HomeMy WebLinkAbout10191475 - Permitq
Assessor's Parcel 410-171-25 Lot: 70
Unit Bldg: Address Range
Tracl 6703 Hisloric No
City of Santa Ana 20 Civic Center Plaza (M-'19), Santa Ana, cAg27o2 Building
Permit Counter; (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1lJ191475
Pin #: 323l)7
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Addition
Addn/Oen
SFD WATT GAR.RESIDENTIAL
R-3, U
VB
cBc 2013
x-0602320259J
2
Patio:
T.l.Area:
Yards Req'd
Valuation:
0@0
s37,060.00
Description of Work: Legalize 340 sq ft den including the removal of (2) walls. Auth on file.I'i
0?t
, ti
Owner:
Address
Phone:
Tenant
Thi v. Tongffhien Nguyen
621 Murphy Ave.
Santa Ara, CA 92707
(71417g',t-7214
Contraclor
Address:
Engineer
Address
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Architect /
Desiqner:
Address:
Phone
License #
Phone:
License #
L6uLrL
16Lr1Ul-lr
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
Fregoso, Vince
So, Anson
Zuniga, Allissa
Dale 0912112017
Oale 0912112017
Date: 09/25/2017
Subject to Field:
{v
\'
Account#
68900
Total
[.4asc. Receipt
lvlisc. Receipt
Misc. Receipt
0 77 76002
07776002
07776002
07776002
07776002
07716002
57607
5 3600
57770
57672
57600
57607
$353.60
$442.00
$21 .72
$2.00
$21.25
$s2.98
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Slds. Revolving
General Plan Update
lssuance
No
No
No
No
Fire lnsp Req'dr No
Polrce lnsp. Req'd: No
Flood Zone Cert. Req'd No
Every permit issued shall become nvalid unless the work on the site authoized by
such permit is comfienced within 180 days anet its issuance,ot I the wot* authoizad
on the site by such peinil is suspendec! ot abandoned lor a period 01180 days after
the ltme the wo* tscommenced
lnspector MID#: 20't6-'133059
01116002
01116002
011 16002
01 '116002
01 1 16002
51600
51601
516'1 2
53600
57770
$21.25
$406.s8
$2.00
$17 00
$21.72
Fee Total.
Paid to Date:
Balance Due:
$893.55
$425 00
s468.s5
Project Address: 621 W Murphy Ave Suite Range:
Zoning: R1Block: NA
Occupancy
Constr Type
Code:
Flood Zone.
# of Stories:
1st FL Area: 340
2nd FL Area:
Other Areasl
Garage Area:
rotar: ;ii',ip$'ii
Planning Conditions:
Owner-Builder
*:rr*rtvrrlxlr
BUILDING- INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNEE B!ILDf,R DEr-(-ARATION
I hq.t'y Emnn ulds p6d'y otFjury rhd t m.rmP 6om rh. ContrE(loB l'c.e l,* for !h. follosi.s.@sn (s.t 70:rl5
Burre\ ori E f<io. Cod.) Anr Cty or C.urt, s'hrh r.qur6 ! Fsi ro sdDd. .ns. inr.ovc {t nolBh or r.Fn d!.
srtuciui Fior lo nr Lsiuecc. ds. r.qun6 th. apglrMl for such tEf,r b lil. t Un.d idtul rha h. or sh. ! li.nsd p!N!,Ir
kr rt Fovii'od of rh. ( odrfor ! l.icar.d lj* t(14tc 0. ( onEtrD! \'irh sdirin 1,00 of Dtrnhn I of rh. Bsina tnd
ProfBrFns (idc) or d h.or ih. i!.tml)l lhd.fio'. Dd lh. h.sir nn l hc alka.! .raplion Anyvnnilionoas(ibn70115 bydnv
aptli..n! aor r Fmn ebJdr rh. q?li.!nl lo . (iyil p.Elr) of hr frtr. the n\. huidr.ri &lls ( i50O)
I, s ownd of rhc F.Fry, o. my mpk',6 wnh s.s6 B th.r $h NnFdion, *ill rb rlE {st !d tlE nnrrd i! d
iiai.d dorEld for nl.(s< 7044, Bui6d sd Pnrlsios ('D& llE (:onlrrioir l-tds lrw d\6 nol .Pply lo d osns ol
th.F$Fi, who hril& n itrFrDE riEBs lxl slE &E nEn Nd hinr.lf or h*lf or tlmtrh nii G hd oe, .npL)c
Fovid.d lh.i rucfi iEFnEGu & mr idnrlat or.ft*d lor sL lt, lssM. th. tlildilli o, in{relocd it $ld wilh'n orc }@
ofcompkioq rlE (nG tuiEs rin h.r. trt hrdi orFwB tlti lE o. iE did d hill G irqoE 0E FtrFty ijr dr F,D.E oI
l. os osn( ofrh. For6r', d.rrkn.ly..ntrdin8 sith licd.d or r&loRl,r c.nnrucr rh. Fq(t (S(. 7014. Bunndl
.rl th'tsrh Cod. lh.conr.dorsIrc.n*ksdo6enqtDio.no$idorprop.n!trhoburd!orimp drhdon.
lnd trh. codrdr for s.h F.jds h r i,nldk'(sl li(4Ed pun@r ro rh. (tnlrdoi. Licdr t{s)
,,,,'")'l[i?/+
I h6.n) aftrm und.r Frh! .r Flurr oft of rh. folhtr im .k L'd
Ih.Erdwilltui'ri.rC.nit(d.oa(oEdroSdf-lMt rvt6 st9csrior d Fvli.d fo. bYS<1itn 1700 ofrh.
L.hor ( ode lor rh. FlollMcc o f rh. wot fo, *{rd rh. p6nir . au.d
I h!\. .rd r ill dajnr.in wod6 .omp.Ml io. irouanc.. 6 rcquiEd by sdrion l70o of lh. l,tnr Cod.. for lh. Ffolllmc. of
rh. *nI fd rnih fii! Fnn i iB.d Mt $ort6 onpaEiion idurft.6it rld polty mnbc c
CriE
Polic, NuDbsr - ErPiB
I Griry rhd in rlE Ffolrlw. orllE so* lor rtrh rhir Fii i! isrn I irll ml dphy 6y F$, it xy m46
$ sro b6.ft rubjcr ro rhc wo{4'comFurion hBolcrlitomi4 sd.sGlhd if I slbsld beom tuts d lo llt
uo 6' orpdqb. Forec 6lsdbn lT0o 6f rh. t t { co& l Jrll- fonlNii @nplr *ith rnor FornbB
WARNTN(; F.,ltrr. h sur. qorlds (ompdsalk'n co!di!. N unh\n,okt rhall rubjsl olpl6r(
'D
.mm.l p6utis lnd
ro.R hund..n rhousd {hll,r ltl00.O0o). r x!]nhn )n, d,nu!6 a mrid.d tor rh.
2
DI'CIJEAIIA!
I ffi, .ilrm ud.r FlXy or Fru.,v rhn I m lk.iEdl und.r lr!vti'. oI ((.ommins rnfi Sdir ]0()o, oaDnfn'n I
nl rh. RurinRi ind lk adrn'E(id. md nv licd\. il in tull f ..tu .lT(l
qqILtIA!(fIANl.llDllClli!!(}
I h<!l'! rrtri un& Frh) of FJury rhd llE i3rcoldrudni lqdie a*o.y lit th. Ffroc. oarh.{.rt tor {hich lhG lEmil ir
Esu.d (s€ lro97. ci! c)
AITU(ANI.0ECIASAIIq!
I ho*),.n'd undd Fill! olFjory on. oathc follosinr d(lsrtion.
D.noliion Pmik-A3b6r.r No(ficdion F.d@lRlsrhhn! ( I nk.$, Prl6)
R.q!t.d LlrqorNdftin.
I .drq rhd rh. f.nd.l rcsul.rioB r.ardD8 lrh6rx..fuu|tu. mr amlt.6k u rhu F.j.al
I (dit rhd lh.!crcdlhs qid'ctrxrn drl nar rsra r. compb qnh rll Cir! !.d (-oun!\
ir6 ofthir cirysd Counryro 016 uFrn rh..i'linin(6 a.d Sr.lc ltrrs r.lln
rh\. mdruftd,ropdr for
1
L4 !/') -Ll/16rwtz ?12'/tt-
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathinq
Shear Wall
Framinq
In su lation/E nerg y
Drywall pllt-l rt T,Ut*'y,<'f-*,'r/r)Ext./lnt. Lath UI
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
ll
FINAL '!ol)7 l8 '0>at-/
I I U\Certificate of Occupancy
Notes, Remarks, Etc
J------:--
t
I
I
I I
I
I I
I
I
I
Brown Coat
I
I I
I
I
I
MAYOR
MiguelA. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILII4EI,lBERS
P. David Benavides
Vicenle Sarmiento
Jose Solorio
Sal Tinajero
Juan Villegas
INTERIi,I CITY MANAGER
Cynthia J. KurE
CITY ATTORNEY
Sonia R. CaNalho
CLERK OF THE COUNCIL
Maria O. Huizar
CITY OF SANTA ANA
PI.ANNING & BUILDING AGENCY
20 Crvrc Center Plaza
P.O. Box I988 . Sanra Ana, California 92702
www.Santa-ana.orqlpba
NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a building permit has been submitted in your name listing yourself as the builder of the property
prov NtS S ecified at
LI I 7
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
DIREqTIONS: Read and initial each statement below to signify you understand or verify this information.
14, ,understand a frequent practice of unlicensed persons is to have the property owner obtaan 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 dsk for any injuries sustained by an unlicensed person and his or her
employees while working on my property. ijty 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 properly.
I'i7V ,. runderstand building permits are not required to be signed by property owners unlesstheyare responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
3. lunderstand as an "Owner-Builder" lam the responsible party of record on the permit. lunderstand that lmayprotecl myself
from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
I
I I v q. t u nderstand Contractors are required by law to be licensed and bonded in Califomia a nd to list their license n umbe rs on
oermits and contracts.'I
@1-a.
'
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 "employer" under state
and federal law.
llV A. I understand if lam considered an "employer" under state and Federal law, lmust register with the state and federal
governmenl, 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.
N-r. , 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.
'[ 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 financial or
personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the wo*manship or
materials.
SANTA ANA CITY COUNClL
Marq Pro Teh Ward 2
\sam e.l.asanla an. or.rid-a!-a@s!4a:@a.el9
P Oavd Benavrdes
dbe.avrdes@sanla-ana oro Mlleas@saob ana do
-70 7
United States Small Business Administration, the California Departm.ent of Benefit Payments. and the Califomia 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.oov for more information about licensed contractors.L
legally
L l understand I may obtain more information regarding my obligations as an employer'from the lnternal Revenue Service, the
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
p n ble for posed on ac at foll sa
address 4)
til,
i-ppri*
'1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
ble laws and requirements that govem Owner-Builders as well as employers.
Ts?/:Z. , agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have
rprovided on this form.
Licensed contractors are regulated by laws designed to protect the public. lfyou 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 com plaint.
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 ofthat individual or flrm is injured while working on your property, you may be held liable for damag es. lfyou
obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verirying 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. Nore A coDv of the DroDerty owner's driver's license, form notarization. or other
verification acc to the /s n he il is issued ,o ve the o
siqnature.
Signature of Property Ow
Print name of Owner
Date
/)-
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)
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 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 notarization, or other verilication acceptable to the agency is required to
be presented when the permit is,ssued to verify the propefty owner's signature.
SANTA ANA CITY COUNCIL
t
moul'do@sanL-ane do
Mayd Pro Tem. Ward 2
n'man,nezlosanE ana oro
vi.srE s5mrsro
!6amL6nto@sa.t3-ana oro Eefgllaletella:lli-gc dbe.aedesosa.la'anaorc r9l]!9!!@5a!E:r!!-e9 sll.arero@santa-an, oro
+
- 1 </1-