HomeMy WebLinkAboutPACIFIC ST 510 12/08/2017CITY OF TUSTIN
C \ Community Development Department— Building Division
300 Centennial Way, Tustin CA 92780
I Building Counter (714) 573-3131— Inspection Recorder (714) 573-3141
BUILDING PERMIT NUMBER: B2017-0758 ADDRESS: 510 PACIFIC ST TUST SUITE
ASSESSOR'S PARCEL NUMBER: 401-371-06
LOT NUMBER ................................:
DEVELOPMENT AREA ................: TUSTIN
PROPERTY OWNER..... .................: CLEARY FAMILY TRUST
1181 FIAMINIAN WAY
TUSTIN CA 92780-2840
CONTRACTOR
pAFRACON INCDBA MARVISTA CONSTRUCTION
603 E ALTON AVE SUITE H
SANTA ANA, CA 92705
714)545-6550
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CITY CF TUSTIN
CASHIER
SUITENUMBER..: car+un
TRACT NUMBE11+,4w, lift Dam" M
ISSUED BY....... Ce!M1c.a ca Aper *�
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JOB DESCRIPTION:
REMOVE ROOF @ MAIN UNIT, BREEZ
BUILDING PERMIT:
MECH PERMIT:
O.C.F.A. Number.........:
Ap
OCCUPANT LOAD:
0
OCCUPANCY GROUP:
NEW DEV. TAX:
RESIDENTIAL SQ.FT:
0
COMMERCIAL SQ FT:
0
GARAGE FT:
0
OFFICE SQ FT:
0
FT
ROOF SQ FT:
2900
TENANT MPR -SQ FT:
0
NUMBER OF UNITS:
I
NUMBERSTORIES:
NUMBER OF SEATS:
0
VALUATION
250.00
PLAN CHECK
$0.00
BUILDING PERMIT:
MECH PERMIT:
$0.00
PLUMBING PERMIT:
SIGN PERMIT:
$0.00
GRADING PERMIT:
NEW DEV. TAX:
$0.00
TSIP ZONE A FEE:
SMIP FEE:
$0.94
MICROFILM FEE:
PENALTY FEE.:
$0.00
REFUNDABLE BOND:
PLN REVIEW:
$0.00
TOTAL FEES: $212.44
Dale; 12_1811:�
INDUSTRIAL SQ FT: 0
WAREHOUSE SQ FT: 0
OTHER SQ. FT: 0
CBC EDITION: 2016
BUILDER VALUATION: $0.00
FEE SUMMARY
$179.00
PLN INSP.:
$28-80
$0.00
ELEC PERMIT:
$0.00
$0.00
PRIVATE IMPR:
$0.00
$0.00
TSIP ZONE B FEE:
$0.00
$2.70
OCFAFEE:
$090
$0.00
MISCELLANEOUS:
$0.00
T SHI
LICENSED CONTRACTOR DECLARATION:
I hereby affirm 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
LICENSENUMBBR: 760053 LICENSECLASS:B C39
Expires DATE:03/31/2019
OWNER BUILDER DECLARATION:
I hereby affirm that I am exempt firm the Contractor's License Law for the following reason (Section 7031.5, Business Professions Code: Any CiTy or county which requires a peen
structure, prior to its issuance, also requites 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 then' 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 improvemeni
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 proicut (Section 7044, Business & Professions Code: The Contractor's Lice
or improves thereon, and who contracts for such projects with a contractor(s) licence pursuant to the Contractor's License Law).
I am exempt under Section._ Business & Professions Code for the following reacon(s): __ _..
Owner Signature:_.. __Date:_._ _ —
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
_ I bave 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 main - orker's Compensation insurance, as required by Section 3700 of the Labor Codc, for the performance of the work for which this permit is issued..
Number are:
POLICY NUMBER: RW C64340 6 COMPANY: EMP SERVICE GROUP
(This section need not -ompl if the permit is for one hundred dollars ($100) or less).
I certify that re pery�`e/maince of the work for which this permit is issued, I shall not employ any p on' y manner so as to become subject io the Worker's Compensat
subject to the We set' COm 6asation a ions of Section 3700 of the Labor Code, I shall forth 4 o �t t envisions.
Signa . _. - _.. - Date:_ o _ -
W G flu to se Worlfen s Compensation coverage is unlawful, and shal . bject an em yer to 1 penalties and civil foes up to one hundred thousand dollars (:
as Drovid For i Secti (370X of the Labor Code, interest and attorney tees. t
A�ation is hereby made to the Building Official for a permit subject to
benefit work is performed under or pursuant to any permit issues as a resp
Chapter 2 of the Uniform Administrative Code. I agree not to occupy or al
information is correct. I agree to comply with all City and State laws re t
and restrictions set forth on this application Each person upon whose behalf this applicati(
(tion agrees to, and shall, indemnify and hold harmless the City of Tustin, its officers, agen
of any building authorized by this permit until final inspection has been received. I certify
mg conctmction, and hereby authorize rcpresennative of die City to enter upon the above in
PERMITS ARF. SUBJECT TO EXP' O WC NOT COMC�fEN�cED WITHIN
OF ISSUANCE OR IF W9' { SU E D FOR 180,YAYb
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