HomeMy WebLinkAboutMAIN ST W 225 04/10/2015• CITY OF TUSTIN
Community Development Department —Building Division
300 Centennial Way, Tustin CA 92780
Building Counter (714) 573-3131 — Inspection Recorder (714) 573-3141
BUILDING PERMIT NUMBER: M2015-0034 ADDRESS: 225 W MAIN ST TUST SUITE
ASSESSOR'S PARCEL NUMBER: 401-574-03 SUITE NUMBER...:
LOT NUMBER ................................: TRACT NUMBER.:
DEVELOPMENT AREA ................: TUSTIN ISSUED BY .............
DATE ISSUED.......: 04/10/2015
PROPERTY OWNER ......................: CHURCH TUSTIN PRESBYTERIAN
MAIN & C STREET
TUSTIN CA 92780-3672
CONTRACTOR ARCHITECT
J C MECHANICAL
1701 E LAMBERT RD STE C
LA HABRA, CA 90631
(714)223-1255
JOB DESCRIPTION: REPLACE (2) CONDENSER, (2) FURNACE, AND COIL, SAME LOCATION
O.C.F.A. Number.........:??
OCCUPANT LOAD:
0
OCCUPANCY GROUP:
FEE SUMMARY
CONSTRUCTION TYPE.:
PLAN CHECK
RESIDENTIAL SQ.FT:
0
COMMERCIAL SQ FT:
0
INDUSTRIAL SQ FT:
0
GARAGE SQ FT:
0
OFFICE SQ FT:
0
WAREHOUSE SQ FT:
0
ROOF SQ FT:
0
TENANT IMPR. SQ FT:
0
OTHER SQ. FT:
0
NUMBER OF UNITS:
1
NUMBER OF STORIES:
0
CBC EDITION: 2013
SMTP FEE:
NUMBER OF SEATS:
??
VALUATION...:
$0.00
BUILDER VALUATION:
$0.00
LICENSED CONTRACTOR DECLARATION:
I hereby affirm that t am a licensed Contractor under the provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code, and my license
LICENSE NUMBER: 561077 LICENSE CLASS: C20
Expires DATE:03/31/2017
OWNER BUILDER DECLARATION:
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business Professions Code: Any City or county which requires a perm
structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License L:
3 of the Business & Professions code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit st
hundred dollars ($500.00).
I as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Busi
not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvemem
building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purposes of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business & Professions Code: The Contractor's Lice
or improves thereon, and who contracts for such projects with a conuactor(s) license pursuant to the Contractor's License Law).
I am exempt under Section , Business & Professions Code for the following reason(s):
Owner Signature: Date:
WORKERS' COMPENSATION DECLARATION:
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the perfornance of the wr
I have and will maintain Worker's Compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
Number are:
POLICY NUMBER: SWC1050064 COMPANY: SECURITY NATIONAL INSURANCE CO
(This section need n be completif the permit is for one hundred dollars ($100) or less).
I cert t t�4errf/ance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensai
subject to thWo ereon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
WARNING:'Fail 'e to secure Vo leer's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ('
as provided for in Section (3700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. Each person upon whose behalf this applicati(
benefit work is performed under or pursuant to any permit issues as a result of this application agrees to, and shall, indemnify and hold harmless the City of Tustin, its officers, agen
Chapter 2 of the Uniform Administrative Code. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection has been received. I certify
information is correct. 1 agree to comply with all City arjAAtate laws relatmQto the building construction, and hereby authorize representative of the City to enter upon the above in
***BUILDING PERMITS ARE SUBJECT TO gkPWION f� ORK IS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS'SfUSP DED FOR 180 DAYS***
FEE SUMMARY
PLAN CHECK
$27.40
BUILDING PERMIT:
??
PLN INSP.:
$10.96
MECH PERMIT:
$89.80
PLUMBING PERMIT:
$0.00
ELEC PERMIT:
$0.00
SIGN PERMIT:
$0.00
GRADING PERMIT:
$0.00
PRIVATE IMPR:
$0.00
NEW DEV. TAX:
$0.00
TSIP ZONE A FEE:
$0.00
TSIP ZONE B FEE:
$0.00
SMTP FEE:
$0.00
MICROFILM FEE:
$5.40
OCFA FEE:
$0.00
PENALTY FEE.:
$54.80
REFUNDABLE BOND:
$0.00
MISCELLANEOUS:
$5.40
PLN REVIEW:
$5.48
TOTAL FEES: $193.84
LICENSED CONTRACTOR DECLARATION:
I hereby affirm that t am a licensed Contractor under the provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code, and my license
LICENSE NUMBER: 561077 LICENSE CLASS: C20
Expires DATE:03/31/2017
OWNER BUILDER DECLARATION:
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business Professions Code: Any City or county which requires a perm
structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License L:
3 of the Business & Professions code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit st
hundred dollars ($500.00).
I as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Busi
not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvemem
building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purposes of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business & Professions Code: The Contractor's Lice
or improves thereon, and who contracts for such projects with a conuactor(s) license pursuant to the Contractor's License Law).
I am exempt under Section , Business & Professions Code for the following reason(s):
Owner Signature: Date:
WORKERS' COMPENSATION DECLARATION:
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the perfornance of the wr
I have and will maintain Worker's Compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
Number are:
POLICY NUMBER: SWC1050064 COMPANY: SECURITY NATIONAL INSURANCE CO
(This section need n be completif the permit is for one hundred dollars ($100) or less).
I cert t t�4errf/ance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensai
subject to thWo ereon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
WARNING:'Fail 'e to secure Vo leer's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ('
as provided for in Section (3700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. Each person upon whose behalf this applicati(
benefit work is performed under or pursuant to any permit issues as a result of this application agrees to, and shall, indemnify and hold harmless the City of Tustin, its officers, agen
Chapter 2 of the Uniform Administrative Code. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection has been received. I certify
information is correct. 1 agree to comply with all City arjAAtate laws relatmQto the building construction, and hereby authorize representative of the City to enter upon the above in
***BUILDING PERMITS ARE SUBJECT TO gkPWION f� ORK IS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS'SfUSP DED FOR 180 DAYS***