HomeMy WebLinkAbout101107546 - Permitc1Project Address: 2074 S Poplar St
Assessor's Parcel 408-344-13 Lot: l2'l
Unit Bldg: Address Range Suile Range:
Zoning: R'lBlock NA Tract: 2209 Hisloric No
City of Santa Ana 20 civic Center Plaza (M-19), SantaAna, cAg27o2 Building
Permat Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section (714) 647-5853
Permit#: {Oll07546
Pin #: {4668
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Miscellaneous
Windows
SFD w/ att garage
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories:
l st FL Area
2nd FL Area
Other Areas
Garage Area
Total
Patio:
T.l.Area:
Yards Req'd
Valuation: S1,000.00
Description of Work: Replacement of (2) windows. Owner form onf file
Planning Conditions: New windows to bs vinyl sliders
Owner:
Address
Phone:
Tenant
Owner-Builder
Engineer:
Address:
Phone:
License #
Architecl /
Desiqner:
Address:
Phone:
License #
VU TRAN
2074 S Poplar St
Santa Ana, CA 92704
(949) 874-3546 Phone:
Slate Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensalion lnsurance
Carrier:
Policy #:
Expires:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp Req'd:
Planning lnsp. Req'd:
Landscaping lnsp Req'd
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Accoun
Guevara,
Zuniga, A ;"v
Date.08/16/2021
Date:
Date: 08/16/2021
Subjecl lo Field:
Misc. Receipt
Misc. Receipt
Misc Receipt
0 777500 2
07776002
07776002
01776002
07776002
57607
57770
51672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$172.64
$4.05
$1.00
$23.79
$59.30No
No
No
No
t#Total
$23.79
$231.94
$1.00
54.05
Flood Zone Cert. Req'd: No
Every parmit issued shall become invahd unless the work on the ste aulhonzed by
such pemil is commenced wilhin 360 days after ls issuance.or i the wo aulho zed
on the site by such peml is suspended ot abandoned lot a penocl of360 days aftet
lhe lime the work ts cofifienced
lnspector MtD#. 2021-168184
01 1 16002 51600
01 116002 51601
0't116002 51612
01116002 57770 Fee Total
Paid to Dale
Balance Due:
$260.78
$0.00
$260.78
R.3, U
VB
cBc 2019
x-0602320257J
Contractor
Address
BUILDING. INSPECTOH RECORD
SITE-WORK DATE ID/SIG.COMMENTS oWNIIR BUILODI' DI:LCARATION
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UFER Ground
SLAB Floor
Sublloor/VenVlnsulation
Rool Sheathing
Framinq
ln su lat ion/En ergy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
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FINAL 4bL,l*L
Certificate ol Occu n
Notes, Remarks, Etc
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Set Backs
Shear Wall
Pool Fence
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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-t 3 CBC 2016
NOTICE TO PROPERTY OWNER
Dear Property Owner
An applica r a building permit has been submitted in your n ame listin yo urself as the builder of the pro erty improvements
specified at S r
We are providing you with an Owner-Builder 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 provasaon, signed, and returned this
form lo us at our official address indicated. An agent of the owner cannot execute this notice unless you, the prope(y 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.
\./ I 1. 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 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.
v I 2. I understand building permits are not required to be signed by property owners unless they are responsible for the
constructaon and are not hiring a licensed Contractor to assume this responsibility.
\ I 3. 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 Conkactor and having the permit flled in his or her name instead of my
own.
l-l-1. t understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
6ilEmits and contracts.
l-\l I 5. 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
"employer" under state and federal law.
l-! I 6. I 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.
V I 7. I understand under California Contractors' State License Law, an Owner-Builder who builds singleJamily residential
structures cannot legally build them wlth 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.
v I 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-
EEi-6? personal in,iuries sustained by any subsequent owne(sjthat result from any latent construction defects in the woriman-
ship or materials.
t-v I L l understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser-
vice, the United States Small Buslness Administration, the Califoinia 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.
{j_10. I am aware of and consent to an Owner-Builder buildan g permit applied for in my name, and understand that I am the
party y and financially responsible for I roposed co nst ction at the followin ad-all ivity
dres
U 1 t t . 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.
{ i tZ. I agree to notify the issuer of this form immediately of any addrtions, 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
Iiable 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
totheagencyresponsibleforisSuingthepermit.Note:
tion, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the
prope,tv ow ne r's siq n atu re.
Sig nature of Property Owne Date
1
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, lhereby 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 fllled out the above
information and certiiy its accuracy.
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.
)
r /,' /,., ,
*NSANTA
AIIAffi
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P r:l i:ii l.--(Snroke & CO
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