HomeMy WebLinkAbout30440961 - Permitcity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA,27O2 Plumbing
Permit Counter: (714) &47-5800 lnspection Requests: (714) 667-2738 lnspector Section: O14) 647-5853
Permit #: 30114096{
Pin #: 38662
l
Project Address: 1125 E Seventeenth St un1: E-l06 Bldg: Address Range:
Tract: A.B. CHAPMAN Historic: NoAssessor'sParcel 396-172-17 Lot POR G.L. RUSSE Block A
Owner:
Address
Phone:
Tanant Name:
Contractor
Address:
North Park Plaza Llc
I125 E 17TH ST N559
Santa Ana, CA 927012265
(818) 974-5097
Anaya Medlcal Center
Owner-Builder
01 1 16002 5160i
01116002 51502
01 1 16002 5160i
01116002 5160C
011 16002 5160t
Amount
14.22
12.70
243.16
22.O8
55.04
Fee Type
Water Closet
Sink
Penalty
General Plan Update
lssuance
Qty
't.00
1 .00
1.00
1.00
1.00
Foe
$14.22
$12.70
$243.'t6
$22.08
$55.04
Phone
State Lic #:
Lic Typel
Bus. Lic #:
workers' Compensalion lnsurance:
Caffie(
Policy #:
Expires:
Building Use:
Job Type:
Nature ot Work:
Planning Condilions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permil #:
Commercial
Altoratlon
Slnk/Water Clo8et
B
VB
cPc 2016
Occupancy;
Constr Type:
Code:
Misc. Receipt:
Misc. Receipt;
Misc. Receipt:
Total
Ewry pemit issued shell bo@rno invahd unlass tlra worr( oa, l,l€ srre
authonzed by such pamit is cgmmenced withh 360 days afrat ts
issuance, ot il the work authonzed on tha sile by such pemtt ts suspended
ot abandoned fot a Ndod ol360 days afret the tirne the wo is
cgmnatEcd
05t2412019
Account#
Notes: Direct change out 3ink and water closet in exisllng
restroom. Auth on file.
$347 .20
$0 00
13/7.20
lnspeclor MID#: 2019-15'1711
$22.08
$325 12
Fee Total
Paid to Date:
Balanca Due:
Suite Range:
Zoning: P
tbate.
\V:::,Zuniga, Allissa
01 1 16002 51600
01 1 16002 51602
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG,COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
Area/Storm Drain
lnterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOUSPA
P{rap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing
Meter Release
FINAL 6-31?
Notes ,R emarks, Etc.t,
/Vd ar-iJt J ,.'a -/,-*!Ewh
OWNII IUILDET DEI'AI TION
I ffi,.rfr o,!&. Frly or F rry l. I & q.n+l tlo fi. Cdr'.!6 Li.rE tr trIIE I brlt l*,ls4.rl,!1.5
Buil5 rd PD&qn C.xL, Ary ciy c Cddy rhih Eq',c r Fir b 6'rn!i .rd. iivrova .laDlii a rqri -y*!.rL!, FEb l] (!E,.ro E$iE rb. !?lird tu sh Fir t. 6L. r{r..1flaH tlr lEa ir i l.!r.d F,rEr
b rlE FDw-, of UE Codftd r Lid!.{ t r (Ct4rd 9, Cffirl. ,an Satnr rO(, of Dirinoi I of tlE Bu,llE .r{
PreFsi,B Cr'&l or drr L rlt.. d.rqr rhdtndr d rlE t-il6. r!..lLt d.e4.e An, vi.hri,n ots<rm,01L b, s,
+ddn &.. Fid &bldr dE .o'ldd ro ..ivil!.rty otmr lle thr lirc hl.dtld.bU-' (1500).
_1. s orE of E FFrt. tr 6y .trplrF. rnh e86 6 rlF nL or+drdn[ will <h UE Errl rd ft r.!e . r*
i,rdxt d o oFd.d fr .k (Sd 7oaa. 8!!!,6 -!d Pofqri.B Cod.r 'l li Coiti.crd r LiBi bw &H ,bl t00ly L D otu ol
rlE FFny slD hiltr or rtn'G tlEsl\ !d wlb.tn rdr s"l hrd.lfor h. lftr lllsud nir n hd oh irrhyc.r.
phvit d$d ch anrrE .dr e mt i,uEr.Ld no&nd 6..L 1( hor.E. rlE l,ihhs or urr'ffid it hld si$h or Frof6,iLriol| th.oDG Brilld qn ll'EitE tioil,oflmqru ds lr6.dE dd mt hild inFE dE p6Fny t'r tlt plrF*ol
_1, d .16 df rlE lniEry. e cr.lu'Ely L$,r.rdinB s.h lrnEn
!d PDtsin Cod.: Tlr Colrn.id r Limr L,y.ls lEl .Ely lo r @c of
.rld rlb @ Elr tr Gi FFNnh . Co,ido(il I'c.Ed F,un kl rh.
--rlz t/a"Q
I lEEby .mm un&r Fmlly of FJu4 oE .f ll: ftrlk!*'n8
_I hrk -d qnl mifi.r ! Cdf.rt. .f C.c
'o
S.l
t4.r Cdd.. tirr rlE tdhll]m. .l rlE eo* lor *,if,h E
I \o'lt.r3 (trnrn$ri.n rs nrn .(l lnr h,"\rrr({ lrrxr Ir1'.
I h.v. .nd vrll nshtlh B0*6r conqENlnon iNEm.. !r r.qur.n hvsdr!'nlr7fi)ofrh.l,n r coi., tu rh. n-fomN. of
lh. rort llr qhtrh rh! Fmrr ! rrEd My ert6 6rrE .lnn rmrd. clrK di,$lq nuoh.r R:
Polry NelEr_Lrpm
_l d,f, ihd
'n
0E FrlmN of
'h.
rort tr rh.t nFDi sr{I trll ml dr"l'y D, Fnn o ey nDE
n d ro h.@r {bi< o d. qrtdr onp.r! t{ hsof C.l'tl r.i.ar.rL'fItDrLlbdre Ei onl.rrrm pr.sm of s.d6 !7m 6f ir t bor Cod.,I lil tnhdi etrFly rrn
cril firr rD rn.E hund.d rhrulnd &nlc (!llx)
,.n,t9/zt)a.tQ777
I h.aby n,Im und.r FrL, of Frny lhi I m oach.rra 9loffims *irh s..rb. nml nf D'!$on l
of rh. 8$16.ad Pbarnm c.d., !n Dy l.G 6 r tull
Li..e NlnLr
colslf,lcllo!.lJlulc-AcElcr
I h.rlt .lIm ud.r Frlry of Frjury ti Ocr i. . oorru.rm t rdrt .t*y tu llr ,Et!ffi oftlt @* tti tl'ah rhn Fn. .
n{.d lsa. log?. Cit. C I
arr rcr{r nfar ltarloN
I Ht.em un kr Frliy otFqry rE of rlr tllbrinr {k lri.d
D.mfuno Pdor]Art io fiorif.lbo F.d..l i.Subliod CtrL to, far6,
-R.$rEd
lrfidoltr i6.re
-l
ctnrfy rh. iE f.d.nl qrldiD ESrn$! lddd ,tmvd R d
-l
6rit rlE! I LE ad rhr .E{rdrn rn rll. di.l rh. .tnE intr co,nnl\ tril'nl( f\ rl Ltrtri\
6rd'BE6 !d Sr.t. L.*! Et rt ro hlld'ig on{ndmr -d hddiy.Nrlfrh'rC y.d Cour y ro .rxs uFn r,!
.hnr lhli.*d nftD.ny f.r
appll.tnr or A*.nr sllh.o.,. i// z /// 1: t/pr.t,&^fa slfozAl4
A)ctL f4 y'A4 a< t
Water Service
Final Gas Test
il
I
fulqolot
[,AYOR
i,4iguel A. Pulido
MAYOR PRO TEIV
N4ichele lvlartinez
COUNCILl\,llEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorao
SalTinajero
Juan Villegas CITY OF SANTA ANA
PLANNING & BUILDINC ACENCY
20 Civic Center Plaza
P.O. Box I988 . Sanra 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 o.f the property
imfiovements soecif ied atJ i",iZ t-tr( Ar trLs e . tz/h sre-ee r sa^.,ra .a ^ ca 927" I
We are providing you wlth an OwnerBuilder Acknowledqment and lnformation Verlfication 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 lorm 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 ACKNOWLEOGMENT AND VERIFICATION OF INFORMATON
DIBECTIONS: Read and initial each statement below to signity you understand or verity this intormation.
/l-ft 1. I understand a lrequent practice of unlicensed persons ls to have the property owner obtain an "Owner-Buildei'' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. l,
as an OwnerBuilder, 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\ily homeownels insurance may not provide coverage for
those in.iuries. 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.
7 7 ) Z. I understand building permits are not required to be signed by property owners unless they are responsible lor' the construction and are not hiring a licensed Contractor to assume this responsibility.
///i)_3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may
prolect myself lrom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name
instead of my own.
,u_zt_4. I understand Confactors are required by law to be licensed and bonded in California and to list their license/ riurhbers on permits and contracts.
5. I understand il 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
"employel' under state and federal law.
,/, Z)_6. 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 disabllity 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.
,.1 -/_J_7. 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 oller them for sale, unless a//work is performed by
CITY MANAGER
Raul Godinez ll
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
I/aria D. Huizar
moul do@sanla.ana.oro
Mayor Pro Tem, Ward 2
rolEanEg@saBa:alg
vicenre Sa.mlento
vsarmierto@sanla-a.a.oro isolgri9@sada:ala dbenavides@sanra ana oro iv lleoas@santa-ana.oro siriaero@santa a.a oro
SANTA ANA CITY COUNCIL
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'
/,, 8. I understand as an OwnerBuilder if I sell the property for which this permit is issued, I may be held liable for any
finanbial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
.,., f " g. 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 Californra Department of Benefit Payments, and the
California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board
(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.
/ 7)1 O. I am aware o{ and consent to an Owner-Builder building permit applied for in my name, and understand that I am
the part ally and {inancially responsible for propose dco nstruction actlvity at the following
addr tl z 5 lb5i/t7E Eta6 *J
t! l l ll.l agree that, as the party legally and financially responsible for this proposed conslruction activity, I will abide by
all applicable laws and requirements that govern Owner-Builders as well as employers.
/t:-L12.1 agree to notify the issuer of this f orm immediately ol any addilions, 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 clvil court. lt is also important for
you io 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
relurned lo the agency responsible Ior issuing t t. /Vo A coDv of Drolrerlv owner's driver's liccnse.
n her verification a ,s ired when the
issued to ownef's n
Date 5 .20ztSignature of Property Owne
Print name ol Owner TAca! SHo/Llbt ft.r,
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibilily, I hereby authorize the
following person(s) to act as my agent(s) to apply for, sign, and lile the documents necessary to obtain an Owner Builder Permit ior my
project.
Scope of Construction Project (or Description oJ Work)
Prolect Location or Address
Name ot Authorized Agent
Address of Authorized Agent:-
Phone Number of Authorized Agent
I declare under penally ol perjury that I am the property owner for the address listed above and I personally Iilled out the above
information and certify its accuracy.
Property Owner's Signature Date
Print Name of Owner
Note: A copy of the owner's drivet's license,lorm notarization, or other ve tication acceptable to the agency is required to
be presented when the permit is issued to verily the propetty owner's signature.
SANTA ANA CITY COUNCIL
mo!lido@santa.ana.oro
N,layor Pro Tem. Ward 2
m man nez@sanla ana oro vsarm enlo@sanla.an a oro i&lqie@s!!la:3!3.p!c
P Davd B-anavdes
dhelavide!@sad!:elaqc ivilgla!@!3!l&a!eer!srrraiero@santa'ana.oro