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Home My WebLink About2202 N Poplar St - Misc. Permit (3)o oAPPLICATION AND PLUMB!NG PERMIT (TYPEWRITE OR PRINT IN INK) CITY OF SANTA ANA 206 W. 4lh Slreel 667-273â‚¬ APPLICANT FILL IN AREA BELOW 4ry .7dO2-?t V*L.-,JOB AODRESS ILING A -3 aB cn\ y' -r- ,- I -XLr,*--qt, Ll/-1-zt----2 STATE/ZIPQazoc OrE-adld r O.dribn I nereb, altrrm h l am ereh lrom the Co.tractois Lrce.* ta* lor th. ,otto*rng rcason (SE 7@1 5 AusrBs and Plol6sons Co<re Any cny or cou.ty whrcn.equ(esa pâ‚¬rmf toconsrruct. alrer. 'dprove dehorrln. or regatr .ny st tucture. pnor to rts rssu6hce. also râ‚¬qur6s the !pph6.t lor soch permd lo lle 3 egned slaleme thst he 's hce.sd pu6ua.t to the previsro.s oi rh. Conlr.cio.s Lâ‚¬e^* La* {Chaprer 9 (comoencr.g w h S..tton 7@) o, Orv6.on 3 or tne Busrnes3 and Pro,63ro.s Code) or ln.t he rs sremDr therekom and lhe bG6 lor th. 6fl,e9od erempton a.y vor.lr6 ol secron 7031 5by any apph@nt lor a pDrmn sub,ets the.pgtlcait lo a c,v'l pe.arry or nor more lha. rrve hund,â‚¬d .torraB (S5O0l E ser'o.7oa4a r,.s owne,ol rhep@oeny. ormyemproyecaw'ln wrges.slne(soDcompen- 3.1'On w l do rne {or* and lhe ll.uctu.e E rcl nlsnded or otlered toi sale E selDn /o.r.A I as ownd oi the p.ope.ry. am ercrusrery conractrng w h rrcensâ‚¬d conlracloR ro cohskucl lhe 9rotecl VLH, 3,,)^ -, tnto , / 24 -07{ SIAIE/zIP a AOORESS CITY tno*y,nir{y'n t^r,,*,*ondo'lhâ‚¬ p.dbio.lr ot cn.ri.. q Dllil|on 3ortlâ‚¬ Bl,.lncrtnd ftol6.Jo.B Co(b. Ild my licâ‚¬rEâ‚¬ a i. tull to.ca .nd .ttscr o//4 7'tb o.te /'/-z -ff co.rrlcror (sig ) ,"**".*9La12u* r.rt . Coi$.rdo.! O.clr.do.! I hâ‚¬reby alitro rhar I h.ve . c.niliere o, consâ‚¬nt to solt-in3oE, or . @dinc.te ot tryb or'3 Cohp6i$rlo. l.su.ancâ‚¬ câ‚¬n i6d copy E tilod *Ih rho oly b!'rdmg r.sp6.tion (bp!rlm.t. 1ce iiy rhd in rh6 p..lo,mMca ol the roit ior f,hich thi. Fmn i! illood, I lhrtt iot â‚¬nptoy !.ry prLson in .ny m.n.r.r io 6 ro b.com !!bl.cr ro the Wort./. Compen$llon t- 3 ol lo!c. ro APrlb.rt rl aner mak'n9 rh's cerlrlrcareolErempt,o.. youshoutd become sub|ect to the wor*els compe6- sat'o^ Fovrs,ons ol rhe L.bor code yor musl loahw{h corpry rrth $ch prdEon3 or lh,s Perm'l shallbâ‚¬ demcd revoted 4L{a 2,2 '? -t I CrpEo. ThE p.m .n!I olPrc by lmrtlrio. and tâ‚¬coFe nulr md,oid it th6 ro.r rdno.iud by this pâ‚¬rm'r a nor comm.nced eihi. l8O @ys toF $e dar. ot lht! p.rhlt or at *ort ,urho.a..d !y thi! p6rm[ b $lpâ‚¬ndâ‚¬d or .bindonâ‚¬d .r r.y rimâ‚¬ .fi.r lh. worx b cornnEocod tor . p..i, ol 1& d.y! A n.w pâ‚¬rmn sndl bâ‚¬ obtsinsd lir.t b.tor6 such eort ci. b. rlcommâ‚¬.E d AtPt .nl'. D.crd(.r I câ‚¬n y thd I n e6 E d rhi. lpplEar'oi lnd rlalc ihat lh6 rboy! intormrtion i. co.E 1. I ro.d to comply wirh rll cary o.dn nc6 and 3i'tâ‚¬ lr*s rd!ri.! io building cst!tuctb.. .nr, h.r.!y &lho.i.od r.pr6.nhrion ot hr! cny ro .nr6 upon thc !bo\.{h.ntionâ‚¬d prop.ny lor ii!p..ii,on Appncanr or Ags (Sâ‚¬ ) ial O lnduslrial E Commercial NO.TOTAL FIXTURES each plumbing fixtue/trap Dental Unit or Medical Gases SEWER 1st 100' + Conn.'t 5.00 Ea. Add'l C,onn.5.00 Ea. Add'l 100' or Fraction 5.00 Private Sewage Oisp. System 30.00 GAS PIPING GAS SERVICE 1 to 4 Outlets 5.00 Ea. Add l Outlel 1.00 Repair or Replace Gas Piping 5.00 Temporary Gas Service 100.00 MISCELLANEOUS Whter Heater - Eleclric or Gas 5.00 r^/aler Piping Ea. 100'10.00 Rain Water Piping (buded) Ea. 100'8.00 Water Softner 4.00 Alt. or Râ‚¬pair of Drainage - Vent Pidrâ‚¬10.00 Lalrn Sprinkler 6.00 Rain System - Per Drain 10.00 lnd. Waste lnlerceptor 8.00 Pool Traps 5.00 H( Drain System - Per Drain 3.00 Repair/Alt. Drainage or Venl 10.00 Vacuum BGakers 1-5 5.00 Over 5 1.00 5.00 Ovet 2"10.00 \ fater Service Ea. 100'10.00 Subtotal Penalty Fâ‚¬e (when applicable) Violation Fee (50.00) (minimum 20.00) Receipt No Pc#Date Plan Check (Adjustment) lssuance Fee 10.00 TOTAL PEBMIT FEE (minimum $35.00)3J-- DATE PEBMIT {5.00 10.00 \ [,--L?1.A----+iEr.rtEo sy t ,etAUILOING '"-.,[* 5q VALIOATION {OFFICE USE ONLY) {ACCOIJNT '1r..1?l tilrl| olsrnbunon r ri3plcro. copy z Fite coot 3 r,na"cetfi[l\fi$pr4l6fffl Cffil $E.m CS-611 l,,c Izo 0oa I EACH Backflow Device 2" or Less Plan Check 65'/. ol subtotal o,a l/- ) f? PEFTMTT ISSUEO AY {Sig } a-",.., a7,O-, . Orl.lnaFctor Approvrl (Sl9n.tur.) ..--1 , -_--.-. o a PLUMBING INSPECTION RECORDS Ground work (Soil) Ground work (waleo Waler Sorvice {Ground) Gas Servrce and Unclerground Lawn Sp.inklers wasle lnterceptor PoolTraps Sewer Rool Orains Waler Healers wabr Sollner Rentalor Medical Gas6s Rough Plumbing Final Plumbrng Temporary Gas Service Noles o e m.Ef,t lâ‚¬fl3 iq8t:l 88\/i Ir r,i P ].er Blocl a e Inc . --O$n r Contttdor CUnn 1n Vzluatioa $ ]]000 Kind of Buildiag ? ts.resl d.enc e &ae5e o.* 51-54 Buildiag Permit No'2 Coarr. Bf e aeho ft Datr 4 Plumbiag Perait No'Sarr I Dro $-4 Electric Petoit No' Deta tl CottLFixors Perait No' He atcr Dirp.Raage Oudr*r Fiancs D. v.ca Sictr Motor!Faa 1 ,,eor ;$ r r;i9p-:tr@!ffitiEjo-effi. ly-Eoanaa Nov.5r195lr eae released r nsif;' A f,*e,' str+i. i,il "5 " B{ }#' f; 5ff il#Ti",, [J 03" o " n irc+az )-12222 r$3if?8 rlx;1 notor :or R rurner bv Bluega Pl:be. #t3"45 L-L3-9? l{/B bq Pacrflo rnst' ,PLbe7#12616 a-9-'lL'ri:H bv Pacific rnst' :tisJ. sota'10-]9-81 bldg. P/c #4800 -:d 532'82 by Andrew L lrlarton' ts1dg /t 15007 ll-5-Bl add.a passive solar collector for Bob Turner by- Andre'.,t L. l'larton, $4C87 . Pr,lc.4684 5-22-85 watex l{eaxex BLdg. 14827 5 LZ-04-86 solar domestic hot water t"rZ, Vzsols L2-o4-86 collector' storage tank ercgrlano l1-3-88 fix 5 (change out) vel 5 I G., 3 Valuatioa S .Frrurte 1 Co'aa.1) ll'l Circui. I Dry.! i ,j \9,6.s - r-- iO i (;) n I F- N l -rJ t-)- :?_ :;-. Ilt -,I !J i! I I I r_l rl l t/ i :._: :: -i ::. 9; (_) :i ilt r.-..':'t:l o 0r. ._ l-s Ir--- o _-! I I til),-.j (.) io +.-.)-2 C\ C< +-, ! F .s C\ _,+,Avf>?tul 21y7Wrv ?v\dQA h0\*2-A b 'n oa ,Câ‚¬ c rt/ ,L )/23olo zp4zb ,-rld ,xtvg '+, )qlod,prl roee -2 V ohbLt tot"Y '$Q MAYOR L4iguelA. Pulido IVIAYOR PRO TEM Michele Martinez COUNCILI\,4EMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villegas ACTING CITY MANAGER Gerardo Mouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\.4aria D. Huizar / ot 7t, tPs CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.org /pba NOTICE TO PROPERTY OWNER Dear Property Owner Ana plication for a building permit has been submitted in your name listing yourself as the builder of the ments speci ed at fbLca rL property oA We are providing you with an Owner-Builder Acknowledoment 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 DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. â‚¬]1. I 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 willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. f ! z I understand building permits are not required to be signed by property owners unless they are responsibte for the'construction and are not hiring a licensed Contractor to assume this responsibility. â‚¬_L 3. I understand as an "Owner-Builder" I am the responsible party of record onthe 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. â‚¬-r?-q I understand Contractors are required by law to be licensed and bonded in California and to list their license iuhbers on permits and contracts. p V 5. I understand if I em ploy or otherwise engage any persons, other than California licensed Contractors, andthe total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. {-D-A. t understand if I am considered an "employer" under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. â‚¬ ? , t understand under California Contractors' State License Law, an Owner-Builder who builds single-family re$dential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANIA ANA CITY COUNCIL moulido@santa-ana.oro Mayor Pro Tem Ward 2 mimartinez@santa-ana.orq Vicenre Samienro warmlento@sanla-ana.oro iso or orosanl,a ana.oro P. Dav d Benavrdes dbenavides@sanla-ana o.o iv eoas@santa ara oro sl.aiero@sanla-a.a.oro licensed subcontractors and the number of structures does not excbed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. Q' f8. 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 owne(s) that result from any latent construction defects in the workmanship or materials. 'l ,4?_t/ L l understand lmayobtain more information regarding myobligations as an "employer" from the lnternal Revenue Sdrvice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. ej_10.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that lam the party and financially respo nsible for proposed constructio at the following a6add re S â‚¬ Q 't, I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by -ll Spplicable laws and requirements that govern Owner-Builders as well as employers. â‚¬--L,, I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the -inf6rmation 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' com pensation 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. /Votei A copv of the property owner's driver's license, form notarization, or other verification acceptable to the ao enc ,s reo to be Dresented when the oermit is issued to verifu the owner's sionature. Signature of Property Own oa.,^orlz-/t k Print name of Owner u t /,'Vl e t'1 .-) 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 llle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Name of Authorized Agent Address of Authorized Agent:_ Phone Number of Authorized Agent: I declare under penalty of petury that I am the property owner for the address listed above and I personally filled 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 noaarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. e -r i j,tr a-j.i._A.r,,,t A:::1i )i_:,::. f!j... r.|-',r;:_i, i:. r al 'tr:ja 1: SANTA ANA CITY COUNCIL moo do@santa ana.oro Mayor Pro Tem, Ward 2 mimarl nez@santa-ana oro Vicente 56m ento vsarmienlo@sa.ta-ana.oro so oroAsanla 3na oro P. Davd Benavides dbenavides@sanIa-ana oro iv eoas@sa.t.-ana o.o sl naero@sante ana oro Project Location or Address: _