HomeMy WebLinkAbout101105391 - Permitcity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA127O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Project Address: 1030 1/2 W Nineteenth St
Assessor's Parcel 399-063-08 Lot 48 & POR 47 Block: NA
Unit Bldgr Address Range Suile Range:
Zoning: RlTract. 1306 Historic No
Building Use: Accessory Dwelling Unit-Convert Occupancy: R-3 lst FL Area 390 Patio:
Job Typer Conversion Constr Type: V B 2nd FL Area T.l.Area:
Nature of Work: ADU Code: CBC 2019 Other Areas: yards Req,d
Existing Bldg. & Use: Sfd wratt garago Flood Zone: X-0602320't/t4J Garage Area valuation: $30,000.00Proposed Use: Sfd w/ det ADU # of Stories: Total 390
Description of Work: Conv6rt existing garage (390sf) to ADU to include (1) bathroom, sleeping/living room/kitchsn area and atackable washer/dryer
closet. SAUSD paid on lr4'124. Auth on file.
Planning Conditions: Remove driveway.
O\f,ner-Builde.Owner.
Address
Contraclor
Addressl
neer:
ESS:
Phone:
License #
Leslie Olivares
1030 W lgth Street
Santa Ana, CA 92705
(714) 661-9466Phone
Tenant
Phone:
Slale Lic #:
Lic Type:
Bus. Lic #:\U
Phon
nse #
Architect /
Desi
ressWorkers' Compensation lnsurance:
Carrier:
Policy #
Expires:
Planning Approval By:
Plan Checked By;
Permit lssued Byl
NPDES lnsp. Req'd:
PWA lnsp Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Enriquez, Gissel
Le, Tung K\r/
ZuniOa, Allrssa \\
Dale. 1210712020
Dale:0410712021
Date: 04/19/2021
Subjecl to Field:No
Yes
Yes
No
Fire lnsp. Req'd:
Police lnsp. Req'd ):" Account#
Misc. Receipt
Misc. Receipt
Misc. Receipt
0 77760 0 2
0 77760 0 2
0777600 2
08907007
077760 0 2
077760 0 2
o77760 0 2
5760 7
53 600
57770
24000
51672
51600
57607
$345.28
$718.02
$36.4s
$3.90
$2.00
$23.79
$59.30
$ 1 .'t88 74
$478 68
s710.06
75022
Total
Permit Fee
Plan Check Fee
lvlicrofilm Records
SMIP - Calegory 1
Bldg. Stds. Revolving
General Plan Update
lssuance
Flood Zone Cerl. Req'd: No
Every pemit issued shall becotue hvalid unless the wo* on the site authonzed by
such pemil $ commenced withn 360 days aftet s issuance,or if the wo* authonzed
on the site by sucll pomit is susponded ot abandohed fot a penod of360 days altor
lhe lime the wod< ts commenced.
51600
51601
51612
53600
57770
24000
$23.79
$404.58
$2.00
$239.34
$36.45
$3.90
lnspector MtD#. 2020-162114
01 1 16002
01 1 16002
01 1 16002
01116002
01116002
08901001
Fee Tolal
Paid to Date:
Balance Due:
Permit#: 1OllO539l
Pin #: 82647
BUILDING. INSPECTOH RECORD
SITE-WORK DATE ID/SIG.COMMENTS oWNIJ* AUILDEII DELCARATIoN
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I]ECI.ASAIION
I herchy afitr undcr F illy ol lErr!ry otu o{ l hc followiu delTarn,n\:
Ihurclnd*illiuiiruinu(cnifiu c ol Con* tu Scll lnrur tur w.rkcn sqx.uiotr. rs Fo!i.,.l ftr by Sccti'n :17()() of ltf,
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rh. *drk for whi.h rh,s Fnnn a !sEl. My worlc^ ('mFncarion in\unm. cuir un lI)Ity nunhd d.:
PolEv Numhcr:-Erpit.
_l c.dityihxr in tl* |Erlo,@N. of llE vo,l for wnih lnir Frmil is iesu.d l shIll
'Er
cdploy.ny Fist in ey mnE
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WARNING: Failur. kt suE *rt r'o'rt .srhn.ot@s. k uda*tu|. rnd {h.ll obFr an atlroFr ro ffiMl FMii\ !'i
.itil fifts up ro om hundn\l lhuwd.[ ls l3l(l,.lxD ry Dtr drmE.r {i F,vkL{ fin rlr
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of rlr Bu\ims dd PrDf.si(ni Co&, d{ ny ltrm ir iI tull t m .d clIcl.
C(TNSTRUCToN LI]\DING A(;!:NCI
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thftnn{u P.rnn$ A{E(o\ Non,icor0n ltlcrul RcBtrhin,nr lTnk J0. Pd6)
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h\c nurNkrl ln)tMy fttr
.{pt i(,nl nr,\!dl SiaDlnn ul\41.21.1-l
Slts lr z la. g
Set Backs Ll Ir ^-oForms/Steel/Holdowns t lHta rr6ufr wN
Erection Pads tl
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathinq
Shear Wall
Framino
lnsulation/Energy
Drywall
Brown Coat
ltrlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL
Certif icate of Occupancy
Notes, Bemarks, Etc
Rev 08-07 2015
I !m.r.,w tn&r Seril)n
o.r., ' 9\t4 lZoZ \ ,
Ext./lnt. Lath
Planning & Building Agency
Building Safety Oivision
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-s800
www.santa-ana.org
APP-I3 CBC 2016
Dear Property Owner:
An applica n for a buildin
specified at \Ll
NOTICE TO PROPERTY OWNER
gp ermit has been submitted in yo ur name listin sy ourself as the builder of the property improvements
D {r. \61\\ft r\z-1 o
We are providing 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 omcial 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
M r 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 workrng 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.
i)WZ. 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.
)
Wr. 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.
0 *--V)_q I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
6n permits and contracts.
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 live hundred dollars ($500), including labor and materials, I may be considered an
"employe/' under state and federal law.
,1Yni/
.)-U_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.
Yu l. t understand under California Contractors' State License Law, an Owner-Builder who builds singleJamily resrdential
structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac-
lors 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.
I
:I(a f understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
clal or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materials.
I /<,, 9. I understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser-
\rice, 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 rhe California Contractors' State License Board (CSLB) at 1-800-
321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.
\ >.-.t- 10 I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
pdrty legally and financially responsible for proposed construction activity at the followrng ad-dress\/ r" re \.: \qrlJ i .-.,'\21 \.-. ( fl :,21u'\r'--
1*/J11 lagree that, asthe party legallyand financially responsible forthis proposed construction activity, lwill abidebyall
applicable laws and requirements that govern Owner-Builders as well as employers.
W, I 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 is also important for you to understand
that if an unlicensed Contraclor or employee of that individual or flrm 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 lorm must be completed and signed by the property owner and returned
to the agency responsible for issuing the permit, ,Vofe.' A copv of the propeftv owner's driver's license. form notariza-
tion, or other verification acceptable to the aqencv is reouired to be presented when the permit is issued to verifv the
p ropertv ow n e r's s i qn atu re.
Signature of Property Own Date qlrq lzl
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 Description of Work)
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 filled out the above
information and certify its accuracy.
Property Owner's Signature Date
Print Name of Owner
)
Print name ot owner LZ:,\r e- O\r..J c..r( 57-
)
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Project Location or Address:
Note: A copy of the owner's driver's license, form notari2ation, 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.