HomeMy WebLinkAboutEL CAMINO REAL 445 10/09/2015p
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C OF TUSTIN ie
'` ' Community Development Department — Building Division' OCT — 92015
300 Centennial Way, Tustin CA 92780 C
Building Counter (714) 573-3 13 1 — Inspection Recorder (714) 573-3141 CASHIE srrN
' R
BUILDING PERMIT NUMBER: B2015-0469 ADDRESS: 445 EL CAMINO REAL TUST SUITE
ASSESSOR'S PARCEL NUMBER: -- SUITE NUMBER...:
LOT NUMBER ................................: TRACT NUMBER.:
DEVELOPMENT AREA ................: TUSTIN ISSUED BY .............
DATE ISSUED.......: 10/09/2015
PROPERTY OWNER ......................: ASISSTANCE LEAGUE
CONTRACTOR
ABSOLUT ROOFING
P O BOX 5262
HUNTINGTON BEACH, CA 92615
800-655-2231
ARCHITECT
JOB DESCRH'TION:
REROOF; INSTALL NEW 2 LAYER UNDERLAYMENT, APPLY EXISTING TILE BACK.
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:
5800
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...: $14,500.00
BUILDER VALUATION:$15,000.00
FEE SUMMARY
PLAN CHECK
$0.00
BUILDING PERMIT:
$253.86 PLN INSP.:
$0.00
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:
$4.20
MICROFILM FEE:
$2.70 OCFA FEE:
$0.00
PENALTY FEE.:
$0.00
REFUNDABLE BOND:
$0.00 MISCELLANEOUS:
$0.00
PLN REVIEW:
$0.00
TOTAL FEES:
$261.76
LICENSED CONTRACTOR DECLARATION:
I hereby affim that 1 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: 761118
LICENSE CLASS: C39
Expires DATE:02/29/2016
OWNER BUILDER DECLARATION:
1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 703 1.5, 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 Ilia Business & Professions code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Scction 7031.5 by any applicant for a permit st
hundred dollars ($500.00).
1 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 ofi'ered for sale (Section 7044, Busi
not apply to an owner of properly 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).
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business & Professions Code: The Contractors 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 aff inn under penally of perjury one of the following declarations:
1 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 perfomtance 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: 1581550 COMPANY: STATE FUND
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
L— 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 Compensat
sultj ec[ t 71 WVpr`�r'F 1pensation provisions of Section 3700 of the Labor Code, I shall forthwith c¢nlply /ith those provisions.
SignaLL}�a/ ,/,� \ 71 ! ,�) Date: 10 J q / /
Failurh to secure Wotktr's Compensation coverage is unlawful, and shall subject an
for in Section (3700) of the Labor Code, interest and attorney fees.
to briminal penalties and civil fines up to one hundred thousand dollars (t
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 applicatii
benefit work is performed under or pursuant to any permit issues as a result ofthis application agrees to, and shall, indemnify and hold hamtless the City of Tustin, its officers, agcn
Chaplet 2 of the Uniform Administrative Code. 1 agree not to occupy or allow occupancy of any building authorized by this pemut until final inspection has been received. 1 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 in
Signature of Owner Contractor, or Authorized Aeh �, U -r `J Date f (C—)
***BUILDING PERMITS ARE SUBJECT TO -P RATION IF WORK IS NOT COMMENCED WITHIN 180 DAY; AFTER DATE
OF ISSUANCE O IF WORK IS SUSPENDED FOR 180 DAYS***
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