HomeMy WebLinkAboutEL CAMINO REAL 365 02/16/2016" CITY OF TUSTIN PAID
Community Development Department — Building Division
300 Centennial Way, Tustin CA 92780 FEB 16 2016
Building Counter (714) 573-3131 — Inspection Recorder (714) 573-3141 CITY OF TUSTIN
CASHIER
BUILDING PERMIT NUMBER: C2016-0016 ADDRESS: 365 EL CAMINO REAL TUST SUITE
ASSESSOR'S PARCEL NUMBER: 401-585-05
LOT NUMBER ................................:
DEVELOPMENT AREA ................: TUSTIN
PROPERTY OWNER ......................: SURFAS ARNOLD H
10942 BENT TREE RD
SANTA ANA CA 92705-252
CONTRACTOR
P R CONSTRUCTION INC
1995 BATAVIA ST
ORANGE CA 92865
714-637-7848
JOB DESCRIPTION:
OCCUPANT LOAD:
RESIDENTIAL SQ.FT:
GARAGE SQ FT:
ROOF SQ FT:
NUMBER OF UNITS:
NUMBER OF SEATS:
SUITE NUMBER...:
TRACT NUMBER.:
ISSUED BY .............:
DATE ISSUED.......: 02/16/2016
ARCHITECT
OUTDOOR SEATING FOR RESTAURANT
O.C.F.A. Number.........:
OCCUPANCY GROUP:
FEE SUMMARY
COMMERCIAL SQ FT:
0
OFFICE SQ FT:
0
TENANT IMPR SQ FT:
0
NUMBER OF STORIES:
0
VALUATION...:
$0.00
CONSTRUCTION TYPE.:
INDUSTRIAL SQ FT: 0
WAREHOUSE SQ FT: 0
OTHER SQ. FT: 0
CBC EDITION: 2013
BUILDER VALUATION: $25,000.00
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: 673267 LICENSE CLASS: B C33
Expires DATE:03/31/2017
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).
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 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 improvement
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) license pursuant to the Contractor's License Law).
I 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. w(
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:
POLI BER:CA1 2583 COMPANY: EVEREST NATIONAL
( s section need o per for one hundred dollars ($100) or less).
I tliat i 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
the W r er ti vi ' f tion 3700 of the Labor Code, I shall forthwith comply with those provisions.
Sign ature?r: Date:
WARDING: Fai a to ure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (:
as pro6ded for in Section (3 700) 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 r application agrees to, and shall, indemnify and hold harmless the City of Tustin, its officers, agen
Chapter 2 of the Uniform Administrative Code. I a occ ow occu y building authorized by this permit until final inspection has been received. I certify
information is correct. I agree to comply with City and s r�a n e ui igg construction, and hereby authorize representative of the City to enter upon the above m
*`BUILDING PERMITS ARE SUBJECT 7(O EXPIRATIOTPT'VVOWfS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS***
FEE SUMMARY
PLAN CHECK
$218.11
BUILDING PERMIT:
$346.59
PLN INSP.:
$62.32
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:
$7.00
MICROFILM FEE:
$16.20
OCFA FEE:
$0.00
PENALTY FEE.:
$311.59
REFUNDABLE BOND:
$0.00
MISCELLANEOUS:
$0.00
PLN REVIEW:
$43.62
TOTAL FEES: $1,006.43
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: 673267 LICENSE CLASS: B C33
Expires DATE:03/31/2017
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).
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 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 improvement
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) license pursuant to the Contractor's License Law).
I 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. w(
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:
POLI BER:CA1 2583 COMPANY: EVEREST NATIONAL
( s section need o per for one hundred dollars ($100) or less).
I tliat i 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
the W r er ti vi ' f tion 3700 of the Labor Code, I shall forthwith comply with those provisions.
Sign ature?r: Date:
WARDING: Fai a to ure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (:
as pro6ded for in Section (3 700) 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 r application agrees to, and shall, indemnify and hold harmless the City of Tustin, its officers, agen
Chapter 2 of the Uniform Administrative Code. I a occ ow occu y building authorized by this permit until final inspection has been received. I certify
information is correct. I agree to comply with City and s r�a n e ui igg construction, and hereby authorize representative of the City to enter upon the above m
*`BUILDING PERMITS ARE SUBJECT 7(O EXPIRATIOTPT'VVOWfS NOT COMMENCED WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS***