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Home My WebLink About101107458 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, cAg27o2 Building Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit#: {O{{07458 Pin #: {6E35vProject Address: 2005 S Forest Ave Assessor's Parcel 408-35241 Lot: 73 Unit Bldgr Address Range:Suile Range: Zoning: RlElock NA Tract: 4402 Historic: No Bualding Use: Single Family Dwelting Occupancy: R-3, U 1st FL Area Patio: Job Type: Reroof Constr Type: V B 2nd FL Area T.l.Area: Nature ofwork: Reroof Code: CBC 2019 other Areas: yards Req,d Existing Bldg. & Use: Sfd watt garage Flood zone: x-o6o232o257 J Garage Area vatuation: ,5,ooo.oo Proposed Use: # of Stories: Totat Description of Work: Reroof house & attached garags - remove comp shingles, rsplace any damaged sheathing, install new comp shingles. Handoute given. Planning Conditions: Owner: Address Phone: Tenant RAMON GAYTAN 2005 S Forest Ave Santa Ana, CA 92704 17141308-1477 Contractor: Address Owner-Builder Engineer Address Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: Architect / Designer: Addressl Phone: License #: Phone: License # Planning Approval By: Plan Checked By: Permit lssued By: ( NPDES lnsp. Req'd: PWA lnsp Req'd: Planning lnsp Req'd: lvlartin, Eric Amsden, Julie Date: 08/09/202'l Date: Date: 08/09/202'l Subject to Field: Misc. Receipt Misc Receipt Misc. Receipt o777600 2 0777600 2 0 777600 2 o 717500 2 0 777600 2 57607 57770 57672 57600 57601 Permit Fee Microfilm Records Bldg. Stds. Revolving General Plan Update lssuance $345.28 $4.05 $1.00 $23.79 $59.30No No No No Fire lnsp. Req'd: Police lnsp. Req'd No No Account#Total Landscaping lnsp. Req'd Flood Zone Cert. Req'd: No Every pemt issued shall becomo invalid unless tl?e wo* on the site authonzed by such pennit is commerrced wihth 360 days aftea is issuance.ot tf lhe wotl< authonzed on the site by such pernit is suspended ot abandoned tot a period ot 360 days aftet the time the wotk ts commencod $433.42 $o 00 $433.42 lnspector MID#: 2021-167890 0l 't 16002 51600 01116002 51601 0't 1 16002 51612 01116002 57770 $23.79 $404 58 $1.00 $4.05 Fee Total Paid to Date: Balance Oue: BUILDING- INSPECTOR RECORD DATE ID/SIG.COMMENTS OWNET BUILDER DELCIARATION I trrhy rlftrn ud( Folr, (f f.qury rh.r I d.rn{, rtum rh. Codrd'oB l-..nr tiw lor rlE lolhrint Elqr lS& ro1l.5 ausircss !d ftorcssbfl Cdo Any Cny or Cddy whth Equncs r Imr lo onrlMl. rlIg- nr{)mt. &mlirh or Eprn otry netw. rir to ir\ isuac, ds Eqri6 rh. +r,lta ror *n |.mi b filc ! risrd idrft thd hc or rlE i lKn<rl |luNnr ro rlE F.yisi)ns or lh. cl'nr*lm'r Liusn L.* (Chaptcr 9. C.,llmrcrns w h SsrEn 7Ix) ot Divi.ro. 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I FINAL Q -70-A \w\t) Cerliricate of Occupancy Notes, Remarks, Etc ?Van SITE.WORK I Planning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 (714) 647-s800 www.santaâ‚¬na,org APP-'13 CBC 2016 NOTICE TO PROPERTY OWNER Dear Property Owner An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at <?Zzo< 5 FaAgff 4L/ c4^/j'4 r7..\/.1 We are providing you with an Owner-Builder Acknowledoment 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 untjl you have read, initialed your understanding of each provision, signed, and returned this form to us at our otflcial 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 AN D VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. I C- l. t 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 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 injuries to workers on my prop- erty. E-Q 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 llcensed Contractor to assume thas responsibility. &G_Z 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 financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. /Z_C_4. I understand Contractors are required by law to be licensed and bonded in Californra and to list their license numbers on permits and contracts. Be_s I understand if I employ or otheMise 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 "employei' under state and federal law. 4.9_e t 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. l<G 7. I understand underCalifornia Contractors' State License Law, an Owner-Builder who builds single-family 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. P_G_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 injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. _9. I understand I may obtain more anformation regarding my obligations as an "employer" from the lnternal Revenue Ser- vice. the United States Small Business Administration, the Caljfornia 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.oov for more information about licensed contractors. _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. 2aa < ,t Ua/zEs /- 4 l,/ tZ r., 12. I aqree 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 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 wlsh 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 permit. /Vote.' A copv of the prope,tv owner's driver's license, form notariza- tion, or other verification acceptable to the aqency is required to be presented when the permit is issued fo verifv the Signature of Property Owner Date ZIQ -cl - 2c- 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 Proj ription of Work) Project Location or Address Namâ‚¬ of Authorized Agent Address of Authorized Agent: Phone Number of Authoriz I declare under penalty m the property owner the addr sted above and I personally filled out the above information and certify Property Owner'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. Agent f perjury that ts accu R_e_11. I 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. propeftv owner's sionatu re. e ffi= -u 0) L/ ) b- Irl --rJJ c.r >iD 1rb ilc)s.o I U iL e ct rD ) o o: -o ol 1' i-r-(r- -' ]l' ''ole -lo = lur -ri-r,lt^,,n Ies ftt-r> l.! lJ\.H I -o :1 =' l(, ID 1) -o -l oi :)o ool l) c> r :) J- tu ) ,t ii i, ri l.' (t I ,]o a ! t : g_ :, L! ; \J (/ J' 6o o' t fc o .J i\- i\ I F; :'. , ! \_' ,, .,t ;, -1 l ,;'; r'l iL t- ,, i' ,,, = !' ll _) a, IP ';- "c,'L -l J ,1. | ": -.I .' <r F1) = !' ] : -,!y,J l-) ., C, 1l 'i,, :l ", ''i(, J i -l ,i ,, .i _,L^ l,l., t) - ru 'l ,: fa >-1: .."-.. aii:itt Y .i ,l !, r, i.:. !\n _.,j -: tu iu1 i+ :i .i -J{ io Q,: _(J- A 5-a aa' -J i" ? a-o l ) li o- u *{ ?i!(, o o :l'lfg j -(.) of. 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