HomeMy WebLinkAbout3RD ST W 344 08/27/2018BUILDING PERMIT NUMBER:
ASSESSOR'S PARCEL NUMBER
DEVELOPMENT AREA:
PROPERTY OWNER:
Community Dev
300 Ce
Building Counter (714)
BR -2018-00290
401-563-06
NO COMMERCIAL DISTRIC?
SPENCE GILBREATH
520 EL CAMINO REAL l
TUSTIN, CA 92780 a,
GALLA - RINI ROOFING INC
239 S WILLOW SPRINGS ROAD, ORANGE, CA
JOB DESCRIPTION: REROOF; T/O EXISTING W OOD & COMPr
S! LYWO 3 LT GAF COMP #1227 �r
OCCUPANT LOAD:
O.CF.A Number `[nr
mgr
-
RESIDENTIAL SQ.FT:
OCCUPANY GROUP:�
.a h V < f
"{r �it :,3 �y x'.. �D
GARAGESQFT:
0 COMMERCIAL SQ FT'
�»
ROOFSQ FT:
0 OFFICE SQ FT:
0 CBb-&DITION:
NUMBER OF UNITS:
TENANT IMPR. SQ FT:.
0 BUILDER VALUATION:
NUMBER OF SEATS:
NUMBER OF STORIES:
VALUATION:
$16,000.00
FEE SUMMARY
BUILDING PERMIT FEE
$211.46 PERMIT ISSUANCE
FEE- $35.00 SB1473CITYFEE,
$0.10
BUILDING
SEISMIC STRUCTURAL FEE -
$2.08 STATE BUILDING
1473 FEE $0.90
RESIDENTIAL
TOTAL FEES
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: 663983 LICENSE CLASS: B - General Building Contractor, C39 - Roofing Contractor
Expires Date: 04/30/2020
OWNER BUILDER DECLARATION
1 hereby offirm that I am exempt from the Contractors License Law for the following reason (Section 70315, Business Professions Code: Any City of county
which requires a permit to construct, alter, improve, demolish, or repair any 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 Contractors License Law [Chapter 9 (commencing with Section 7000) of Division 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 subjects the applicant to a civil penalty of not more than five 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, Business & Professions Code: the Contractors License Law does 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 improvements are not intended or offered for sale. If, however, the
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 License Law does not apply m an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(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:.
WORKER'S COMPENSATION DECLARATION:
_ 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 work for which this permit is issued.
_ I have and will maintain Worker's Compensation insurance, as required by Section 3700 of the Iabor Code, for the performance of the work for which this
permit is issued. My Workers Compensation insurance carrier and Policy Number are:
POLICY NUMBER: COMPANY:
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
_ I certify that in the perl&brr�rance 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 Compensation law ,ro�Cath 0 dLug[ -e that if I should become subject to the Workers Crok„',ienationjJ;rovisions of Section 3700 of the Labor
Code, dull forthwith curl �x vnth thus provisions. ,t' j� ) �'
Signan �-.✓ Date: V 19- /
WARNIN re to s ure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousan ollars ($100,000) in addition to the cost of compensation, damages as provided for in Section (3700) of the Labor Code, interest and attorney fees.
Application is hereby made to the Building Offend for a permit subject to the conditions and restrictions set forth on this applicatiom Each person upon whose
behalf this application is made and each person at whose request and for whose 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, agents and employees in accordance with the provisions of Chapter 2
of the Uniform Administrative Code. I agree not to occupy or allo ceupancy of any building authorized by this permit until final inspection has been received. I
certify that I have read this application and state that the above i ation is correct I agree to comply with all City and tate laws relating to the building
construction, and hereby authorize representative of the City to to upon the rmentioned property for inspectio�o os /
-...�____,_.I-- 1-
***BUILDING PERMITS ARE SIX7834sC -Tb EXPIRATION IF WORK IS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS***
0
I
a
a a
'J
G
V n
V
Q) �
z�
0
E
v,
r
b
Z
c2a
O w
O
m
O
v
v
J
w
�
J
v
V in
4
+n
,Ls Y 5
m6l