HomeMy WebLinkAboutX2019-1387 - Permitsr < City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIII
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COMB Permit: X2019-1387
' os 100 Civic Center Drive, Newport Beach, CA 92660
X 2 0
1 9 _ 1
3 8
7
Project No
Fire Inspection:
;° Permit Counter Phone .(949)644-3288
'r:1.
0
$0.00
Disabled Access : $0.00
Hazardous Mat $0.00
Inspection Requests Phone(949)644-3255
Building Green Fee : $1.00
$0.00
SJH Trans :
a rr.,r'y Combination Type - SFP
$0.00
Demolition Fee
Issued Date: 0413012019
$0.00
In -lieu Housing Fee:
$0.00
Inspection Area : 4
$0.00
$0.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE
OR LAST VALID INSPECTION.
General Service
$0.00
Construction Hours: Monday -
Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays
$0.00
Job Address: 28 ROYAL SAINT GEORGE RD NB
Description: SFR REROOF REMOVE/REPLACE EAGLE
TILE 18 SOS CLASS "B" ESR #1900 7.2 LBSa��'1r'
`�111l
PAN Plan Check:
$0.00
Legal Desc : N TR 7323 LOT 24
Grading Bond:
$0.00
San Dist:
$0.00
>oee
NMUSD Fee:
Owner: MORROW DONALD L
Contractor: MC CORMACK ROOFING ENERGY
Architect:
• •
• •.
o
Address: 28 ROYAL SAINT GEORGE RD
Address: 1260 N HANCOCK #108
Address:
• ...
• ° • • ° °
NEWPORT BEACH, CA 92660
ANAHEIM CA 92807
Fee Due at Permit Issuance:
, e ®•
0 0
Phone:
Phone: 714-777.4040
Phone:
State Lic:
Applicant: MC-CORMACK ROOFING ENERGY
Con State Lic:. 643700
Engineer.
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. °
Address: 1260 N HANCOCK #108
Lic Expire: 0613012020
Address:
° ° O°
`• • °
ANAHEIM CA 92607
Bus Lic: BT30064748
•see
Phone: 714-777-4040
Lic Exp Date: 10/31/2019
Phone:
e e
State Lic: • °
• e e ° ��
.Code Edit: 2016
Worker's Compensation Insurance
Designer.
•
Type of Construction: V -B
Carrier: EMPLOYEE SVC GRP
Address:
°°•°°•
°
Occupancy Group: R31U
Policy No: WC900085108
Added /New sq.ft, Bldg: -0
Expire: 12131/2018
Phone:
Added /New sq. ft. Garage: 0
_ • °>`a •C
No of Stories: 2
No of Units : 1
Bldg Height: 0 -
Bldg Sprinklers:
Building Permit Fee: $324.00
TOTAL FEE: $325.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Building Setbacks
Excise Tax:
Additional Fee:
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: I
Front: I
Left: I
Right: I
0
Special Conditions: PI
$0.00
Plan Check Fee: $0.00
Overtime Plan Ck $0.00
Fire Department
Investigation Fee: $0.00
$0.00
Record Management ; $0.00
Energy Compliance: $0.00
Fire Inspection:
CA Seismic Safety.: $0.00
$0.00
Disabled Access : $0.00
Hazardous Mat $0.00
Fire Plan Rev
Building Green Fee : $1.00
TOTAL FEE: $325.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Building Setbacks
Excise Tax:
Additional Fee:
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: I
Front: I
Left: I
Right: I
0
Special Conditions: PI
$0.00
Planning Department -
Fire Department
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
$0.00
Fair Share :
$0.00
Fire Plan Rev
$0.00
$0.00
SJH Trans :
$0.00
Demolition Fee
$0.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
$0.00
$0.00
Public Works Department -
General Service
$0.00
$0.00
Park Dedication :
$0.00
Refund Deposit
$0.00
PAN Plan Check:
$0.00
Grading Bond:
$0.00
$0.00
San Dist:
$0.00
$0.00
NMUSD Fee:
$0.00
$0.00
$0.00
$0.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance:
$325.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s)
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applifant for
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Busiwess and
Professions Code) or that he or she is exempt from licensure 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 pInalty of
not more than five hundred dollars ($500). -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
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 it was not built or
improved for the purpose of sale).
❑ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an ownergfpioperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
f I am exempi are Acensure under the Contractors' State License Law for the following reason:
t;jr qty gtnatur%bip"M I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legall)
s@II a stMcture thayl� Xe built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Professions Code, Is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
E;gr?1%lw9 of Properly Owner or Authorized Agent Date
LICENSED C®NTI0%CTOR'S DECLARATION
I reRpy9ffirm LVIerIftinalty of p rjur hat I am licensed under provisions $� C�h�p r cSr9Q�encing with Section 7 0 Division f the Business and rotes ' n de, and m 11 is ! ree-
endefect. Licer�ss0ass License No l/X _VZ Date Contractor Signat e
VYQ�RS' CCIMPENSATION DE LARATION
NALiNTNG:f AILURE TO -SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUN
DR D AND DOLLARS I$f 00,000), IN AOOITION TO THE
Op$i d�PeOMPENSA=ION, DJ MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I fiereby affirm 08LIMpit alty of perjury one of the following declarations:
�••••
I have and will Rnai2tain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
Ee oVance of the nnik for which this permit is issued. Policy No.
Y
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation,
nsura,, ce[[pp��arr�rier and policy numbr� are: /, I�/y� / 2
Policy Number "J�! 6/40�/ Expiration Date !� -31-
certify
1-
m r9ern '---
certify that, in the f the work for which this permit is ' sued, I shall not employ any person in any manner so as to become subject to the workers' co pensation laws of California, and agre,
I, if I should be me subj to t e workers' compensa n r I ' ns of Sect! 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of App'cant Dat �K_
CLARATION R G C NSTRUCTIO END N AGENCY
:reby-affirm under p alty of rjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 309 , Civil Code).
Ider's Name Lender's Address
my signature below, hVifify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
1 have read this application and the information I have provided is correct.
I agree to comply with all applicable city my rdinances and state I a rata g to building construction.
I authorize representatives of this city county t nter he above-identifi r p rty fo ns ction purposes.
nature of Property Owner or Authorized ant ' t Pro art Owner's or Authorized Agent's Name ate
TION DATE BYCLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY 0
EGULATIONS PART 63 OF TITLE 40 AND AOMD RULE
PERMITEXPIRED
NOTIFICATION TO
CERTIFICATEOF '7 • 3 I 1 rte' SIGNA7 EST ENOTIFI TION IS NOT APPL AB E TO
OCCUPANCYISSUED
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