HomeMy WebLinkAboutX2019-1978 - Permits- h City of Newport Beach - Building Division 11111111111111p111Im1111p111111111111111p1111� Jill
100 Civic Center Drive, Newport Beach, CA 92660 X. 2 0 1 9 1 9 7 6
. Permit Counter Phone(949)644-3288
$ Inspection Requests Phone (949)644-3255
ra„geagx> Combination Type -SFP
COMB Permit: X2019-.1978
Project No :
Issued Date: 0 6124/2 01 9
Inspection Area : 2
Building Permit Fee:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 6:00 a.m. to 6:00 p.m. No work on Sundays or Holidays
Job Address: 37 LINDA ISLE NB
Overtime Plan Ck::
$0.00
Investigation Fee:.
Description:. SFR REMOVE/REPLACE (E) 25 SQ OF B.U.R, CLASS'S' MIN.
Record Management :
$0.00
Legal Desc.: N TR 4003 LOT 37.
$0.00
CA Seismic Safety:
$0.00
Owner: SIEGELCO LLC
Contractor:
.PACIFIC ROOFING SYSTEMS
Architect:
Address: 2857 PARADISE RD #3503
Address:
r P 0 BOX 454
Address:
LAS VEGAS NV 89109:
Fair Share:
DANA POINT CA 92629
$0.00
Phone:
Phone:
949-495-4200
Phone: State Lie
Applicant: PACIFIC ROOFING SYSTEMS:
Con State Lie:
898367 -
Engineer:
Address: P O BOX 454
Lie Expire:
0613012021
Address:
DANA POINT CA 92629,
Bus Lie:
BT30069532
Public Works Department -
Phone: 949-495-4200
Lie Exp Dater
06130/2019
Phone: State Lie:
Code Edit: 2016
.Worker's Compensation Insurance -
Designer:
Type of Construction: V-BSPR
Carrier:
STATE FUND
Address:
Occupancy Group: R31U.
Policy No:.
`9133929 -
$0.00
Added /New sq.ft. Bldg: 0
Expire:
06/01/2020
Phone:
Added /New sq. ft. Garage: 0
$0.00
NMUSD Fee:
No of Stories: - 2
Building Setbacks
Rear: I
Special Conditions: LIQUEFACTION AREA
No of Units : 1
Front: /
.Bldg Height: 0
$0.00.
Left: /
$0.00
Bldg Sprinklers: Y
$326.00
Right: /
Building Permit Fee:
$324.00
Plan Check Fee: $0.00
Overtime Plan Ck::
$0.00
Investigation Fee:.
$0.00
Record Management :
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access:
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$2.00
Use Zone:
Excise Tax:
Additional Fee ;
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
TOTAL FEE: $326.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
3arking Spaces:
0
Fire Hazard Zone : N
$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
PM 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 :
$326.00
E - I UBLIC WORKS APPROVAL:
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PLAN CHECK BY:
cc coc E.co APPROVAL TO ISSUE:
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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 applicant for
is 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 Business and
'rofessions 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 penalty of
of more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Iusiness 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
nprovements 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
n roved for the purpose of sale).
I, 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
pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
I am exempt from licensure under the Contractors' State License Law for the following reason:
ly my signature below 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 legally
ell a structure that I have 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
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000 f visio of the Business andpfessio s od license is in full force
nd effect. License Class License No Date 2 Contractor Signatur
VORKERS' COMPENSATION DECLARATIONIII
DARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain 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
e4ormance of the work for which this permit is issued. Policy No. .
have and Ifintain 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'
Date
Name of Agent 11 '-,X 1 J\�j --vnones _
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 workers' compensation laws of California, and agre
that, if I should becom s ject to thep@
rwork� nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant A U \ r„',j( �, z,{
DECLARATION REGA ING C NSTRUCTION LENDING AGENCY `"`�
I hereby affirm under pe ally of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and cou ty ordinances le laws relating to building construction.
I authorize representatives of this city or cou ant t a- a rty for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owners or Authorized Agent's Name
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
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PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION 70• • • •• ••. "•�
PERMIT CANCELLED 0EPA • • •• ` • • ; ;
PERMIT EXTENDED OMD ` • • • `
PERMITFINAL BES OS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATE OF a PR S DE .•. • • • •.• .•
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