowner: pARtsA RoSHANZAMIR Contractor: owner-Builder A(,-t+: Frqlir 1ir!1r-r:r441;i
Address: 6 SABLE SANDS Address: Address: Fi.E,l+:r:r1g??i77 - li,/ii.)i,t1i iti9 t:1
Neryport coast, cA 92657,1907 Tfon':fl(ticrfi Totol $lrtrllr'?i
Phone: (949) 903{808 Phone: Phone: f i:,F:I5A R0SHANTAi.1IFI
Tenant: state Lic #: License #:Licrype: Arch*ecr/ lilit.ilrl,ii*ll,lixl: t-- r1:r;r.'
Bus.Lic#: Desiqner: il",lAir, li.r,;.i. tr; ,
Workers' Compensation lnsurance: Address: ttl116ut:t2- 51,.t:r1 l-rr_t,Carrier: tltdg std.- Revolv ing I I r
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories:
R.3, U
VB
cBc 2016
x-0602320144J
1
Patio:
T.l.Area:
Yards Req'd:
Valuation: $6,500.00
Policy #
Expires:
Phone:
License #
r:rl I 160r.12- 516I2(rt[:r-
llicrof i 1r & DocufientE ii,
orrruffi i*f4&fn.c-utr*ggr,; :, :i,l ;,i$343.06
57770 Microfilm Records $3.91
51501 lnvestigation 9100.57
57607 Penally $252.69
s7612 Bldg. Stds. Revolving $1.00
57600 Geneftl Plan Update $22.95
51601 lssuance $57.20
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert Req'd: No
uevara, Je
Br i, Teri
Date: 12105/2019
Date:
Dale: 12105/2019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
0 77 7 6002
017760 02
011760 0 2
07776002
0717 60 0 2
0 77750 0 2
No
No
No
Account#Total
Every permit issued shall become invalid unless the work on tho sile authorized by
such pemil is commencod within360 days alter its issuance,ot iflhe wo* authotized
on lhe site by such pemit ts suspended or abandoned tot a peiod of360 days aflet
the time the wotk is commenced
$771 38
$0 00
$77'r.38
lnspector
01 116002 51600
01116002 51601
0't116002 51612
011 16002 57770
$22.95
$743.52
$1.00
$3.91 Fee Total:
Paid to Date:
Balance Due;
Planning Approval By:
MID#: 2019-156330
BUILDING- INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUTLDI'R DELCARATION
I hseby rmrfl unds pdulry ol !.dury thd I an .r.mfl fmr, th. Conrado6 l-i.4. Lrw aot th. following r.Mn (58.7011.5
Busin6s ad Prof6sion Cod.)r Ary Citt or aounly which rcqun6 a pqnt lo .odtuct. ahs, inprovc, &nolieh ot rqEr'dy
slnrcrurq rior ro ils tr$ c., .lso r.qut6 lt€ applicet for su.h Fmi lo 6L a si8n.d sldmdl lhat h. or sh. is licnE rl pusudt
lo lhc prov$io6 Jr thc Conrador's Licc.$d Law (Cnaqd 9. Comncocins wilh Scrion 70Oo of Divisiofl I oftt. Busin.is md
PmLsions codc) or rhat h€ or shc is.xcmpl ths€frod dd rhe b4is loi fi. .ll.Bcd .xmption. Any lioLnion ofs*ron 70ll s 6, dy
appli.air lor a DEfl.n subjels rhc applica roacililpcndtyolnol'n rcrho fivc hundierl douds ($500).
I, 6 owncr of thc proFny, or my cmploys w'lh q'as6 s rh.ir $lc corpms.lion. will do $e work dd $c slMm G not
inrsded or o[r.d fo. el. {se 7(x4. ausins ed Prcasions Codc '11€ Conrrador3 Lrsc Lae do6 nor apply lo e ownr or
rnc pNpsry *ho h'il& or inpmrG rhdan. od *ho do6 sucn m* himscllor hffilf di rkouBh his or hB own cmployc6.
tNlid.d rhal srch imprevorcnls c rcl hlddcd or o,Id.d tu ek I[ now6. tnc hildins or hp.o!@ b$ld*thinon.rd
ofcompl.rion, thc(}vns AuiBd\iU ha!.$€ hrd., ofp.olina rn he or she did ml huild or i,n!ro!c lh. popdly for th. purpoFof
- - l. 6 osr.r o t rh. trop6ln m .r.hsiv.l, .onradins wilh liccNed conrEclo6 lo @nntud lh. Frj..l (S*. ?044. Bsms
Md PDlsbr Codc: Thc Contractor's Lic.6. Law do6.or apply lo e ownd oaprcp.nyuho build. o. inProvd $d.on.
and vho .lntracrs for 3u.h projeds wnh a Conl6o(s) lt$cd pusuatn lo Oc Conuaclor's Lichs t *).
I n €xcmpl unrl6 Sdrion
I hs.by aflim !!dr p..rlly olprjury on. oath.lolloNins d(ldalioE:
I have and $ ill nuinlain , Cmific,tc of Co6nl ro S€lf-lcurc for rori6 &npo&rion, a Pmvid.d aor by SEIion l7C$ o r rb.
Labor Code tor lhc pgiomdc€ of $c vod foi *hi.n rhe paril is isu.d.
I havr a.d sillmainiain wort6 comp.Bation ilsurancc.4 .qtrn d b, Sattrh 1700 ollh€ Labor C!de. foi thc pnfomtn.€ oa
th. *ork 16r whi.h ihis potr n issu.d. My $ork6 comFerion iNudcc cMid d policy nuDbd ac:
I cdlifylhat in th€ p€.fomance oalhc work io *hich rhG pemn is issu.d. I s,Ellnol {rplo, a.y p6o. i. any nmas
$ 6 b b.con 3ubj(r ro rh. wort6 .onp.Bation ls"s of Califomir. ed ar@ lhai if I should b€.omc subjsl to lh.
No*6.omFMrionproviriosolSdionlT0oofrhcLahorCode.lslqllfonhsnhcohplysi'nlhosttrorisioN
w RNING: rzifurc ro suc \rorkas ompssalion covcagc ir u.la$ful, d subjcl dployd ro oinin l Fuhi6 d
iivi! 6n.s np lo on. hun&€d thousud doll6 ddascs d prov .d fo. rt
Scdn,n 10?6olrlE Labor Codq inlcr6l md
I h6cby amrn undcr poalry oa pejlrt thar I m licmcd urdq provision olchapro 9 (
of th. Busins and Prci*sions Code, and ty lics. G in tull iotcc md €rtrl
ins wnhS{lion7000)orDivi! nl
(l)rsraucuor_tElDllc1cllcr
I hscbyalIflnu er p.n.h, ol lcdurr lhal thd€ is r consiruclDn knding t8d.y lor IIE prlonnancc ol the work aor wlrich $is p.nnit is
isucd (56.3097. Civ. C.).
Lnda B Na,n.:
-
ASELICANLDECLAEAIIA!
I heltry armuo&r poahy ofpdjuy6n of th. followiq d(ldalions:
D.Eolnion Pmns-Asb6ros NorrlicatD. F.<tdrl R.grLtions (TnE 40. Pan6)
Re{uncd Lals of Norific*ion
-l
.ol il, lhar Ihc lcddal resuiations rcssdins 6b.ska rmoval r€ not opplic.bl€ ro this prcjel
i.rrbr rJ{dcrhar rheah.\€ inr.Tdri.'r is.onar lJEre
and cotrnryro cn(Lr up()n d'c
7
Qfrft
2-f- t
Set Backs
Forms/Steel/Holdowns
Erectron Pads
UFER Ground
Subf loor/VenVlnsulation
Roof Sheathinq
Shear Wall
Framino
lnsu lation/Energ y
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL 7,-La-La
Certificate of Occupancy
Notes, Remarks, Etc.
SLAB Floor
41
I
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
NOTICE TO PROPERTY OWNER
Dearpropertyowner PhAtSA RlSllnilZnnt<_
An application for a ild in gpe it has subm tted i yo ur name listin sv ourself as the builder of the pro e rty improvements
specified at b
We are providing you with an Owner-Builder Acknowledoment and lnformation Veriflcation 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 permitting authority.
OWNER'S ACKNOWLEGMENT A ND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build-
g 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 risk for any injuries sustained by an unlicensed person and
his or her employees while working on my property. My homeowneis 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.
| )-t -r 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.
(}j I 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 filed in his or her name instead of my
own.
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts
alue of
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
"employef' under state and federal law
I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal
rnment, 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.
-)a_\_7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential' struEfures 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.
A-lf 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-
I cid"f-or personal in.iuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
F=_9. I understand I may obtain more information regarding my obligations as an "employed'from the lnternal Revenue Ser-
vlce, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi-
sibn of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 'l -800-
321-CSLB (2752) or www.cslb.ca.oov 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
arty legally and financially responsible for proposed construction activity at the following ad-
dress
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
pp tca ble laws and requirements that govern Owner-Builders as well as employers
agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
ve 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 propefty owner and returned
to the agency responsible for issuing the permit. Ivote: A copv ot the propertv owner's driver's license, form notariza-
tion, or other verification acceptable to the aqency is required to be presented when the permit is issued fo verify the
propeftv owner's siqnature
Sig nature of Property Owner I2-r-t1
TnAtsn Qts /R_
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 Constructjon Project (or Description of Work)
Name of Authorized Agent
Address 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 property owner's signaturc.
Date:
Print name of Owner
Project Location or Address:
Phone Number of Authorized Agent:
Property Owner's Slgnature:
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