HomeMy WebLinkAbout10194816 - PermitProject Address: 1038 W Highland St
Assessor's Parcel. 010-192-07 Loi POR 16
Unit: D Bldg: Address Range
Tract: HILLYARD ADDBlockr 2 Historic. No
Cify of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA\27O2 Building
Permit Countel (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: lO{948{6
Pin #: 4lJ677
Building Use: Multi-Family (5 or more units) Occupancy: U, R-2 1st FL Area: Patio:
Job Type: Alteration Constr Type: V B 2nd FL Area: T.l.Area:
Nature of Work: Windows/Door/Drywall Code: CBC 2016 Other Areas: yards Req,d:
Existing Bldg & User s-Unit Apt Watt garages Flood Zone: X-0602320257J
Garage Area: Valuation: S6,000.00
Proposed Use: # of Stories: , _o,",,
Description of Work: Change out (3) windows & (1) sliding glass door with same sizdstyle. Handout giv6n. Remodel kitchen & bathroom, drywall where
necessary.
Planning Conditions: Windows/Ooor to be vinyl.
Ownel
Address
Phone:
Tenant:
DAVID K MILLER
2870 CHTOS RD
Costa Mesa, CA 926263524
(714',t 557 -1235
Contractor
Address:
Owner-Builder
Engineer
Address:
Phone:
Slate Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #
Plannrng Approval By ,--6uevara, Jer
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp Req'd
B ki, Teri
Oale 1111512017
Date:
Oate '1111512017
Subject to Faeld
Misc Receipt
Misc Receipt
Misc. Receipt
$154.26
$1.00
$21 .25
$52.98
07776002 5160I Permil Fee
07776002 57672 Bldg. Stds. Revotving
07776002 57600 Gene.al Plan Updale
07776002 51601 lssuance
No
No
No
Fire lnsp. Req'd;
Police lnsp. Req'd
No
No Account#TotalPlanning Insp. Req'
Landscaping lnsp Req'd Flood Zone Cert. Req'd: No
Every peftnit issued shall bocone invalid unless the wo* on lhe sile authoized by
such pemit is cofimenced within 180 days efter its issuance.or if the wo* authotized
on lhe site by such penlit is suspendod ot abandoned fot a penod of 180 days aftet
the time tho wo* is commenced
lnspector MID#: 2017-139966
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
$21.25
$207.24
$1.00
Fee Total:
Paid to Dalel
Balance Due:
$229 49
$0.00
9229.49
{t
Suite Range:
Zoning: R3
'N\'
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.OWNI]R BTIII-DER I'ELCARA''loN
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Shear Wall
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Pool Fence
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D uty Final Report
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Flood Zone Certif
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Certificate of Occu pancy Tl-I
COMMENTS
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Notes, Remarks, Elc.
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MAYOR
MiguelA. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILMEiiIBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
INTERIM CITY MANAGER
Cynthia J. KurE
CIIY ATTORNEY
Sonia R. Ca^.3lho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submittedin your na e li stin
J
gyo urself as the builder of theiD property
improvements specified at t
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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
$Af . f understand a frequent practice of unlicensed persons is to have the property owner obtain an .Owner-Builder" building
permit that enoneously 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. l\,4y homeowner's insurance may not provide coverage for those injuries. lam willfully acting
as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
UU\ ,
'
understand building permits are not required to be signed by properly owners unless they are responsible for the
cbnstruction and are not hiring a licensed Contractor to assume this responsibility.
h\.u\ g. f understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself
from potential financial risk by hirjng a licensed Contractor and having the permit filed in his or her name instead of my own.-t\l\J\4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
dermits and contracts.
N-f,l-S. f understand i, I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of
lfiy construclion rs al least five hundred dollars ($500), including labor and materials, I may be considered an'employer" under state
and federal law.
lf\,!b. , understand if I am considered an "employer" under state and Federal law, I must register with the state and federal
dovernment, wrthhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious flnancial risk.
D\ftll undersland under California Contractors' state License Law, an Owner-Builder who builds single-family residential
Structures cannol legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontractors and
the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed
general building Contractor.
UNI8 , understand as an Owner-Buitder if I sell the propefty for which this permit is issued, I may be held liable for any Ilnancial or
[ersonal injuries sustained by any subsequent owner(s) that result ftom any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
Mryor Pro Tem Wa.d 2
mrman'n€z@sanla ana o.o
V'cenre Sam enlo
!$am'slo.asanta ana do 60lno@sanr3 ana.tro
P OaMd Benatdes
dbenaMds@sa.ta-ana orc N'lleoas@sanla ana oro slinarerolasaota anaoro
PTANNING & BUILDING ACENCY
20 Crvic Center Plaza
P.O. 8ox I988 . Santa Ana. California 92702
www.santa ana.oroioba
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.
noui do@$nla-a.a oro
ilfAg t understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service. the
{rdited States Small Business Administration, the California Department of Benelit Payments, and the California Division of lndustrial
Accidents. I also understand I may contact the Calilornia Contractors' Stale License Board (CSLB) at 1-800-321-CSLB (2752) or
www.cslb.ca.oov for more information about licensed contractors.
\\A]!.1 O. I am aware of and consent lo an Owner-Builder building permit applied for in my name, and understand that I am the party
-legally and financially responsible for proposed construction activity at the following
address:
)L\, , I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all-applicable laws and requirements that govem Owner-Builders as well as employers.
N,U\, , 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 nothavea license,
the Contractors' State License Board may be unable to assist you with any llnancial loss you may sustain as a result of a complaint.
Youronly 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 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
agency responsible lor issui
ed, this form m st be leted and signed by the property owner and returned to the
the Note:owner's driver's license form notarization oro
I is lssued to ve the owner's
sidnature./s /\Signature of Property Owner Date )r-
Print name of Owner )llvt c l{1t /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 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
Nots: A copy of ahe owner's driver's license, form notarization, or other yerification acceptable to the agency is required to
be presented when the permit is rssued to verify the propefty owner's signature.
PLink:\'^iP51 CcunierActrvilyrAssemil yBilis,Notrce to Proler1y Form
SANTA ANA CITY COUNCIL
mo!l'doasant6-sna d.
Matq Pro Tem. Ward 2
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vsa.m'enio@sa.ta ana o.o Esi.a!9@r!!l&a!!,!!c
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