HomeMy WebLinkAbout102103580 - PermitProiect Address: 5026 W Fifth St
Assessor's Parcel 100-291-09 Lot: NA
Unit Bldg: Address Range Suite Rangel
Zoning: A1Block: NA Tract: NA Historicr No
city of Santa Ana 20 civic center Plaza (M-19), sanla Ana, cAg27o2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714])667-2738 lnspector Section: (714)647-5853
Permit#: lO2lO358O
Pin #: 85977rf\
Building Use: Single Family Dwelling Occupancy: R-3, U '1st FL Area Patio:
Job Type: Demolition Constr Type: V B 2nd FL Area T.l.Area:
Nature of Work: N/V-Demo code: CBC 2019 other Areas yards Req,d
Existing Bldg. & Use: SFD w/ att garage Flood Zone: A-0602320256J
Garage Area: Valuation: $1,000.00Proiosed Use: # of Stories:
Total
Oesc[iption of Work: Demo all un-permitted partition walls inside the home (first and second tloor) and all walls constructed around the open patio
cover, in order to return the patio cover to it's original approved design per Building Permit No '10141656).
ALL UN-PERMITTEO WORK TO BE REMOVED AND LAYOUT OF THE HOME TO RETURN TO ORIGINAL DESIGN Auth on file.
Planning Conditions:
O!vnel
Addressi
Phone:
Tenant
Ngoc Anh T Huynh
8900 Bolsa Ave #A
westminster, CA 92683
(714) 894{518
Owner-Builder
Engineer
Address
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsufance
Carrier:
Policy #:
Expires:
Phone:
License #
Oater 04113/2020
Date:
Darei 05/08/2020
Subject to Field:
Misc. Receipt
l\risc Receipt
Misc. Receipt
No
No
No
No
Total
57601
57770
5 7607
5760 7
57672
57600
57607
07776002
0777600 2
0 7776002
07776002
0 777600 2
07776002
o7776002
$166.53
$3.91
$100.57
$252.69
$1 .00
$57.20
Permil Fee
Microfilm Records
lnvestigalion
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
No
No Account#
Every pefinl issued shall become invahcl unless the wo* on the sile authorized by
such pemit is comfienced within 360 days after its issuance.or I the wo aulhorized
on the sile by such perfiil is suspencled ot abandoned fot a penod of360 days aftet
the lme the wo* is commenced
lnspector MID#: 2020-158600
011 16002 51600
01 1 16002 51601
011 16002 51612
011't6002 57770
$22 95
$576.99
$1.00
$3.91 Fee Total
Paid to Date:
Balance Due:
$604 85
$0.00
s604.8s
Contractor
Address:
Archilect /
Desiqner:
Address:
Phone.
License #:
Planning Approval By:
Plan Checked By:
Permil lssued By:
NPDES lnsp. Req'dl
PWA lnsp Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Orozco. lvan
Zuniga,nffi"s"(
BUILDING. INSPECTOR RECORD
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Framinq
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Drywall
Ext./lnt. Lath
Brown Coat
Nrasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif .
FINAL
Certificale ol Occupancy
Notes, Remarks, Etc.
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Flood Zon6 Certif.
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Notes, B€marks, Etc.
BUILDING- INSPECTOR RECORD
I
Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
wvrrw.santa-ana.org
APP.I] CBC 2016
Dear Property Owner:
An applicati
specified at
on for a building pe
LLi
NOTICE TO PROPERTY OWNER
rmit has been submitted in o r name listin you lf as the builder of the prope rty improvements
I a ct
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.
4lt-, I understand a frequent practice of unlicensed persons is 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. l, 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 provade 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.
-E-E-r. 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.
P-Y-! I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
fu-1. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
A H S. t 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 ($500), including labor and materials, I may be considered an
"employe/' under state and federal law.
Alt-A tunderstand if lam considered an "employea' under state and Federal law, lmust register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com-
pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
0l l. I understand under California Contractors' State License Law, an Owner-Builder who builds singlejamily residential
structures cannot legally build them with the intent to offer them for sale, unless a/l work is performed by licensed subcontrac-
tors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract
with a licensed general building Contractor.
f y'-8 I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
cial or personal in.,uries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
B-g. I understand I may obtain more information regarding my obligations as an "employer'' from the lnternal Reveirue Ser-
vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California DivF
sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-
321-CSLB (2752) or www.cslb.ca.oov. for more information about licensed contractors.
A 4 f O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
!:gl"$trrrrTrS9llv4";co,''l'iole
for proposed construction activitv at the followins ad-
A ,1 ll.l 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-Builders as well as employers.
W12.1agree 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.
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 copv of the D.rooaftv ownar's drivefs licensa, form notariza-
tion. or other veritication acceptable to the aoencv is reouired to be presented when the permit is issued to verifv the
owner's si neture.e
agnature of Property Owner
l1
l, i 1 f),.,e Date /'7 202o
L
Print name of Owner
Scope of Construction Project (or Description of Work)
flL IU N
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 responsibilaty, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Builder
Permit for my project.
D tnuLL ;:, n pet n c7, ct' o/ rr, (t {n h'c,,
Proj ectLocationorAddress: 502L LU </AsL N.r+rbr.ilc:Lin., B J+,t-taAnct^ CALI)toe
Name of Authorized Ag
-)
ent, .THOi J-HANH VO nHIS AS.5/GNEF-
Address of Authorized Ag ent:{D26 tr/<7hsL Sct,'in Anc,(-t1 427 b1
Phone Number of Authorized Agent:'7/tl- 7ZC- Oi ) 1 ?L 7/ t1 -fiz. 2oO/
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 accurac
\
1
I6Property Owner's Signature
Print Name of Owner:
,l
H THI H\-'
Dale O z
A/
Note: A copy of the owner's driver's llcense, 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.
Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a
license, the Conkactors' State License Board may be unable to assist you with any flnancial 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.
1
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