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• CITYOF TUS
Community Development Departmen Iding Division
300 Centennial Way, Tustin C 92780
Building Counter (714) 573-3 131 — Inspection Recorder (714) 573-3141
BUILDING PERMIT NUMBER: B2012-0010 ADDRESS: 138 W MAIN ST TUST SUITE
ASSESSOR'S PARCEL NUMBER: 401-622-02 SUITE NUMBER...:
LOT NUMBER ................................: TRACT NUMBER.:
DEVELOPMENT AREA ................: TUSTIN OLD TOWN ISSUED BY .............
DATE ISSUED.......: 01/12/2012
PROPERTY OWNER ......................: ZAMORA TRUST PT
138 W MAIN ST
TUSTIN CA 92780-4333
CONTRACTOR ARCHITECT
AMERICAS BEST ROOFING COMPANY INC
5503 CLEARSITE STREET
TORRANCE, CA 90505
:(310) 792-1261
JOB DESCRIPTION: REROOF; REMOVE EXISING ROOFING AND INSTALL NEW 4 -PLY CAPSHEET BUR AND TITLE
LICENSED CONTRACTOR DECLARATION:
1 hereby allirm 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: 938527 LICENSE CLASS: C39
Expires DATE:10/31/2013
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 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 impmvemeni
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).
1, 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) licensr, 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: 238-0014218
COMPANY: STATE FUND
(Phis 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 Compensal
subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions.
Signature _Date:
WARNING: Failure to secure Worker'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. 1 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
Sie.nalure of Owner Contractor. or Authorized Agent Date
—BUILDING PERMITS ARE SUBJECT TO EXPIRATION IF WORK IS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS—
O.C.F.A. Number.........:
OCCUPANT LOAD:
0
OCCUPANCY GROUP:
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:
1700
TENANT IMPR. SQ FT:
0
OTHER SQ. FT: 0
NUMBER OF UNITS:
I
NUMBER OF STORIES:
0
CBC EDITION: 2010
NUMBER OF SEATS:
0
VALUATION...:
$7,446.00
BUILDER VALUATION: $7,500.00
FEE SUMMARY
PLAN CHECK
$113.79
BUILDING PERMIT:
$197.55 PLN IN SP.:
$32.51
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
SMTP FEE:
$1.57
MICROFILM FEE:
$3.00 OCFA FEE:
$0.00
PENALTY FEE.:
$0.00
REFUNDABLE BOND:
$0.00 MISCELLANEOUS:
$0.00
PLN REVIEW:
$22.76
TOTAL FEES:
$372.18
LICENSED CONTRACTOR DECLARATION:
1 hereby allirm 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: 938527 LICENSE CLASS: C39
Expires DATE:10/31/2013
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 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 impmvemeni
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).
1, 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) licensr, 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: 238-0014218
COMPANY: STATE FUND
(Phis 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 Compensal
subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions.
Signature _Date:
WARNING: Failure to secure Worker'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. 1 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
Sie.nalure of Owner Contractor. or Authorized Agent Date
—BUILDING PERMITS ARE SUBJECT TO EXPIRATION IF WORK IS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS—
138 W. MAIN ST, TUSTIN • 0