HomeMy WebLinkAbout102103307 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, cAg?702 Building
Permit Counter (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {02{O33O7
Pin #: 458{t
Assessor's Parcell 407 -051-57 Lot: 'l
Suite Range;
Zoning: PBlock NA
Building Use: Duplex Occupancy: R-3 1st FL Area Patio:
Job Type: Altoration Constr Type: V B 2nd FL Area T.l.Area:
Nature of Work: N/V-Demo Code: CBC 2019 Other Areas: yards Req,d
Existing Bldg. & Use: Duplex w/ garage Flood Zone: X-0602320257J Garage Area: Valuation: $1,000.00
Proposed Use: # of Stories:
Totat
Description of Work: Remove an un-permitted carport and remove partitions to an existing patio cover (patio permitted under #1464). Auth on file.
Planning Conditions
Owner:
Address.
Phone:
Tenant
Contractor
Address:
Owner-Builder
Address:
0ff ice:(:T
- 2/27 /211211 I0: nFINSDA
[r.(l n s+ IGuadalupe castellon
2115 W Edinger Ave Unit B
Santa Ana, CA 92704
17141279-9853
29
1/(r2t:2
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Architect /
Designer:
Address:
Phone;
License #
Frp t + : [?9r:t:t5u3 -
Tr(rncact. ion Tstq I
6Lr(doIUpe (:ostel lon
GpnPr'(ll Plon [.lpdote Fee
t]1 1 l,{[r]7- 516t:rIr-lt_[]-
Bu i ld inc
it1 1 l6tlt'j2- 5t6r:ttr:riri-
P,l ds Stds Revol v ins
rl1 I 161:112- l1612rlr:fl:r-
fii.rnfilr t nnflr&rpnte
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Orozco, lvan
Zuniga, Alli
Dale 0212712020
Date:
Dale:0212712020
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
No
No
No
No
Account#Total
irt '. I ri !.rr.r .l li/i l;/r,lllljr1-l
017769Q2\ F1609 Sermit Fee $166,53
017760A2'i51:t7rO r. Mtffih'R34Ords .,r1,,;r .. ,$3.9.1
07776002 51501 lnvestigation $100.57
07776002 s1607 Penally $252.69
07776002 57672 gldg. Stds. Revolving $1.00
07776002 57600 Generul Plan Update $22.95
01776002 51601 lssuance $57.20
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Every permit issued shall become invalid unless lhe work orl lhe sile authorized by
such permit is cofimenced within360 days after its issuanco,ot if the wo* authorized
on the site by such peinit is suspended ot abandoned fot a petiod of360 days after
the time the work is commenced.
$604.85
$0.00
$604.85
lnspector MID#: 2020-'158109
01116002 51600
011 16002 51601
01116002 5'1612
01116002 57770
$22.95
$576.99
$1.00
$3.91 Fee Total
Paid to Date:
Balance Due:
Project Address: 2115 W Edinger Ave Unit: B Bldg:
Tract: 9773
Address Range: 2107 -2121
Historic: No
Engineer:
Phone:
License #:
$576. 99
$ 1 . I:rt]
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNDR AUII,DT:R DI:I,CA R^'TION
LEEby alfrm !nd.r plndry of p.rjlry (b I m .x.mpr t n rhd Conhro6' Ljc.o$ Law fo. rL follo*in! rcae. 15...7011.5
Busincs and Pr.Ic$ion C.J.)r Any Cirt or Cornry qhich rcquncs . Foir ro connrucl alrc( irprot, d.mlish or ftpan .n)
nruduE. prirr ro irs isumcc. lho EquiE rh. .ppli.sr for su.h n flri b fil a sigrEd sr'r.mnr ihtrr lE o. 3h. is lic. al pum&nt
ro rhc 0mvi\ions oI rlE Contactoas l-iccnEd law lchaprcr 9, CommcncinS qirh Sc.ri..7000 .lDivisio.I .lrhc Bosires and
P(rtsionsCodc)orrhrrhcorshcNerdhpirh€renohdddDb*irhrrlElllq.deremprion..{nyviohiionofSecrionT0ll.5bylny
applicrnrforaDcmirsubl.carh.0pplicr rorcivilp.nrhyotnormr.rnunfivehundrcddoll0n(t5{X)).
,s ownc. . r rhc p.oNny. o ny cmplnyrcs *irh wag.s as rhcn k . !$'rycnsari.i, *il, do rh. wo* and rhc sMrE n mr
inr.'rlal or orLEd for slc (Se 704-4. Busin.ss rnd Prolaaiotu Cod.: In. Codhdol! Licene Lrw dB nor apply ro rn.M.r oI
rh. pNn ny wlF hoild! or inpDws rlr.@c llld wtu dB such mlt biru.lf or hec.lf or rhtu!3h his ot h$ own .r{loyes.
pr.vidc'l rhar su.h iryowmdi e mr id.'i.n m o,Ied for eL lli hNcv.i r hriBins or inpmEmnr is sld wihr oE Fa
oi.onfhhn. rrE Owftr Buili]., wil n E tlE boln.n ot pFvirs lld ,E or dE diJ dt erix or in{ow rh. pmFdy lot $. p!'pe of
_1,dsown.rofrh.psp.dy,.m.rclusiv.ly.onkd.rin8wnhli.ctr*!co rurouro !!!No.r lh. pdj.cr (Scc.70i4, Busin.sr
lnd PbL\sinr c.d€: Th. Conrrrol s Lic..s. Low d@s nor arply ro !n o*ne. of propedl *hd builds or impior.r rh.ron.
and who contads tor such pDjccN wnh a Conk&!r(.) liccnEd pusud ro rh. conra.roar Licctr{ hw)
lrn(r.n' trn c' Sccrtrl
llr!!4-ts-a-I1!]}
I hcr.hy linmundcr pcnaxyofpcrluryonc.l rhc blloein8 dccl& ions
_l hrv. rrl wrll nEinrain. C.nifcd.oIC.nscnr !o s.lfJNuE tor sorli.r'ronlxmario!.3s previd.d for bys..rioi 1700 ofrh.
Ijh.r Codc. lor rhc perlirturce oI rhc rort lor {hich 'h. p..6n is isstr.d.
_lhuv.rtrdwillmainrdnso.h.onp.nsrrnrnn$rMc.,arrquir.dbySecrion3T00olrh.LlhorQ)J.,ti,rrh.rcdodB eof
rh. worlln. wlrch rhh l).mit is is$.n. My workcc coqrcosrrion Bure. cnri$ Mi policy nuf,hq uc:
-l
ccnityrhar iofic Frlor@rc ofth! *o* for *hich rhis pc,nir is iisu.d.l $!ll hn.hploy yFsrinlny'DEr
e 3\ h li.$ft subl.cr ro rhc rortch oqfnsiion lr?s of c.litom8. and asec rhd if I shnuld hccoN subjcct r. rtE
*o*.h (oq'.nsarion poisios ot Sdlion 3700 of rh. Labor Codc. I slEll. fonhwirh .omply wilh rlEe pDvilioc
WAINNC Failur. to sk work.r' compcmdion corcaE. is lnlastu| lnd shdl subjccr ro
.ivil fioe{ ul) ro nne hu r.l rhous , 'lollm (Sl
s..!.n :1076 or rh. rrhor (roJ. i'n.r.{ ann atu
!E!!f-81!t1\
I h.ft5y.finm und.r pcn.hy of pcrjurr rhar I im lietrr'd unde. prc!$i.n of Ctuprs , lcommncing wnhScdbi 7000) ofDivhhn 3
oi rhc BusiNs ard Pmtcsiotu CoJ.. ad my ltc.* is in tull toE drl clfccr.
l-iccorc Clasr_Lia.s. Numb€.:
Conlro.ror-
eoNglrllqrloNLrlllllli-lcEl.cf
ilsu.d is.. 1017 cn c )
AT8IICNIDECI,ASATON
I ffiy&ffmtondd p€nrk, of p.rjury on. of rhc follrwinadelc.nons:
D.nrliriotr Pcmih-Asb.nos Norili*rion F.d.ril R.gul,i.ns (Tirl..l0, Pdn6)
R.quir.d ldrd of Norinqiion
_l..nilyrhar ih. f.d.ftl Esulariotrs EBrdi'U asb.sos Emvll!rc nor amlicabL b rhis pmiar.
dxt im. rh.r rh. !bo!. infomriotr i\cor*r.I ig'e h.lmply Qirh allciry inl coo.ry
aJn h.Ehy aurt fla EoEenrarives ol rhis C y lnd Cnudy ro ..16 up.n rL
trtr,Yc mnrn)tuJ F^rr.ny tnt 2-2 rlrt
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Sublloor/VenVlnsulation
Roof Sheathino
Shear Wall
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
/1-</t/7-t / n-hYlt,,)
Certilicate ol Occu
Notes, Remarks, Etc
Rev.0B.07-2015
,./-- ?- I L,../
Drt.:-
tJtrdcf. Nxnc
Lldcat Addss
-
FINAL
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 20't6
Dear Property Owner:
An applicat for a buildin sp ermit has bee
specified at
NOTICE TO PROPERTY OWNER
ur name listin g urself a th builder of thesubmitted in yo p perty improvem ents
We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form lo 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 agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATIO N OF INFORMATON
D/RECI/O/VS; Read and initial each statement below to signify you understand or verify this information.
)-- C.'lA-l understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builde/' build-
ing p6rmit that enoneously implies that the prope(y 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.
f-- (
ry. 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.
t-n
lJ:3. I understand as an "Owner-Builder" 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-n
/Z_yq. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
f- /4l-2_% I understand if I employ or otheruise 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
"employef' under state and federal law.
t-- nq \--6. I 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 workeri' 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.
,^
/2_ t-7. I 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// 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.
E_L 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-
cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
C,AL{q I understand I may obtain more information regarding my obligations as an "employed'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. lalso understand I may contact the California Contractors' State License Board (CSLB) at'l-800-
321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors.
fa1lJ-'lO I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
party
dress
ndfi ially resp onsible for propo sed construction activ ity at the follow ad-C,4 a q
V,"
Ll " 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.
---l-:f-92 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 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.
p ropertv own er's sid natu re.
Signature of Property Owner oate: t 2 -27, Zo
Print name of Owner jb ttd>luPE /k Woo
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 Pro.iect (or Description of Work)
Project Location or Address
Name of Authorjzed 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 Owneis Sig nature Date
Print Name of Owner:
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. /Vofe.' A copv of the propertv owner's driver's license. form notariza-
tion, or other verification acceptable to the adencv is required to be presented when the permit is issued to verifv the
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 vefify the properv owner's signature.
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