HomeMy WebLinkAbout10294006 - Permitq
Project Address: 4025 W Marv Cir
Assessor's Parcel 198-O22-27 Lot 50
Unrt Bldg: Address Range Suite Range:
Zoning: RlBlock NA Tract 1830 Historic: No
)City of Santa Ana
Permjt Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, eAgzTOZ Building
lnspectaon Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: l0294006
Pin #: EE296
Building Usel
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Owelling
Addition
Bathrm/Porch Addn/Demo
SFD Watt garage
R.3, U
VB
cBc 2016
A-0602320143J
1
1st FL Area: 54
2nd FL Area:
Other Areas:
Garage Area:
Total: 54
Patio:
T l.Area:
Yards Req'd
Valuation:
180
s5,500.00
Description of Work: Legalize bFthroom-addn (at NE rear of sfd) & front porch. Demo/remove unpermitted addn @ south & west side of 6fd.
f$h u1" (\\r.
Planning Conditions: All materials to match existing.
Owner
Address
Phonel
Tenant
Thanh Duc Nguyen Family Trust
4025 W Mary Cir
Santa Ana, CA 92703'1629
(7141808-2216
D M S Roofing
3 644 Highlan ourt
P dale, C 3552
(66 304-3 6
914
Contraclor:
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers'C
Carrier:
Policy #:
c-39
3419
Architect /
Desiqner:
Address:ompens onl rance
s te Com
3-0032s32
Expires: 03/01/2013
TMC Engineers lnc
Tien Chu, P.E.
9542 Pacific Ave
Anaheim, CA 92804
(714) 829'5{153
72324
Midway Arcs Architectural Servlces
Toby Nguyen
14832 Monroe Sttedt
Midway City, CA 92555
17141251.90
Engineer
Address
tion lnsurance Fur
Phone:
License #
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
Orozco. lvan
:rt::l;[\
Date: 08/30/2017
Oale. '1012412017
Dale: 1012412017
Subject to Field:
Misc. Receipl
l\4isc. Receipt
Misc. Receipt
0 77 760 02
0 77 7600 2
0 777600 2
08907007
0 777600 2
07776002
o7776002
57607
53 600
57770
240 00
57672
57 600
s7507
Permit Fee
Plan Check Fee
[,licrofllm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Updale
lssuance
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#
69991
Total
$604.26
$375.00
$25.34
$0 72
$1 00
$21.25
$s2.98
$1,080.55
$375 00
s70s.55
Flood Zone Cert. Req'd: No
Every pemit issued shall become invahd unloss lhe wo* on the sile aulhonzed by
such pe nit is commenced wlhih 180 days aftet its i$suance,ot if the wotk authonzed
on the site by such pennit is suspendod or abandoned fot a peiod of180 days aftet
the time lhe work ts cofimenced
lnspector MtD# 20 t7-138003
01116002
01116002
01 1 16002
01116002
08901001
51600
51601
516'l 2
57770
24000
$2',1.25
$657.24
$1.00
$25.34
$0.72
Fee Total:
Paid to Date
Balance Due:
I
Occupancy:
Constr Type
Codei
Flood Zone.
# of Stories:
Phone:
License #:
SITE-WORK DATE ID/SIG.COMMENTS
Set Backs _.41\:,,-.\)wL
Forms/Steel/Holdowns r
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathing Llz, tii ,44tr4"cRM.Shear Wail 3,,/2,\li4 s n
Framing 319;llts v$b
lnsulation/Enerqy I t_(-P,
DgOrvall ^,)/ ')>-^ir ltEx7.ilnD-*h4 v Letu 415/R r4( rftz, 61
E6wn Coat qlxle W.+tCa-L,l
Masonry II
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
tl .. /r..
FINAL 1tu ilx wtrt4
Certificate of Occupancy I
Notes, Remarks, Etc
(I a
^t-^l .n l, ,1 .-^L ULl(5lt/ /'tt4i(l)/ l,baa worK hr', 5a" ,aarQ t a*efuH la#
BUILDING- INSPECTOR RECORD
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(.ONSTiT]CTI(TN I flIDINC AGENCY
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AIIIIIANLDECI.ASAIIq!
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I,4AYOR
MiguelA. Pulido
MAYOR PRO TEIV
Michele N4artinez
COUNCILMEMBERS
P. David Benavides
Vicenle Sarmiento
Jose Solorio
Sal Tinajero
Juan Villegas
Dear Property Owner
INTERIM CiTY I\,4ANAGER
Cynthia J. Kurtz
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNING & BUILDINC AGENCY
20 Civic Center Plaza
P.O. Box I 988 . Santa Ana. Califo-nia 92702
www.santa ana.oro oba
NOTICE TO PROPERTY OWNER
An application for a building permit has been submitted in your name listing yourself as the builder of the property
imorovements soecified at .,
^ozs
vtlR't aeclt fava ftNA (A Qztol
hourdo@sanla-3na oro
Mayor fto Tem Ward 2
mrmanrne:@sanla-ana oro Boono@sanla-ane oro
P Da,d Bonasdes
dbenav des@srnta'ana.oro !9X99?s@$da:a!!.0r9 slrruErolasanla'ana oro
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.
jLp t. t understand a frequent practice of unlicensed persons isto havethe property owner obtain an "Owner-Builder" building
permit that erroneously impliesthatthe property owner is providing hisorherown laborand material personally. l,asan Owner-
Builder, may be held liable and subject to serious llnancial 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.
& P z. I 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.
VIE t I undersland 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 hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
d ^J q. t understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
,D_P S. t understand if I employ or otheMise engage any persons, other than California licensed Contractors, and the total value of
my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an'employer" under state
and federal law.
ful/-A. I undersland 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
compensalion ofeach "employee." I also understand my failure to abide by these laws may subject me to serious Unancial risk.
-Q l'1. I understand under california Contraclors' 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.
O z L l understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held laable for any financial or'personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or
materials.
SANTA ANA CITY COUNCIL
vsamrenlooss.la-a.a oro
-*--N g I understand lmay obtarn more information regarding my obligalions as an "employer'from the lnlernal Revenue Service, the
United States Small Business Administration, the Califomia Department of Beneft Payments, and the Califomia Oivision of Industrial
Accidents. lalso understand lmaycontactthe California Contractors' State Liqense Board (CSLB) at 1-800-321-CSLB (2752) or
www.cslb.ca.oov for more information about licensed contractors.
a.t I O. 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 financiall res sible for proposed c onstructi at the followinpon
rl ('on activih Lloaddress:
4-u,,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.
)
t-UZ. I agree to notity the issuer of this form immediately of any additions, deletions, or changes to any of the information I have
provided on this form.
Licensed contraclors are regulated by laws designed to protect the public. lf you 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 is also important for you to understand that if an unlicensed
Contractor or employee of that individual or flrm 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 lheir 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 coDv of the proDertv owner's driver's license, form notarization. or other
verification acceptable to the aqency is required to be presented when lhe permit is issued lo verify the propeftv owner's
sionature,
Signature of Property Own
Print name of Owner ,
6
o"t, tol"3l11
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
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 o'^/ner's driver's license, form notarization, or other verification acceptable to the agency is required to
be presented when the permit is issued to verify the propetty owner's signature.
SANTA ANA CITY COUNCIL
moulrdo@sanla€na oro
Mard Pro Tem. Ward 2
mh3n'nez@sa.Ia ana do samientoAsarb ana do E AqOeSa!&:!!!_!!9 dbenaydesasa.ta-ana oro elleoas@sanb..na oro st,.a€roosanta ana orc
-z)
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Phone Number of Aulhorized Agent:
&