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Home My WebLink AboutX2019-1209 - Permits (2)a' City of Newport Beach - Building Division *X2019-1209* Building Permit Fee: $324.00 - COMB Permit: X2019-1209 p 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check Fee: $0.00 Project No: Additional Fee: Permit Counter Phone (949)644-3280 Overtime Plan Ck: $0.00 Grading Bonds Fee: ' 4r .Inspection Requests Phone (949)644-3255 Investigation Fee: $0.00 Grading PC Consultant: Combination Type - SFP Record Management: issued Date : 04/17/2019 Grading Permit Fee: $0.00 Energy Compliance: Inspection Area : 3 Grading PC Fee: $0.00 CA Seismic Safety: $0.00 - PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. NMUSD Fee: Disabled Access: 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 Job Address: 69 CAPE ANDOVER NB Hazardous Mat $0.00 Electrical %: Description:.. SFR - TIO WOOD SHAKE, INSTALL 1-LYR 30# FELT W142 SQS PRESIDENTIAL COMP CLASS "A" Building Green Fee- $1.00. Mechanical %: Legal Desc.: N TR 15012 LOT 41 I,Pau A�k,. TOTAL r � Owner MATTHEW3 MATT Contractor R H ROOFING INC Architect: ZONING APPROVAL: Address: 69 CAPE ANDOVER Address 620 S GRAND AVE #104 Address:i.�i - NEWPORT BEACH, CA 92660 SANTA ANA, CA 92705 Phone:. Phone: '714-381-1870 Phone: State Lie: Applicant: HENRIQUEZ RAFAEL Con State Lie: 1007845 Engineer.. ...... ee°°• Address: 620 S GRAND AVE #104 Lir Expire: 1013112019.. Address: e ° SANTA ANA, CA 92705 Bus Lie: BT30053038 m e ° e ®° • o ° o Phone:. 714.381-1870 Lie Exp Date: 1113012019 Phone: State Lir .... Code Edit: .2016 Worker's Compensation Insurance Designer. Type of Construction:. VB Carrier: EMPLOYEES SERV - Address:. G ° • ° C ° ° ` Occupancy Group:. R31U Policy No: CWC719491028' ° ° ° Added /New sq.ft. Bldg: 0 Expire: 02126/2020 Phone: • m ° ° ++ ° Added /New sq. ft. Garage: 0 ° ° ° • ° ° ®„ No of Stories: 2 Building Setbacks Rear: / Special Conditions: ` ° ° •° ° °. No of Units : 1 Front: / ° ° ° • ° Bldg Height: 0 Left: /. f°°•°• ° ° Bldg Sprinklers:. Right. I - Flood Zone: - Use Zone: Parkina Soares: 0. Fire Hazard 7nne • N $0.00 Building Permit Fee: $324.00 - Excise Tax: $0.00 Plan Check Fee: $0.00 .$0.00 Additional Fee: Fair Share Overtime Plan Ck: $0.00 Grading Bonds Fee: Investigation Fee: $0.00 Grading PC Consultant: $0.00 Record Management: $0.00 Grading Permit Fee: $0.00 Energy Compliance: $0.00 Grading PC Fee: $0.00 CA Seismic Safety: $0.00 WQ Insp. Fee NMUSD Fee: Disabled Access: $0.00 Hazardous Mat $0.00 Electrical %: Building Green Fee- $1.00. Mechanical %: Plumbing %: TOTAL F $325.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: $0.00 Planning Department - $0.00 Plan check Fee: .$0.00 $0.00 Fair Share $0.00 $0.00 SJH Trans $0.00 In -lieu Housing Fee: .$0.00 $0.00 Public Works Department - $0.00 Park Dedication: $0.00 $0.00 PAN Plan Check: $0.00 $0.00 San Dist: $0.00 $0.00 NMUSD Fee: $0.00 $0.00 Plan Check Fee: $0.00 PUBLIC WORK: PLAN CHECK B APPROVALTO Fee Due at Permit Issuance : $325.00 Fire Department $0.00 Fire Inspection: .$0.00 $0.00 Fire Plan Rev $0.00 $0.00 - Demolition Fee $0.00 Building Dept Adm .$0.00 General Service $0.00 Refund Deposit $0.00 Grading Bond: $0.00 $0.00 $0.00 Fee Due at Permit Issuance : $325.00 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) action 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 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 �fessions 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 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 L) portions of the work, and the structure is not intended or offered for sale (Section 7044, 5mess 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 movements 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 )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 )ly 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: 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 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 ifessions Code, is available upon request when this application is submitted or at the following Web site:http://wm.leginfo.ca.gov/calaw.html. nature of Property Owner or Authorized Agent ' Date TENSED COilWACTOR'S DECLARATION ;reby affirm unAl"fienalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 0) of Division 3 of the Business and Prof s ' ns (3eQe end y 'cense is in full force 1'^% Licelt%*Qlass License No Dat Contractor Signature 1RKERS' COMPMATION DECLARATION IN14941PAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUB.IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001, IN ADDITION TO THE IT OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. rteby affiml under penalty of perjury one of the following declarations: I Nage and vQll piahltain 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 m,rrce of tlro'work for which this permit is issued. Policy No. - y vs 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' compensatiol I ncecarriera�rj pgl(;y number are: {. r -r -r 1 ' Policy Number Expiration Dale D® DEAgent " Phone ff 00 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 t, if I should become subject to theorkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. H ' nature of Applican.�(,[—� �� Dat CLARATION REGRRDING CONSTRUCTION LENDING AGENCY :reby affirm under penalty 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). Ider's Name Lender's Address 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 county ordinances and state laws relating to building construction. I authorize representatives of this city or count a bove-identified property for inspection purposes. nature of Prooertv Owner or Authorized Aoent" Print Property Owner's or Authorized Agent's Na(ne ACTION DATE BY `` DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED i 1 11 U I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED EPA PERMITFINAL J/�//5 a/-o/r' SBESTOS NOTIFICATION IS NOTAPPLICABLE TO CERTIFICATE OF en PROPOSED DEN�f71JITIV n OCCUPANCY ISSUED 'F+ SIGNATURE: jj( I