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HomeMy WebLinkAbout10189183 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Sa nta Ana, CA 92702 Building Permit #: 10189183 Permit Counter: (714) 647-5800 Inspection Requests: (7 14) 667-2738 Inspector Secti on: (714) 647-5853 Pin#: 86651 Project Address: 3101 S Deegan Dr Unit: Bldg: Ad dress Range: Su ite Ra n ge: Assessor's Parcel: Building Use: Job Type: 412-152-31 Lot: 26 Single Family Dwelling Addition Block: NA Occupancy: Constr T ype: Tract: 7434 R-3 , U VB Na ture of Work: Addn Existing Bldg. & Use: Std w/att garage Proposed Use: Code: Flood Zone: # of Stories: CBC 2013 X-0602320259J 1 Description of Work: Bathroom add ition at rear of house. Owner-Bui lder form on file. Planning Conditions:AII materials to match existing. Owner: Veronica Eggers 3101 S Deegan Dr Contractor: Owner-Builder Address: Phone: Tenant: Santa Ana, CA 927046612 (949) 545-4100 Address: Phone : State Lie #: Lie Type: Bus . Lie #: Workers' Compe nsation Insurance: Carrier: Po licy#: Expires: Planning Approval By: Pla n C hecked By: Permit Issue d By: NPDES ln sp. Req'd: Orozco, Ivan C h ehade, N abil Chavez,Davef~ No • Date: 11/23/2016 Date: 11/23/2016 Date: 12/06/2016 Subject to Field: Misc. Receipt: Misc. Receipt: Misc. Receipt: PWA lnsp. Req'd: No Fire ln sp. Req'd: No P lannin g lnsp . Req'd : No Police lnsp. Req'd : No Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 180 days after its issuance.or if the work authorized on th e site by such permit is suspended or abandoned for a period of180 days after the time the work is commenced. Inspector MID#: 2016-128634 Account# 01116002 51600 0 111 6002 51601 01116002 51612 0 111 6002 57770 08901001 24000 Engineer: A ddress: Phone: License #: A rc hitect/ Desiqner: Address: Phone: License#: 67964 Total $20.56 $351.26 $1.00 $3.50 $2.60 Historic: No 1st FL Area: 136 2 nd FL Area: Other Areas: Zoning: A1 Patio: T .I.Area: Yards Req'd: Garage Area: Valuation : $20,000.00 T otal: 136 ;~,tit < .. ii~· ,i./~ i'.~0 -t.~ .. --0 . .2(il~S (!)~ '-~:os1;LE3 {)f ·: '--·~ :_.i l!I l"r.:-tn~=~~ J 1 of :~ ti .. ,:t ~ :=~~=·=~: :i.O.lf.f_.:133 h.1 .. 1,C~;fijC,f~:5/4 -J.,_ \. '·1 M -'>:! "7 Af~ ,i,11::-r·:t.i;)n Tc,tt\.~ .•J"!- Jenkins ~rchite:cts t;s:•~!I":· Robert G . Jenkins 224 Sapphite .. ,Ave neiep Bal°ijcfa Island?. L .. O •• _ .. 6 Newport ,Bea~~•,1e°A"92660 U!,ti,C, (949) 244-7:4 17" 1 ns 'i~~,i. '...t. , . l }. _; ,.Si)IJ./ r~i 1-:·)U .l fl('(; - UJl161_lUL-~l,~l~1J•_liJ•- 01116Q(),2 _ ,~;I;fiQ,7.1 Pc.el'..111itf.,ee,, ,.;:; $300'.00, '.J1 01116Qq~ .535b'O Pl an (';.fle ck Fee .... $30op9 ,,n 01115991/ MPf-~lf5£ii ~!!])}ecords _ $3'.s o·" · 0B9010Q.~ ,.:?:40()Qtr·$.MIP -Category 1 $2;60, 61r 0 1116002 i516'1'2 :'B ldg. Stds/.Flevolving,1.t h;-, 00,.:,$1 100 01116002 51600 General Plan Update $20.56 0 1116002 5 1 601 Issuan ce $51.26 Fee Tot al: Paid t o Date: B alance Due: $678 .92 $300 .00 $378.92 SITE-WORK DATE ID/SIG,.. Set Backs Forms/Steel/Holdowns Erection Pads Vt\....,/ UFER Ground SLAB Floor Subfloor/VenUlnsulation I Roof Sheathing Shear Wall Framinq I nsulation/Enerqy l Y, Drywall E xt.II nt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. BUILDING-INSPECTOR RECORD COMMENTS OWNER BUILDER DE L CARATION I hereby affirm under penall y o f perj ury 1hm I am exempt from the Contractors· License La w for the following reason (Scc.7031.5 Business and Profession Code): Any City or County which requires a penni t to constn.ict. alt er. im prO\'C. demolish or. repair any structure. prio r to its issuance. also requires the appl icant for such pennit to fil e a s igned statement that he or she is licensed pursuunt to the provisions o f the Contractor's Li censed Law (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that heor she is exempt therefro m and the basis for the alleged exempt ion. Any violation of Section 7031.5 by any applicant for a pcm1it subjects the applicant to a civ il penalty o r not more Limn five hundred do ll ars ($500). _I. as owner of the property. or my employees wit h wages as their sole compensat ion, will do the work ru,d the stnicture is not intended or offered for sale (Sec. 7044, Busin ess and Professions Code: The Contra ctor·s License Law does not apply to an owner of the property who buil ds or improves thereon. and who does such ,vork himself or herself or thro ugh hi s or her own employees. provided that such improvements are not intended or offered fo r sale. If. however, the bu ilding or improvement is so ld within one year of comp letion. the Owner Build er will have the burden o f proving that he or she did not build or improve the propeity for the pmposc of ti/). as owner of t he property. run exclusively contracting with li censed contractors to construct the project (Sec. 7044. Business and Profession Code: T he Contractor's Li cense Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contractor(s) li censed pursuant to the Contractor's License Law). _1 am exe_n!t "Ider !j<etion ~ for this reason. Dale ,fq/;//0 Owner: ~~~ I l WORKERS' CO~IPllNSATION DEC LARATION I hereby affirm under penalt y of perjury one o r the following declarations: _I have and will maintain a Certificate of Consent to Self-Insu re for wol'kcrs · compcnsalion, as provided for by Section 3700 of1he Labor Code. for the perfonnance of th e wo rk fo r which the pcnnit is issued. _I have and wi ll maintain workers · compensation insura nce. as required by Section 3700 of th e Labor Code. for the perfon nance of t he work for which this pennit is issued. My wo rkers ' compensation in surance carrier and policy number are: Deputy Final Report ~Numbcr; _____________ Expires: Enqineer Final Report t--~'---------L--------l-------+------1------------------~ _ ertify that in the performance of the work for which th is permit is issued. I shall nol employ any p<..-rson in any manner Flood Zone Cert.if. so as to become subjecl 10 the workers' compensat ion laws ofCalifom ia, and agree that if I should become subjec t to the workers· compensation prov isions of Sect io n 3700 of the Lalxlr Code. I shall. forthwith comply with those provisions. WAltNLNG: Fai lure to secure workers' compens at ion coverage is unlaw ful. and sha ll subj ect an empl oyer to a iminal penalties and : FINAL civil fi nes up to one hundred tho usand do ll ars ($100.000}. in addition to 1he cost or compcnsa1,·~on. da iages as provided for the Sectio n 3j 76 of 1 c La bor f ode. interest and attorney's fees. / /4, ~.4 ././ ~ Dale: La.,//;, / {?, Appli ca nl:,.,,.:~=~.!,.,<,t"~ /4.c..,<:~.!e:,~:,C.,,..:/,:_:vt-=---.,..'-----~~-ll'---11--- Certificate of Occupancy V V Notes, Remarks, Etc. / ( LICENSED CONTRACTOR LU DECLARATION I hereby affirm under penalty o f perj ury that I am licensed under provis ion of Chapter 9 (commenc ing with Sectteln 7000) o f Div ision 3 of the Business and Professions Code. and m y license is in full force and cITcct. Lice nse Class: ______________ Licensc Number: _______________ _ Dntc: ____________ Contrnclor: _____________________ _ CONSTRU CTION LENDING AGENCY 1 hereby affirm under penalt y of perj ury that there is a co nstructio n lending agency for the perfonnance of the work for which this permit is issued (Sec. 3097 . Civ. C.). Lender's Name: _________________________ _ Lender's Address: _________________________ _ ;\PPLICANT DECLARATION I hereby affinn under pena lty of perj ury one o f the fo llowing declarations: Demo lit ion Permits·Asbestos Notification Federal Regul at ions (Tit le 40. Part 6 ) _Requi red Letter ofNotifi catKm 1----------------------------------------------------~~I certify that t he federal regulations regarding asbestos removal are not appl ic abl e to this project. ~ \/:Jli certify that I have read this application and state that the above info rmation is correct. I agree to comply with all Ci1y and County 1-----------------------------------------------------'I orclinances and State Laws relat ing to buil ding construct io n. and hereby a ~1horize epresentat ives of this City and County to enter upon the above mentioned propcny for ins pection P"?J'· ,. .,-:;:?" / 2 // J, Applicant o r Agent Signature: -,t... ~ _d,~~~? ~~,.,.._-Dale: • Lft:::::>d ~ /1 /-4,__,,n,.,."7 L=--Y~_..r----I { Pcrmite:e name: (print):_°?_"'~--l~/6, ~'~-~~r~JLZJ.t-~t-8. L:A..~..__ _ _f,~~'.A-c;~~::'./~~~---....:_ __ _!'.__ {/ u MAYOR Miguel A. Pulido MAYOR PRO TEM Vicente Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Sal Tinajero Dear Property Owner: CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civi c Center Plaza P.O. Box 1988 • Santa Ana, Cal i forni a 92702 www.santa-ana.org / pba NOTICE TO PROPERTY OWNER CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNC IL Maria D. Huizar An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at r . J J\ . -.r-: ..L o ':1. -:1..../) l-/ -~ \CO \, ~ , (2e e~a..Y\ R Y ~ r)-r' L....-, 1 L Pt -· l_cr ·1 '-' l We are providing you with an Owner-Builder Acknowledgment and Information 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 official address indicated. An agent of the owner cannot execute th is notice un less you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON ~T/ONS: Read and initial each statement below to signify you understand or verify this information. ~ 1. I understand a frequent practice of un licensed persons is to have the property owner obtain an "Owner-Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, 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 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 inj uries to ~ers on my property. f J!!i)__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. ©3. I understand as an "Owner-Builder" I am the respons ible party of record on the permit. I understand that I may protect myself from potential financia l risk by hiring a licensed Contractor and having the perm it filed in his or her name J1::8fd of my own. ( !l!!i._ 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license )J;r;}ers on perm its and contracts. ( ~5. I understand if I employ or otherwise 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 ,?3ployer" under state and federal law. (tf/ __ 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 workers' compensation disability insurance, a nd contribute to unemployment compensation of each "employee ." I also understand my failure to abide by these laws may subject me to /.~us financial risk. (_ ~_Vt} __ ?. I understand under California Contractors' State Li ce nse Law, an Owner-Builder who builds single-fam il y residential structure s cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licen sed general building Contractor. Miguel A. Pulido Mayor JMPuli do@s anta-ana.org SANTA ANA CITY COUNCIL Vicente Sarmiento Michele Martinez Mayor Pro Tern, W ard 1 Ward 2 VSa rmie nto@santa -ana .org MMartinez@santa -a na.org Angel ica Amezcua Ward3 P. David Benavides W ard 4 Mmezcua @santa-ana.org DBenavi des@sa nta-a na.org Roman Reyna Ward 5 RReyn a@santa -ana.org Sal Ti najero Ward6 STinaiero @san ta-ana .org /ji) 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 financial or personal injuries sustained by any subsequent owner(s)'th~t result from any latent construction defects in the ~anship or materials . ~9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service , the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board jCSbf3 ) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. '!!f!!_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 responsib e for proposed constfi.l,l.ction ac.!1¥ity at th follo~g _ ~-, '1./J U address: ~( 0 ( ? -.J-.,1) ->, rr//lA C ?'/ c = / ........ 1 {i!j)_ 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by ~plicable 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 provid ed on this form . Licensed contractors are regulated by laws designed to protect the public. If 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. It is also important for you to understand that if an unli censed Contractor or employee of that individual or firm is inj ured while working on your property, you may be held liable for damages. If 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 t heir workers' compensation insurance coverage. Date: _/.~~~;(_c::,_,L-/j-'------'1/ b_ l ( 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 auth orize the following person(s) to act as my agent(s) to apply for, sign, and file the documents ne cessary to ob tain an Owner-Builder Permit for my project. Scope of Construction Proje ct (or Des criptio n of Work):. _______________________ _ Project Locati on 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 informatio n 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 required to be presented when the permit is issued to verify the property owner's signature. PLink:WP51/CounterActivity/AssemblyBills/Notice to Property Form 03 -14-2016 Vicente Sarmiento Michele Martinez SANTA ANA CITY COUNCIL Angelica Amezcua Ward3 P. David Benavides Ward 4 Miguel A. Pulido Mayor MPulido@santa -ana.org Mayor Pro Tern. Ward 1 Ward 2 VSarmiento@santa-ana .org MMartinez@santa-ana.org AAmezcua@santa-ana .org OBenavides@santa -ana.org Roman Reyna Ward 5 RReyna@santa -ana.org Sal Tinajero Ward6 STinajero@santa-nna.org