HomeMy WebLinkAboutPROSPECT AVE 130 10/18/2018CITY 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: BC -2018-00063
ASSESSOR'S PARCEL NUMBER: 401-583-02
DEVELOPMENT AREA: DOWNTOWN CORE
PROPERTY OWNER
FEW
CC i 8 ?1a8
CITY OF TUSTIN
CASHIER
Cdy of Tuenn
Commumry Development Department
ADDRESS: 130 PROSPEL1Wo&Vot Appropdatenen
IWD BY: KIM HONDj �.��i
Dom.
10/18/2018 2
SCANNING FEE BUILDING
SB1473 CITY FEE $0.10 SEISMIC STRUCTURAL FEE- $4.12 STATE BUILDING 1473 FEE $0.90
COMMERCIAL
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: 289222 LICENSE CLASS: C39 - Roofing Contractor
Expires Date: 07/312019
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 of comity
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 Contractor's 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 Contractor's 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 to 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 reqs in(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 Workers Compensation insurance, as required by Section 3700 ofthe Labor Code, for the performance of the work for which this
permit is issued. My Workers Compensation insurance carrier and Policy Number are:
POLICYNUMBER: BNUWC0140275 COMPANY: MIDWEST EMPLOYERS CASUA
(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
Workers Compensation�ws of California, and I agree �1/,,,t if should become subject to the Workers Co�[pensation rovisions of Sectea 3700 of the Labor
Code_I shall forthwitti'cotdply with those provions. ( \ /1 \ �j
we to secure o . Compensation coverage is unlawful, and shall subject an emp?oyer tA(alminal penalties and civil fines up to one hundred
($100,000) in addition to the cost of compensation, damages as provided for in Section (3700) of the Labor Code, interest and attorney fees.
Application is hereby made t the Building Official for a permit subject to the conditions and restrictions set forth on this application Each person upon whose
behalf this application is made and each person at whose request and for whose benefit work is performed under or pursuant to any permit issues as a result of this
application agrees to, and shall, indemnify and hold harmless the City of Tus in, its officers, agents and employees in accordance with the provisions of Chapter 2
of the Uniform Administrative Code. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection has been received I
certify that I have read this application and state that the above information is correct. I agree to comply with all City and State laws relating to the building
construction, and hereby authorize representative ofty to tST-Won the above mentioned property for inspection purposes u
***BUILDING PERMITS ARE S TO I hTMN IF WORK IS NOT COMMENCED W1T�V 180 DAYS AFTER DATE
OF SSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS***
24361 EL TORO RD STE#260
The.pnopg"d work insolvae lmprwNrwM to amrttur01A)"t WanawweaeaMOW
LAGUNA WOODS, CA 92637
ofT"sOn Historical Asee'dn So,A.ye�c DYE$ 1g No
prow stranw.b/slyi•: Y(A
CONTRACTOR-
Rafina
ROYAL ROOFING CO.
MatM[o"ifts with ordlMnn No. 1001, au Community llsvalapnnaDatoaitYogs
mieiY
.1144 N ARMANDO, ANAHEIM, CA
92806
ane eMarmimathar
714761100
j3 FM proposed work mnlorma to ma Munlnw� Coee.ne.awalalW eaaiya
sbndxda, it sppl.aele. ....
e prowsetl woo does nor advereeiy anon ma cnarectx of ItreWarta
JOB DESCRIP'T'ION: REROOF; REMOVE EXISTING FLAT ROOF, CAP SHEET, CERTAJ%TjF,T''AMS{mWurces whin me oontt
OCCUPANT LOAD:
O'.C.F.A Number
Pri The mp;o�rr@_Rirpl�pirlAlaaiennp sunounatrrya in iameol
arc,qt„y;;�yrJeiq,gcq,.lq, eua. height, placement. and uea 0 anew 0
RESIDENTIAL SOFT:
OCCUPANY GROUP:
+..•.. np ., t a "bong ouildngs and wmt, res and Na
GARAGE SQ FT:
0 COMMERCIAL SQ FT:
0,1-•.,. aA�4RL�I0USE S FT 0
'
ROOF SQ FT:
0 OFFICE SQ FT:
0 CBC ED UO 2013
Apt ...0 `" °' '�—� Detc:
NUMBER OF UNITS
TENANT IMPR SQ FT:
rY2 --- _lL1�L>341�
11111ER VAL 333\YR
NUMBER OF SEATS:
NUMBER OF STORIES:
VALUATION: $14,700.00
FEESUMMARY
BUILDING PERMIT -DIGITIZING/
$4.05 BUILDING PERMIT FEE
$196.99 PERMIT ISSUANCE FEE- $35.00
SCANNING FEE BUILDING
SB1473 CITY FEE $0.10 SEISMIC STRUCTURAL FEE- $4.12 STATE BUILDING 1473 FEE $0.90
COMMERCIAL
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: 289222 LICENSE CLASS: C39 - Roofing Contractor
Expires Date: 07/312019
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 of comity
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 Contractor's 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 Contractor's 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 to 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 reqs in(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 Workers Compensation insurance, as required by Section 3700 ofthe Labor Code, for the performance of the work for which this
permit is issued. My Workers Compensation insurance carrier and Policy Number are:
POLICYNUMBER: BNUWC0140275 COMPANY: MIDWEST EMPLOYERS CASUA
(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
Workers Compensation�ws of California, and I agree �1/,,,t if should become subject to the Workers Co�[pensation rovisions of Sectea 3700 of the Labor
Code_I shall forthwitti'cotdply with those provions. ( \ /1 \ �j
we to secure o . Compensation coverage is unlawful, and shall subject an emp?oyer tA(alminal penalties and civil fines up to one hundred
($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 t the Building Official for a permit subject to the conditions and restrictions set forth on this application 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 Tus in, its officers, agents and employees in accordance with the provisions of 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 that I have read this application and state that the above information is correct. I agree to comply with all City and State laws relating to the building
construction, and hereby authorize representative ofty to tST-Won the above mentioned property for inspection purposes u
***BUILDING PERMITS ARE S TO I hTMN IF WORK IS NOT COMMENCED W1T�V 180 DAYS AFTER DATE
OF SSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS***
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