HomeMy WebLinkAbout101106116 - PermitProiect Address: 4713W Henderson Pl
Assessor's Parcel r 08-101-26
Unil Bldg: Address Range Suite Range:
Zoning: RlBlock NA Tract 1288 Historic: No
City of Santa Ana 20 Civic Center Plaza (M-19), Sanla Ana, cAg27o2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (7141667-2738 lnspector Section: (714) 647-5853
Permit#: tOl{06l{6
Pin #: 49054P\
Building Usel
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Owelling
Alteration
Windows
sfd
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories:
R-3, U
VB
cBc 2019
A-06023202s6J
Patio:
T.l.Areai
Yards Req'd:
Valuation:$3,500.00
Description of Work: Legalize windows changed out.
Planning Conditions:
Owner:
Address
Phone:
Tenant
Hanh Le
4713 W Henderson Pl
Santa Ana. CA 92704
(408) 431-8743
Contractor
Address:
Owner-Builder
Engineerl
Address
Phone:
State Lic :
Lic Typel
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Architect /
Desiqner:
Addressl
Phone:
License #
Phone:
License #
Planning Approval By:
Plan Checked Bv:
Permrt lssued av, ( *
NPDES lnsp. Req'd ( '
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
lnspector
Gomez. Pedro
Amsden, Julie
Dale 0311212021
Datel
Oale: 03112J2021
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc Receipt
o 7 7 76002
07776002
07776002
07776002
07776002
5760 7
57770
57672
57600
5760 7
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$172.64
$4.05
$1.00
$23.79
$59.30No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
No
No Account#
Every perm issued shall become nvalid unless lhe wor* on lhe silo aulhonzed by
such pe nil is comtuenced w hin 360 days aftet s tssuance,ot I lhe wgt* aulhonzed
on the site by such permit is suspended ot abandoned fot a peiod 01360 days after
the time the wo* ts commenced.
01116002 51600
01116002 51601
01116002 51612
01116002 s7770
$23.79
$231.94
$1.00
$4.05 Fee Total:
Paid lo Date:
Balance Due:
s260.78
$0.00
$260.78
Lot 5
'I st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total;
Total
MtD#. 2021-164842
BUILDING- INSPECTOB RECORD
SITE-WORK DATE ID/SIG.COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
SLAB Floor
Rool Sheathinq
Shear Wall
Framino
lnsulation/Energy
Drywall
Brown Coal
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Beport
Enqineer Final Report
Flood Zone Certil.
t, I
FINAL lll
Certif icate ot Occupancy
Notes, Remarks, Etc
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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-13 CBC 2016
Dear Property Owner:
An applicati
specified at
on for a buildin g perm t has een submitt
NOTICE TO PROPERTY OWNER
In yo ur na e listing yourse lf as the builder of the property improvementS)7c'A
We are providing you with an Owner-Builder Acknowledqment and lnformation Veriflcation 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information
4 L f f understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build-
irig 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 inluries 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.
4-LZ. t 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.
4tI 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 hiring a licensed Conkactor and having the permit filed in his or her name instead of my
own.
-ll-l--0. f understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
.rl't- S. t understand if l employ or otherwise 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
"employei' under state and federal law.
xlll\--6. Iunderstand rf Iam considered an "employer" understate and Federal law, I must register with the state and federal
-government,
withhold payroll taxes, provide workeri' compensation disabality insurance, and c6ntribute to unemployment com-
pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
-llLZ. f understand under California Contractors' State License Law, an Owner-Builder who builds single{amily residential
structures 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.
jd!=
'
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.
$---g. t understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser-
vice, the 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 (27521 or www.cslb.ca.qov for more information about licensed contractors
ttL-10. 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 financially responsible for proposed construction activity at the following ad-
dress:
t1L- f .l agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner-Builders as well as employers.
#lrn.l 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 rs 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 pe rmit. /Voter A copv of the Dropeftv owner's driver's license, form notariza-
Signature of Property Owner Date l)Ll
Print name of Owner -XrAt\I+LE-
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 ption of Work)
Project Location or Address
Address of Authorized e nt;
Phone Number of Au orized Agent
I declare under
information and
alty of perjury that I am the pro and I personally filled out the above
rtify its accuracy
Property ner 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 re-
quired to be presented when the permit is issued to verify the property owner's signature.
owner for the address listed a
Drooeftv owner's siqnature.A
Name of Authorized Agent:
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