HomeMy WebLinkAboutPROSPECT AVE S 150 12/22/2015 (2)- • CITY OF TUSTIN PAID
Community Development Department – Building Division
300 Centennial Way, Tustin CA 92780 DEC 2 2 2015
�- Building Counter (714) 573-3131 – Inspection Recorder (714) 573-3141
CITY OF TUSTIN
BUILDING PERMIT NUMBER: B2015-0504 ADDRESS: 150 S PROSPECT AV TUST SUITE SHIER
ASSESSOR'S PARCEL NUMBER: 401-583-03 SUITE NUMBER...:
LOT NUMBER ................................: TRACT NUMBER.:
DEVELOPMENT AREA ................: TUSTIN ISSUED BY .............
DATE ISSUED.......: 12/22/2015
PROPERTY OWNER ......................: KIM MUN HWA/SHIN HYE JIN
13 HOLLY ST
IRVINE CA 92612
CONTRACTOR ARCHITECT
ACECON INC
1206 PRICE STREET
POMONA, CA 91767
(909) 622-3180
JOB DESCRIPTION: 15.12 KW COMMERCIAL PV SOLAR 56 PANELS, 56 MICRO -INVERTER
LICENSED CONTRACTOR DECLARATION:
I hereby affirm that I 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: 999611 LICENSE CLASS: B C46
Expires DATE: 12/31/2016
OWNER BUILDER DECLARATION:
I hereby affirm that I 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 peen
stricture, 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 703 1.5 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 improvemen
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 contractor(s) license pursuant to the Contractor's License Law).
1 am exempt under Section , Business & Professions Code for the following reason(s):
Owner Signature: Date:
WORKERS' COMPENSATION DECLARATION:
I 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 performance of the we
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: 9129320 COMPANY: STATE FUND
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
I certify that in the performance 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 the Wor er' Compensation pr o?'Section Section 3700 of the Labor Code, t shall forthwit corn ly withpose provisions.
Signatu Date: 2- I- _-
WARNIN lur o secure Worker's npensation coverage is unlawful, and shall subject an emplo er to c incl penalties and civil fines up to one hundred thousand dollars (:
as provided for in ection (3700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby trade to the Building Official for a permit subject to the conditions and restrictions set forth on this application. Each person upon whose belialf this applicatig
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. I agree to comply with all City and State laws relating to the building construction, and hereby authorize representative of the City to enter upon the above m
0-112- !l
***BUILDING PERMITS ARE SUBJECT TO EXPfRAYON 1F WORK IS NOTiCOMMENCED WITHIN 180 DA�dS AFTER/ATE
OF ISSUANCE OR IF WO IS SUSPENDED FOR 180 DAYS***
O.C.F.A. Number.........:
FEE SUMMARY
OCCUPANT LOAD:
0
OCCUPANCY GROUP:
$483.22
CONSTRUCTION TYPE.:
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
NUMBER OF SEATS:
0
VALUATION...:
$0.00
BUILDER VALUATION: $42,000.00
LICENSED CONTRACTOR DECLARATION:
I hereby affirm that I 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: 999611 LICENSE CLASS: B C46
Expires DATE: 12/31/2016
OWNER BUILDER DECLARATION:
I hereby affirm that I 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 peen
stricture, 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 703 1.5 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 improvemen
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 contractor(s) license pursuant to the Contractor's License Law).
1 am exempt under Section , Business & Professions Code for the following reason(s):
Owner Signature: Date:
WORKERS' COMPENSATION DECLARATION:
I 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 performance of the we
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: 9129320 COMPANY: STATE FUND
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
I certify that in the performance 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 the Wor er' Compensation pr o?'Section Section 3700 of the Labor Code, t shall forthwit corn ly withpose provisions.
Signatu Date: 2- I- _-
WARNIN lur o secure Worker's npensation coverage is unlawful, and shall subject an emplo er to c incl penalties and civil fines up to one hundred thousand dollars (:
as provided for in ection (3700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby trade to the Building Official for a permit subject to the conditions and restrictions set forth on this application. Each person upon whose belialf this applicatig
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. I agree to comply with all City and State laws relating to the building construction, and hereby authorize representative of the City to enter upon the above m
0-112- !l
***BUILDING PERMITS ARE SUBJECT TO EXPfRAYON 1F WORK IS NOTiCOMMENCED WITHIN 180 DA�dS AFTER/ATE
OF ISSUANCE OR IF WO IS SUSPENDED FOR 180 DAYS***
FEE SUMMARY
PLAN CHECK
$313.75
BUILDING PERMIT:
$483.22
PLN INSP.:
$89.64
MECH PERMIT:
$0.00
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
SMIP FEE:
$11.76
MICROFILM FEE:
$10.80
OCFA FEE:
$0.00
PENALTY FEE.:
$0.00
REFUNDABLE BOND:
$0.00
MISCELLANEOUS:
$0.00
PLN REVIEW:
$62.75
TOTAL FEES:
$973.92
LICENSED CONTRACTOR DECLARATION:
I hereby affirm that I 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: 999611 LICENSE CLASS: B C46
Expires DATE: 12/31/2016
OWNER BUILDER DECLARATION:
I hereby affirm that I 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 peen
stricture, 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 703 1.5 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 improvemen
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 contractor(s) license pursuant to the Contractor's License Law).
1 am exempt under Section , Business & Professions Code for the following reason(s):
Owner Signature: Date:
WORKERS' COMPENSATION DECLARATION:
I 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 performance of the we
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: 9129320 COMPANY: STATE FUND
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
I certify that in the performance 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 the Wor er' Compensation pr o?'Section Section 3700 of the Labor Code, t shall forthwit corn ly withpose provisions.
Signatu Date: 2- I- _-
WARNIN lur o secure Worker's npensation coverage is unlawful, and shall subject an emplo er to c incl penalties and civil fines up to one hundred thousand dollars (:
as provided for in ection (3700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby trade to the Building Official for a permit subject to the conditions and restrictions set forth on this application. Each person upon whose belialf this applicatig
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. I agree to comply with all City and State laws relating to the building construction, and hereby authorize representative of the City to enter upon the above m
0-112- !l
***BUILDING PERMITS ARE SUBJECT TO EXPfRAYON 1F WORK IS NOTiCOMMENCED WITHIN 180 DA�dS AFTER/ATE
OF ISSUANCE OR IF WO IS SUSPENDED FOR 180 DAYS***