HomeMy WebLinkAbout101106455 - PermitCify of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requestsr (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: lOl {06455
Pin #: 10856pt/
Proiect Address: 1228 W Fifth St
Assessor's Parcel OO8-O82-27 Lot.7
Unit Bldg: Address Range
Tract: MATTHEWS' ADD
Suite Range:
Zoning: RlBlock: NA
Building Use: Commercial Occupancy: S-l 1st FL Area: Patio:
Job Type: Reroof Constr Type: V B 2nd FL Area: T.l.Area:
Natureof Work: Roroof Code: cBc 2019 other Areas: yards Req,d:
Existing Bldg. & use: commerciat Flood zone: x46o232o257 J
Garage Area: valuation: $s,ooo.oo
Proposed Use: # of Stories:
Total:
Doscription of Work: Tear off sxisting roof material and install new comp shingle roof material. Repair and ropaint any damage to windorv trim, stucco,
oaves, fascia, rafters as needed. 26 squares. Ownsr-Builder form on file. Handout given.
Planning Conditions:
Owner:
Address
Contractor
Address:
Owner-Builder
Engineer
Address
Enrique & Yolanda Perez
1228 W sTh Sr
Santa Ana, CA 927033804
(714) 231-88s9
Fifth Auto Collision
Phone:
Stale Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensalion lnsurance
Carrier:
Policy f:
Expires:
Phone;
Tenanl:
Archilect /
Desioner:
Address:
Phone:
License #:
Phone:
License #
Planning Approval By:
Plan Checked By;
Permit lssued By:
NPDES lnsp. Req'd:
PwA lnsp Req'd:
Planning lnsp. Req'dl
Landscaping lnsp. Req'd
Enriquez, Gissel
Chavez, Dave
*-?
Oale: 0111912021
Date:
Date: O4l19/2021
Subject to Field:
Misc. Receipt
lvlisc. Receipt
Misc. Receipt
07176002
07776002
07776002
07776002
07776002
57607
57770
57672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuanceNo
$345.28
$4.05
$1 .00
$23.79
$59.30
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Total
Every pefinil issued shall bacohe invald unless lhe wo* on tho site authonzed by
such pemit $ cofimenced wilhih i@ days altet ils issuance,ot if lhe wotk aulhonzed
on the site by such peftnit is suspended ot abandonod lor a peiod ol 360 daysaft6t
tho tifie the wotk is commenced
$433 42
$0.00
$433.42
lnspector MID#: 2021-165575
01116002 51600
011 16002 51601
011 16002 51612
01116002 57770
$23.79
$404.58
$1 00
$4 05 Fee Tolall
Paid to Oale:
Balance Due:
Historic. No
BUILDING- INSPECTOB RECORD
SITE-WOBK DATE ID/SIG COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor I
Subf loor/VenVl nsulation
Roof Sheathing s/to lzr .\" 86)
Shear Wall tl
Framing
lnsulation/E n erg y
Drywall
Ext./lnt. Lath
Brown Coat
It4asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL 5/?-.1/Lt JK Bb
Certificate of Occupancy / /
Noles, Remarks, Etc
--n
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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-i3 CBC 2015
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An applicati
specified at
on for a building permat has been su rn your na mel sting ourself as the builder of the prope tm provements
.1//o
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 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 infomation.
Z, 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 providang his or her own labor and material personally. l, as an
Owner-Builder, may be held liable and subject to serious flnancial rask 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.
/ -./'/2. I understand burlding 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.a,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.
ZZ_4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
125 I understand rf 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 materaals, I may be considered an
"employer" under state and federal law.
fVU 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.
A 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.
A 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 anjuries sustained by any subsequent owne(s) that result from any latent construction defects in the workman-
ship or materials.
fDs. tunderstand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser-
vice, the United States Small Business Administration, the California Depnrtment of Benefit Payments, and the California Divi-
sion of lndustrial Accidents. lalso 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.
,/z'
pany re
0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
gally and financially resp onsible for pro sed constru ctiglr€ctiv at the following ad-
dress ,.?/,1 .tr
&, 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.
2,, 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 Llcense Board may be unable to assist you with any financial loss you may sustain as a result of
a complaint. Your only remedy agaanst unljcensed 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 p ermit. /Vofei A copy of the propertv owner's driver's license, form notariza-
tion, or other verification acceptable to the aqencv is required to be presented when the permit is issued to verify the
p roDertv own e r's s i qn atu re.
Signature of Property Owner
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 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 llsted above and I personally lllled out the above
information and certify its accuracy.
Property Ownef s Signature
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.
Da.. l- /7 2/
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