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Home My WebLink About40135098 - PermitCity of Santa Ana 20 Civic center Plaza (M-19), Santa Ana. c492702 Mechanica I Permit #: 4Ol35OgA Pin #: 19ll74Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 -h( Project Address: 2102 N Westwood Ave Unit: Block: NA Address Range: Hisloric: No Suite Range: Zoning: RlAssessor'sParcel: 001.162-21 Lot: 13 Owner: Address: Laurie Hampton 2lO2 N Westwood Ave Santa Ana, CA 92706 (714) 623-6433 0't't 16002 51604 01116002 51600 01116002 51604 01'116002 57770 Foe Type Decorative F/P - Gas General Plan Updale lssuance Microfilm Records Qty 2.00 1.00 1.00 1.00 Fee $12s.26 $23.79 $59.30 $4.05 Phone: Tâ‚¬nant Name: Ovrner-Builder Phone State Lic #: Lic Type: Bus Lic #: Workers' Compensation lnsurance: Carrier; Policy #: Expires: Building Use: Job Type: Nalure of Work: Slngle Family owelling Alteratlon Fireplace R-3, U va cMc 2019 Notes: Mechanical for (2) gas fireplaces Planning Conditions Planning Approval By Oate: Date: Date: 1111912020 Account# Misc. Rec6ipt: Misc. Raceipt: Mlsc. Receipt: Total PIan Checked By Permit lssued By subject to Field: Building Permit # Amsden, Julie 01103751 $212.40 Ewry pemit issued sholl becomo invalid unless tlre woar( on lre s/te autlloized by such permit is commenced within 360 days aflot its issuanc.â‚¬, ot il be wo* authotiled on tho site by such petmit is susponded ot abanfuned fgr a pedd of360 deys after the tirno the wo* is camrctl@d. ) lnspector MID#: 2020-158837 011'16002 51600 01116002 51604 01 1 16002 57770 $23.79 $184.56 $4.05 Fee Total: Paid to Date: Balance Due:i212 Bldg: Tracl:2977 Amount 62.63 23.79 59.30 4.05 Contraclor Address: Occupancy: Conslr Type Code: MECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNEX BUILDER DEI.CAiATIOII I h6d,, rrffi uor'6 lddry of !dj!"y rh, I E qcrorl 6!0 tlE coflnddr' Uc.M Lrp 6r fi. folbwios !!en (s*.?o:ll.t a6irs rrd Pre&sbo C.dc)r Ary Ciry or Couly wtict rlqunE . Ffri lo otutud. d6, inFow. &i'oli.h or E d d, n^dB.. 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I tldL fonn\ilh onpb snh tlo- FDviri6. $'ARNING lrailur. ro s-u. *0116' crrl lin6 up n, on. hun'jr.d lhoNnd l. ed JEll sbjdl M dploF ro 6im@l ,qEnb dd .on ot comp.drion. ddue6 6 FoviLd for lh. t(b t h6!t, .rm undc Fdq of Fiuy $, I h lica!.d @rb Fovtbn of cllala I (o.tl,!Ebs *nh s.dai ?0()0) ot Divitbt l ot tlr B{ixr !d Pbh*r Cod., r!.1 6, li.@ b i! tull &c td.f&d. Licru NuDhd sol6lauclloul.&lDllElclNcr I lElby.iftn u& Fqrly ol Fiury tl,. l}E! i. o.trrtl<rbn ladiiE.SG, for lll. Fe.l!re of E wl b. *nit lh. Fdr i is.d (Se. 309?. Civ. C.). AIIIICAUI.DIG!'IAIIO! I ha!6r.fE u& pary or Fi-, oE ot rlE bltNbs iktrriE: D@ohio. Pmn+Atbdoa Nodfrnbt r.&.1 R.SnhiB fliL a0, ?n6) -R.qsn!d Lrt-of Nodr.riE -l c6it rhd lh. Horl c8!lri.N nadb8 sb6rG r@\d & ml rpplE bL lo rltir Foi..r. ,tr cdiry rnd r hec rh. llE .torr infon'iiln ir c(ral. I .rrE ro @[Pl, *hh .ll Ciy r.d Couty on-.n{j hsc6\ iurhtri.rqn.sdndi\.a ofrhh ( 'lv lnd (irutrrl ro dro uF)nrh. /.-4rqfP.t *"'ny'y'a Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnslalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release -Jr t^,IV FINAL Sltudl vru,ru \\4{J Notes, Remarks, Etc.I I I I .=l:- knd.it addra - --------r------ I I Planning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 (714) 647-5800 www.santa-ana.org APP-I3 CBC 2016 NOTICE TO PROPERW OWNER Dear Property Owner pplication for a building permit has been submitted in your name ified at 2/O Z- tt/ D./â‚¬<7Ato oO <Ail-Dn listinq yourself as the burlder of the property improvements A D,a' ?a2m LAna spec We are providing you wilh an OwnerBuilder Acknowledqment 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 owne r, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. JZ_l. t understand a frequent practice of unlicensed persons ls to have the property owner obtain an "Owner-Builder" build- ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious flnancial 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 prop- erty.il -L2 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. Al " 4.3 | understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potentlal financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. n /l-* , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. *LU. tunderstand if I employ or otheMise engage any persons, other than California licensed Contractors, and the total t'alue 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. nl .-(,r\ a. t understand if lam 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 com- pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious flnancial risk. .//l l. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential sfructures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- tors 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 -W. t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. /1 I -4./_9 I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser- viEe)he United States Small Business Administration, the California Department of Benefit Payments, and the California Divi- sion 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.qov for more information about licensed contractors. A,0. 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 and flnancially responsible for proposed construction activity at the following ad- dress: Lt o z ,L/ f./e</z..ooe Sm,nt Anto 1 1. 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 govern Owner-Bullders as well as employers. /2 -llS, ,agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I heve 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 tabl eto to the agency responsible for the ermit. A/ote: A copv of the propertv owner's driver's license, form notariza-p tion or other verification enc ls re uired to be resented when the if is issued to the Signature of Property Ow Date. / Print name of Owner 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 notaization, or other verification acceptable to the agency is rc- quired to be presented when the permit is issued to verify the property owner's signature. Dropertv ow ne r's s i a n aty re. I