HomeMy WebLinkAbout10196252 - Permit"YProject Address: 909 N Sheffield St
Assessor's Parcel '100-444-50
Bldg: Address Range Suite Range:
Zoning: RlBlock. NA f.acl 2464
city of Santa Ana 20 Civic Center Plaza (l\4-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Permit #: {O196252
Pin #: 54432
Building Usel
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Usel
Single Family Dwelling
Reroof
Reroof
SFD Watt Garage
R.3. U
VB
cBc 2016
A-0602320143J
1
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation:$8,000.00
Description of Work: Tear-off & apply compostion shingles. Handout given.
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Trinity Gomez
257 E. Osgood Street
Long Beach, CA 90805
(307) 256-7837
Bslt-h+143477 - 4 /?',.1
Llll ice r t:TYH trctn!
Acct+:
Frcpt+:r:r??4(r19:j - (
IPonsClct i on f!t rr I
Owner-Builder
Engineer
Address
Total
lrll! r t,;
+tPhone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Eu i 1d ing
0l I l6rl0?- 51,9rl t I,.[:r -
Gererol Flon llp d n i,r r.r
tl l l16002- 51srxlr:rrr!-
Blds Stds Re',,o1v i ns
r:r1 1 1 6r:[:r?- 51 I 1 :Llri',r -
Fee Total:
Paid to Date:
Balance Due
Phone:
License #
Phone:
License #
Irioitc Gone--
Architect /
Designer:
Address:
Planning Approval By
Plan Checked By
Permit lssued By
NPDES lnsp. R
PWA lnsp Req'd:
Planning lnsp Req'd
ara,Dale: 0412412018 Misc. Receipt
Date: N4isc. Receipt
Oate: O4l2Sl2O1B Misc. Receipt
Subject to Field:
No
No Account#
07776002 51601 Permit Fee
07776002 57672 Bldg. Stds. Revolving
07776002 57600 Genetal Plan Update
07776002 51601 lssuance
$308 52
$1.00
$21.25
$52.98ki, Teri
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every pemit issued shall become invalid unless the wotu on the sile authoized by
such permit is commenced within 180 days aflet its issuance,ot if the work authoized
on the 6ite by such pemit ts suspended or abandoned for a period ofl80 days aftet
the time lhe wotu iscommenced
lnspector Ir/lD# 20'18-142933
01 1 16002 51600
01 1 16002 51601
01 1 16002 516'12
$21.2s
$361.50
$1 00
$383.75
$0.00
$383.75
Lot.50
Unit:
Historic. No
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories:
Contractor:
Address:
ql
t
I
BUILDING- INSPECTOH HECORD
ID/SIG.COMMENTSSITE-WORK DATE
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
I I
Rool Sheathinq o ?3lr$'-l-4o71YShear Wall I
Framinq
ln s u lation/En erg y
Drywall
Ext./lnt. Lath
Brown Coat
lVasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
-41/rst<',zr{2?)FINAL
Certilicate of Occupancy
Notes, Remarks, Etc
d6 'to .to
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APPLICAN'f DI'(I ARdTION
I trrby.iltN undcr nc.nhy oflr.rjury.rc ofrlrc foll.*ira dcclararions
Dc nt I d1 Pcnnir! Arhc*.s Norificdn,n f{dcri] Rqlhlior ('l itlc 4}, Pari6)
Rcquncd lrrlcr oa Norifi urinr
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ccnify rhar rh. r. cmlrcSulalions rcsardins $.{or n nril .rc nol lPplic,hk b rhh projccr
na i.lnmhrtr ir corer I xgrd t, .onrtly wirh all Ciry ind Connr,
rurkrizc rcprc{Drrrir.\ or rhh Cny Nd Coxtrr, lo cnrs ulx,n rhc
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Subf loor/VenVl nsulation
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MAYOR
N4iguel A. Pulido
I\4AYOR PRO TEiT
l\4ichele Martinez
COUNCILMEI\,4BERS
P. David Benavides
Vicente Sarmiento
Jose Solo.io
SalTinajero
Juan Villegas CITY OF SANTA ANA
PLANNINC & BUILDINC ACENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, California 92702
www.santa-ana.org/pba
NOTICE TO PROPERW OWNER
Dear Property Owner
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at q (+.?5
We are providing you with an Owner-Builder 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 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON
DSSI/OIJS: Read and initial each statement below to signify you understand or verify this information.
X1 . f understand a frequent practice of unlicensed 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. 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 homeowner's insurance may not provide coverage for
those injuries. I am wjllfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to
ryorkprs on my property.
cot4l.
Y, Z I understand building permits are not required to be signed by property owners unless they are responsible for
thAaorstruction and are not hiring a licensed Contractor to assume this responsibility.()E)
2{ , understand as an "Owner-Buildel' 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 Coniract,cr and having the permit filed in his or her name
instead of mv own.(x)
)4 + t understand Contractors are required by law to be licensed and bonded in California and to list their license
?r\mlers on permits and contracts.\.b)X, s. t 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 ($500), including labor and materials, I may be considered an
"enolqyer" under state and federal law.GJbt
5O , understand if I am considered an .employer" under state and Federal law, I must register with the state and
federal gouernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to
seridus financial riskI/\ 7 . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
ACTING CITY I\,IANAGER
Gerardo Mouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
l\ra a D. Huizar
moul do(osanla-ana oro
Mayor Pro Tem, Ward 2
mim6dinez@sania'ana.o.o vsa rn e.lo,Osanta-anE oro so ono@sanla anz.oro
P Dav d Benavdes
dbenavdes@santa-ana ora ivl soas@sanb-ana.oro slinaie.o@santa-ana.oro
licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is
eSSmed under contract with a licensed general building Contractor.
214. f un0erstand as an Owner-Builder if Isell the property for which this permit is issued, I may be held liable for any
fin-ancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the*$nsn1o o,. materials'
Y, t understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the
California Djvision of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board
TQSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.i.B)v 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 an d financiall res po n efo oosed,S+construction activ ity at the following
llsss:)<-rr I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by
aJl?B{)licable laws and requirements that govern Owner-Builders as well as employers.s)\)
YlZ. 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 Conkactors' 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'
com pensation insurance coverage.
form notarization, or other verification acceptable to the aoen c ,s reouired to be oresented when the Dermit is
issued to the ner's nature.
Signature of Property Owner Date: q
Print name of Owner
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
prolect.
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 ,illed out the above
information 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 ,he permi, is issued lo verify the propedy owner's signature,
SANTA ANA CITY COUNCIL
moulido@sanra-ana oro
Mayo. P.o Tem, Ward 2
m manrnez@sanla-ana ora
Vrcenle Sam ento
vsarhienlo@sanla-ana oro soloro@sanla.a.a ora
P. Dav,d Benavdes
dbenav!es@sanla ana.oro ivi eoasrosanla ana.oro sl na ero, sanla ana .ro
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 propertv owner's driver's license,
DropeI