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Home My WebLink About20166421 - Permit20 Civic Center Plaza (M-19), Santa Ana, C492702 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Electrical Permit #: 2fJ166421 Pin #: 60338 City of Santa Ana Permit Counter: (714) 647-5800 ProjectAddress: 1901 S Evergreen St AssessolsParcel: 014-245-02 Lot. 19 Unit: Block: NA Bldg: Tract: 3594 Address Range: Historic: No Suite Range: Zoning: R3 E Owner: Address Phone. Tenant Name: Contractor Address: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: Fee Type Amount 125 Volt Receptacle 1.45 Light Switches, Occ. Se 1.58 Spec. R/w Per 100' 24.79 NIin Fee Adj 14.85 General Plan Update 22.08 lssuance 55.04 Donold l1onthrs Botch+:4.(814 - 7/16/?018 I0: CCUE|-LARoffice: CIYB Tnonsi: 107 I of 1Acct+: Refi: 20166421 Rcpti:02325828 - 7/16/201& 2.16 Pn Tronsact ion Totol t I Ftl .50 Donald Manthry 11509 Aquamarine St Fountain Valley, CA 927082501 (7',t41418-3545 Owner-Builder 01 1 16002 01 1 16002 0'r 1 16002 01 1 16002 01 1 16002 01 1 16002 5160: 51603 5160: 51603 5160C 51603 Fee $29.00 $4.74 $24.79 $14.85 $22.08 $s5.04 Genarol Plon lhdste Fee 01116002- 51600000- Electr ical 0l1l6m2- 51603000- Viso CCi : rrrr*I*i*rr*54.(9 _ 9,J.7 " t.t?) _ $ 1?S.4? 1150. 5[ Auth+ ! I l6:i4C Planning Condilions Planning Approval By: Plan Checked By: Permit lssued By: Subject to Field: Building Permit #: $n"rn"no"r, xrtny Date: Date: Date: Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Triplex Miscellaneous Electrical Occupancy: Constr Type: Code: U, R-l N/A cEc 2016 07116t2018 Account# $22.O8 $128.42 $150.50 $0.00 $150.50 Every pefinit issued shall become invalid unless the work on the slle aulhoized by such permit is cofifienced wilhin 1 80 days after its issuance, or il the wotu aulhorized on lhe site by such pemit is suspended or abandoned fot a period of 180 days after the time the wotu is commenced lnspector MID#: 2018-144659 01 1 16002 51600 0'1 116002 51603 Fee Total Paid to Date; Balance Due; Qty 20.00 3.00 1.00 1.00 't.00 1 .00 Phone: Building Use: Job Type: Nature of Work: Notes: ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground 7-21-lg v.v*a) Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Lite Satety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFEB Transformers Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilinqs (Hard & Soflit Rouoh Ceilings (T-Bar Rough) ,/a--\ Rough 7-z+.-lI \.vL1*)) Service Ir/eter \< FINAL 7.-zr-ly )t"wtJ Notes, Remarks, Etc.\_-/ OWNER BUILDER DEI,CARATION I hcrchy ufirm undcr pcnalry ol Erjury lhal I !n cxenu ircm lhc Conlraclor' I-t n$ hw l;r rh. rollowing raion (5(.7011.5 Burincs lrn Aoaâ‚¬sion Codc): Any Cn, or Couhry which rcqut$ a pcmrir b c,nsr d. alrd. i.rr.ovc, dcnnlnh o, rct{t dn, $tu.rfiu. rritrb ns is\u!tu.. rho mquircs rh.nmli.anr rd sn.hFmI ro filc n siSncd srkrrcn' rh,i hcorsh. n liccnsd punuMt ro Ihc fmvkions of rhc Conxrcln s t-iccnscd L0* (Chaprer 9, Commencins wirh Sccrion T()Oi) of Divi\ion -l orrh. Bu\in.s rnd PmfcssionsCodc)orrhor trorsic i\ cicnfl rhcrcfromrnd thc hash l'or rhc alle-ged crcmprion. Any viotlrionorSerknTosl J byany rppli.lnr lor a pcmrir srhj$t rhc rptli.rnr b rcivilrctuhyDfnor tux. rhM fiv. hrndrcd dollrs (S50O) -1..\ owrcroflhc pmlrn]. or nr, cmploycc\ wirh wagcs as lhcir $lc conrpcnsrlion. willdo Ihc w.rk dxl thc srruturc is nol irlcri.d or !flcrd tu slc i S( ?044, Busirc$ ,nd Prordsio s Codc Thc Co.rrdois Liccnr L4q docs nor lplly ro u oNncr oa rhc pmpcny who builds.r inrroE rlErcn. ui sho dms such sorl him\clfor hcrsclfor rhmuEh hh or h$ o*n cnployccs. providcd rh.r such nnlrov.mnF N nor intRL\l or oficBl for st l( ln'swr. rn t[ i*liq or i'rgm,ecmnr iq r,ld wirhir orE )qt of.om.rirn.rhcowNrBuih$willhrEthchunlctroiln)vn,Brharhcorsh.dilmtttrildorimpmvcrhcpmltnyforrt Inqil{or l. r\ ovnn.rrhc Imrdy. ancxclusivclyconn ring *irh lic.ns.d conr.ctor roconnfld lhc pr.j.rr (Scc ?(!4. B!\urcss rnd h.fc$hn Codc lhcConrracloasLiccn\c La* docs nolapplllo!nosner.apbr. yqho boildsor impii,vcs rhcrcon. itrd who.onrmrsrdsuchpn+dswnhaConhcro(s)liccns.nNNitrrrothcConlracrolsLi.enscLa*) ?c,/{ DECIIIIA.IIIIN I hcrcby lffirm undcr Fnohy of pcrjury orc ot lhc lolloBing dccllBl ions: -lhrwandwiumi dnnccnnicrlcofconscnrbSclf.lnsurcforworknscompctrsrion.asrmvidcdr'orbySccrnrnITOOolrhc t [or Gdc. r.. rhc lcdolr1M. of fic ]brk ror which rh. pdmir i! i*su.d. _l holc rnd will nrainloia wortc^ compensation insuEncc, us rcquiEd bySdbn l70O.rrhc tjb.r Codc. ior thc p.rformmc ol' thc Nork for whkh lhn p.mit is n$cd. My sorkc6' .omrcnsarion inslratuc csi( ,rd Flk, ntrnb.r m -l ccrlily rhil in Ihc l.rlornrer ofrh. w.rl tn which rhis Fnnir is i\sucd. l \h.llnor cmfloy lny pcmon in.ny rooncr $ ,rt,ls.nr slbrcd ro rh. *o.rcn ompcnqrion hws of aalirornir, daaEcrhrr ilI sh.uld hccoB subjcd rothc work.s.ompcnc iontrcrisionso{Scclionl70ootth.trhtrCod.,Irlmll,fonh!irhomply*irhrho*Dn,vnn,N.. WARNINGT rarlurc tu w!,c $orkc6 co.rFnsurion mvcBsc is unhwful. and nhll subli nn ohpk ru u aimin0l,tMltas and civil finc\ u! lo om hundrcd lfiolsrnd dollar (i100.(t)O), in addirioo 'o rh..oi or co'npcnsalion. domscs !s plovacd aor rhc Scc'iun.1076ollhc tr6o! 4oJc. io'urcduJ u "tr.!'\ r.r\ ,,,". ) /r fu/u "/ k no,,,-*A /4 .,*4L Lt( F(\Fn ( (|N',l',R CfoR DECT.AaAIIaN I hcal,y dlrm undcr pcnslryofn rjury rh0r I tr.r l,.cn*lundc. pmvhion ofChaplcr 9lcommrcitrB wilh Scdn,n'7000) orDivilion l of lhc Businc$ md Pmtcssions Code, ard o, li.cnc is in tull fo@ ad .firr. AIILTANfDECLAAAIPN I hdrt'yaJfrnrndfi F.n y ofFrjury om ollhc followinS d(lmtions Dclmlition Pcrnils'Asbcsros Norificarion F.dcrsl R.sullrioos(Tirlc40. Pnn6) -Rcquncd Lâ‚¬ttcr olNorifi dion I ccdiry rhilh. r.dc.al Egul,rio.s rglrdin8 asbcsros r.mvd 0rc m' lrplicahle ro lht p,oi{r -l cdrily lhol I Mvc rc$d thk lpllnrrn,n anl ddc rhar rhc uh,vc nrioruridr i\.odccr. I iSre ro.omplywirh aU CU lnd Counry onlinrncc\ md Starc tiws rcbr ins x, hu ildins con{rucrio!, orn herchy aurlxtri2e Eprs.iorilt\ ,,r rhi\ Ciryud(t,untyh cnlc, rlili rlt fto\c rnrn,.d /op.nylnr i.sF{(iotr purposcs. A0dicn t.r Asol Silnnluft z/ze4aâ‚¬ IMeter Release g}NIIAICIIONIENIIIIIG-AGEICI I h.rcby lrfiro.lnd$ Fnalty or Frjury rhd llrcrc n r oNlruct k n hndin8 a8crcy tor rhc r.rfomte ot tli. wrt for *hih thn Fnil ir issucd (SE. 309?. Civ.C.). Lcndcr': Nrmc. - knd.r'( Addrrr I tt I MAYOR lMiguel A. Pulido IT4AYOR PRO TEI\,4 L4ichele l\.4artinez COUNCILMEI\4BERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDINC AGENCY 20 Civic Center Plaza P.O. Box I988 . Santa Ana, California 92702 www.santa-ana.org/pba 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 rmproveme cified at9i 4 S d a-.1 s 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 ACK NOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. &K 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 in.juries 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. 2. 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.0]-ILS I understand as an "Owner-Builder" I am the responsible pa(y of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contracior and having the permit filed in his or her name instead of my own. 0*r Pv 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nqmbers on permits and contracts. n) fr* S. I 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.A /n U 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' 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.Af t, t/7 lJy'11 I 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 SANTA ANA CITY COUNCIL mrurido@santa-ana oro Liaycr Pro Tem Ward 2 n man nez@sanla ana oro Vicenle Sarm ento 6armientorasanta-ana.oro P Davd Beralrdes dben3vaes@sa.1a-ana ors iv eoas@sania ana orc stinaiero@sa.1a-ana oro CI'TY [,4ANAGER Raul Godinez ll CITY ATTORNEY Sonia R. CaNalho CLERK OF THE COUNCIL lvlaria D. Huizar iso oao@sanla-ana oro 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. O7,/ru t 8. 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 owner(s) that result from any latent construction defects in the wo-ikmanship or materials.I L'v- LVG I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, 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 wvvw.cslb.ca.oov for more information about licensed contractors.6h- W'tO.l am aware of and consenl to an Owner-Builder building permit applied for in my name, and understand that I am the party lega ly nd financi respo nsible for proposed construction activ at the lowi s (,ca-z-address /,/z rZ-e,..c- fu,I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applica ble laws and requirements that govern Owner-Builders as well as employers .l%r t 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 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' 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. /Vote.'A coDv of the DroDertv wner's driver's license. form notarization, or other verification acceptable to aqencv is reouired to be presented when the Dermit is lssued fo the owner's sir nature. Signature of Property Owner Date .â‚¬"2- o le Print name of Owner D onu /c/fr7n p f/< o-z-. 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 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 verification acceptable to the agency is required lo be presented when the permit is issued to verify the property owner's signature. P i,'!'i-a il,r. nrjA.: f _,, :r.-rr:,iil i t!j:.: i ir .::i.ir t.:: 1,-, :! :': r a SANTA ANA CITY COUNCIL 6oulido@santa-a.a oro Vrce.te Sarmienlo vsamienlo@santa ana oro isoloro@san1a-ana oro P. Davd Benavides dbe.avides@san!a'ana.oro ivi eoasrosanta-ana oro slrna eroaosa.t.-ana oro Name of Authorized Agent: Mayor Pro Ten, Wa.d 2 nimartrnez@sa.la-a.a.oro