HomeMy WebLinkAbout10191564 - Permitq
Proiect Address: 1025 N Lowell St
Lot.50
Unit Bldg: Address Range Suite Range:
Zoningr RlBlock. NA Tract 354 Historic: No
City of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, cA 92702 Building
lnspection Requests: (714) 667-?738 lnspector Section: (714) 647-5853
Permit #: I Ol91 564
Pin #: 33205
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Addition
Addn
SFD w/dot garage
R-3
VB
cBc 2013
x-0602320144J
Patio:
T.l.Area:
Yards Req'd:
Valuation: $19,7't3.00
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
175
175
Description of Work: Extend (2) existing bedroom with closets and add bathroom. Auth on file.
Planning Conditions:
Owner:
Address
Phone:
Tenant
Contraclor:
Address:
Engineer
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Suzanne Furianic
1025 N Lowell St
Santa Ana, CA 927032325
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus Lic #:
Workers' Compensation lnsurance
Ca.ner
Policf f:
Expires:
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
Ni, Ann
Kwak, Jason
Zuniga, Allissa
Date: 12108/2016
Date: 05/09/2017
Date: 08/28/2017
Subject to Field:
lvlisc. Receipt
Misc. Receipt
Misc. Receipt\('
0 777600 2
o7776002
0 777600 2
0 777600 2
o7716002
07 77600 2
57607
53600
57770
57672
s7600
57607
$300.00
$106.93
$32.s8
$1.00
$21 .25
$s2.98
Permit Fee
Plan Check Fee
Microfllm Records
Bldg. Stds. Revolving
General Plan Updale
lssuance
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#Total
Flood Zone Cert. Req'dr No
Every permit issued shall become invalid unless the wo* on the sile authorized by
such pamit is cofimenced within 180 days after ils issuahce.ot if the wo* authorized
on the site by such pennil is suspencled ot abandoned lot a ponod ot180 days aftet
the lime tho wotk is conmenced
lnspector MID#: 2016-133359
51600
51601
51612
53600
57770
$21 .25
$3s2.98
$'1 00
$106.93
$32.58
Fee Total.
Paid to Date:
Balance Oue:
0'11 't6002
011 16002
011 16002
01 1 16002
011 16002
$514.74
$0.00
1514.74
Assessor's Parcel: 405-283-08
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Storiesl
BUILDING. INSPECTOR RECORD
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Handicap Req
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Flood Zone Certif
FINAL 5-J/'la,r)-!*(TY\
Certificate of Occupancy
Notes, Remarks, Etc.
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MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Michele l\4adinez
COUNCILMEI!!BERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
Sal Tinajero
Juan Villegas
INTERIM CITY MANAGER
Cynthia J. Kurtz
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PI.ANNING & BUILDINC AGENCY
20 Civic Center Plaza
P.O. 8ox 1988 . Sanra Ana, California 92702
www.santa-ana.orq i oba
NOTICE TO PROPERTY OWNER
Dear Property Owner:
AF application for a building permit has been submitted in your name listing yourself as the builder of the property
irhorovements soecified at
-+- I t 75 N. t-z"ve// <*.
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
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
SF f . t 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.
SF Z t 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.
JF S. t understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may prolect myself
from potential flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
SF a. f understand Contractors are required by law to be licensed and bonded in Califomia and to list their license numbe rs on
permits and contracts.
S S. tunderstand if lemploy or otherwise engage any persons, other than Califomia licensed Contractors, and the total valueof
my conslruction is at least flve hundred dollars ($500), including labor and materials, I may be considered an 'employer" under state
and federal law.
SF A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious frnancial risk.
F Z. f understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale. unless a// work is performed by licensed subcontractors and
the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed
general building Contractor.
F g. t understand as an Owner-Builder if I sell the property forwhich this permit is issued, I may be held liable for any financial or
personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
moUido@sanla'atu oro
Msyor Pro Tem Ward 2
m man'ne2rOsanta.ana oro
V'canle Sa.mrenlo
!sam'eoloosanl,a 3na oro Ed.!!9@$!1a:!!4!9 dbe.av,desasanra a.a oro v'rreoas@san|a ana o.o snnaE.o@sanla-ena oro
SF
9. I understand I may obtain more informalion regarding my obligations as an "employer" lrom the lnternal Revenue Service, the
United States Small Business Administration, the Califomia Department of 3enefit Payments, and the Califomia Division of lndustrial
Accidents. I also understand I may contacl the California Contractors' Stale LicenSe Board (CSLB) at 1-800-321-CSLB (2752) or
www.cslb.ca.qov for more information about licensed contractors.
SF n.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 f,nancially responsible for proposed construction activity at the following
address:o ?7
lF 't'tll agree that, asthe party legally and financially responsible for this proposed conslruclion activity, lwill abidebyall
applicable laws and requirements that govem Owner-Builders as well as employers.
][t Z. t "gr"" 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. lfyou contract with someone who does not havea 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 isalso 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 damag es. 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 property owner and returned to the
agency responsible for issuing the permit. IVote; A coDy ol the Dropeftv owner's driver's license. form notarization. or other
verification acceptable to the aqencv is rcouired to be presented when the permit is issued to verifv the propeftv owner's
siqnature.
owner - Sfur. 1a*tt-.'Date 6.2.e. /7Signature of Property
Print name of Owner A4?a{/E RtRtaN<-..
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 Project (or Description of Work)
Name 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 fllled 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 lo
be presented when the permit is issued to veify the propefty owner's signature.
PL rn k.$J P51 /C ou nte.Activity,Assenr L,lyBrlls Notrce to Property Forn'l
SANTA ANA CITY COUNCIL
moul'do@$nta{n. do
Matlr Pro Tem Wa.d 2
oirurl nez@sant.-3.a do
V6re Samisro
6ampnto@santa€ne m Ed!!gell!la:@a-ar9
P Davd B6nsvd6
db€navd6@sant3.ane oro MllMs@senra-ana oro sr na€ro@sa.ta-am oro
Project Location or Address:
Address of Authorized Agent: