HomeMy WebLinkAbout101102804 - PermitCity of Santa Ana 20 Civic center Plaza (M-19), Santa Ana, cAg?702 Bu'lding
Permit Counter. (714) 647-5800 lnspectron Requests: (714) 667-2738 lnspector Section (714) 647-5853
Permit #: lOl{O28O4
Pin #: 98239
1.r
Proiect Address: 2727 S Susan St
Assessor's Parcel 414-121-OA Lot POR 2
Unit Bldg. Address Range Suite Range:
Zoning: M1Block NA Tract 1013 Hislonc No
Buildrng Use Commercial Occupancy: B, S-1 l st FL Area Patio:
Job Type Altoration Constr Type: lll B, SPK 2nd FL Area: T.t.Area:
Nature of work ln-Fill Doors/lnterior oemo/Remove code cBc 2019 other Areas: yards Req.d
Existing Bldg & Use: Comm/Whse Flood Zone: X-0602320258J Garage Area. Valuation:
Proposed User vacant # of Stories: 1 ,ot"l, O
Description of Work: Dsmolish interior partition walls/restrooms within existing warehouse & offices. Remove unpermitt6d exterior shed.
Planning Conditions:
$40,000.00
Owner
Address
Phonel
Tenanl
DANNY BARKHO
91,I4 ADAMS AVENUE, #208
Huntington Beach, cA 92646
(714) 785-6696
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic *:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Engineer
Address:
Phone
License #
Architecl /
Desiqner:
Address:
Phoner
License #
BAM ARCHITECTURE STUOIO
VERONII(A FERNANOEZ
453 S SPRING STREET, #408
Los Angeles, CA 90013
(929) 999-5279
Plannrng Approval
Plan Checked By:
Permit lssued By:
NPDES lnsp Req'd
PWA lnsp. Req'd:
Planning lnsp Req'd
a, Jerry
o Anson
Brodowski, Teri
No
Dale. 0211212020 Misc. Receipt
Dale. 0211812020 Mrsc. Receipt
Oate O2l2Ot2O2O Misc. Receipt
Subject to Field:
73999
Total
0 7 7 76002
017 760 02
07776002
07776002
01776002
0 7 7 76002
57601
si600
57770
57672
57600
57601
$499.59
$692 61
$27 .37
$2 00
$22.95
$57 20
$1,301 72
$692 61
$609.11
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuanceNo
No
Fare lnsp. Req'dl
Police lnsp. Req'd
No
No Account#
01 1 16002
01116002
01'116002
01 1 16002
Landscaping lnsp. Req'd: No Flood zone Cert. Req'd: No
Every pemit issuod sha becofie invalid unless the worl on the slle authorued by
such pertuil ts cgmmenced w1lhtn360 days after ls tssuanco or if the wo* aulhonzed
on the s e by such perml B suspenclecl ot abandoneat [o. a penod ot360 days afto(
the lfie lhe wo* is commencecl
$556 79
$2 00
$27 .37
lnspector MID#: 2020-156998
51600
51601
51612
57770 Fee Total.
Paid to Date:
Ealance Due
Contractor
Address:
BUILDING- INSPECTOR RECORD
SITE.WORK ID/SIG.COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathinq
Shear Wall
Framino 'a- 1 - ?.-r >fr4+z
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Ivlasonry
Pool Fence
T-Bar
Handicap Req.
Deputv Final Report
Enoineer Final Report
Flood Zone Certil.
FINAL 7- l-zr 14..4{.
Certificate of Occupancy
Notes, Remarks, Etc
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2 Z 762o
liev. u8{7-2015
DATE
I
I
APP-13 CBC 2016
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a buildi ng p ermit has been submitted in ur nameyo isting yourself as the builder of the property improvements
specifled at
We are provrding 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 pnor approval of the permittang authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this infotmation.
Dfl 1 | understand a frequent practice of unlicensed persons is to have the prope(y 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 subiect to serious financial 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 in.iuries to workers on my prop-
erty.
\y< Z. t understand building permits are not required to be signed by prope(y owners unless they are responsible for the
conskuction and are not hiring a licensed Contractor to assume this responsibility.
Sh g. f understand as an "Owner-Builder" lam the responsible party of record on the permat. I undersland that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
!L, , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and conlracts.
h.b S. f 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 (9500), including labor and materials, I may be considered an
'employer" under state and federal law.
bB-U
'
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' 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.
\h-,
'
understand under California Contractors' State License Law, an Owner-Builder who builds sangle-family residential
structures cannot legally build them with the antent 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.
Vr. tunderstand 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 injufles sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
Planning & Euilding Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
santa Ana, cA 92702
(714) 647-s800
www.santa-ana.org
Vg. lunoterstand I may obtain more information regarding my obligations as an "employei'from the lnternal Revenue Ser-
vice, the Uniied 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.qov for more information about licensed contractors.
H)rO 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:
il$ f f . 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-Builders as well as employers.
DhlZ. I agree to notify the issuer of this form immediately of any addltions, 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 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.
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. Arofe: A copv of the propertv owner's driver's license, form notariza-
tion, ot other verification acceDtable to the aqencv is requ ired to be oresented when the perrnit ,s ,ssued to verifv the
propertv owne r's sionatu re.
Signature of Property Ow ner
Print name of Owner rl C<
Excluding the Notice to Property Owner, the execution of whach 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 per1ury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy.
Property Ownels 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 rssued to verify the property owner's signature.
Date:
AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF
zl *