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Home My WebLink AboutX2019-3287 - PermitsgtY1Yj3 City of Newport Beach - Building Division II IIIIIIII lailli1111IIIIIII1'III111111III II COMB Permit: X2019-3287 �4 ti 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 3 2 8 7 Project No Permit Counter Phone (949)644-3288 Inspection. Requests Phone (949)644-3255 r'att•nxr`�"P Combination Type - SFP Issued Date : 1011612019 Inspection Area : 4 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 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 4 WINDSOR NIB Description: SFR - TIO SHAKE, APPLY 403 SYNTHETIC W/20 SQS BORAL SAXONY 600 SLATE 5.9 LBS ESR-1647 CLASS "A" Legal Desc.: N TR 10151 LOT 12 Owner. KHORRAMSHAHI VAHID DAVE Contractor: RESCUE ROOFING Architect: �{ j�i3dSNI Address: 4 WINDSOR Address: 23120 ALICIA PKWY #206 Address: V v NEWPORT BEACH, CA 92660 MISSION VIEJO CA 92692 Phone: 949-981-2223 Phone: 949-294-8317 Phone: State Lic Applicant: RESCUE ROOFING Con State Lic: 1043972 Engineer. Address: 23120 ALICIA PKWY 9206 Lic Expire: 09/30/2020 Address: MISSION VIEJO CA 92692 Bus Lic $T30069344 ° .... Phone: 949-294-8317 Lic Exp Date:. 10/31/2020 Phone: State Lic: - ...... Code Edit: 2016 Worker's Compensation Insurance Designer. o o. Type of Construction: VB Carrier: STATE COMP Address: Occupancy Group: R3/U Policy No:. 9240501 Added /New sq.ft. Bldg: 0 Expire: 10/25/2025 Phone: Added/New sq. ft. Garage: 0 - °•.° oO0"` No of Stories: 2 Building Setbacks Rear: I Special Conditions: No of Units: - 0 Front: 1 Bldg Height: 0 Left: I Bldg Sprinklers: Right: I - _ • < < ° ° Flood Zone: X Use Zone: 1 Parkino Spaces: 0 Fire Hazard 7nne - N ° J °. ° o e • ° Construction Valuation: $19 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 : $1.00 TOTAL FEV. $325.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Excise Tax: $0.00 Planning Department - Additional Fee : $0.00 Plan check Fee Grading Bonds Fee: $0.00 Fair Share Grading PC Consultant: $0.00 SJH Trans Grading Permit Fee: $0.00 In -lieu Housing Fee: Grading PC Fee: $0.00 Public Works Department - WQ Insp. Fee: $0.00 Park Dedication : $0.00 PAN Plan Check: $0.00 Electrical %: $0.00 San Dist: $0.00 Mechanical %: $0.00 NMUSD Fee: $0.00 Plumbing %: $0.00 Plan Check Fee : $0.00 Fee PUBLIC WORKS APPI PLAN CHECK BY: tt APPROVAL TO ISSUE: 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 Due it Issuance : $325.00 )VAL: 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) 1 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 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 Business 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 penalty 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 U all of or U 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 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). ❑ 1 am exempt from Iicensure under the •Contractors' State License Law for the following reason: By 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 thispermit, I cannot legally sell a structure that 1 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent - Date LICENSED CQ51M!CTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secti 7 of Division 3 of the Business and Profss;ie CD license is in full force anrlekfeot. Licem@,Uass License No Date 0— --+` Contractor Signature, ll�� VVQRKERS' COO MPENSATION DECLARATION WARRING: -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 CUST 6FPCOMPENSA=ION, D4,MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I jrgrgebf affirm ufld&Vbralty of perjury one of the following declarations: 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 thi pelfo,T fSiDce of the for which this permit is issued. Policy No. 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' ier and policy number are: G� g rG Policy Number 7 2 y b r G` Expiration Date d a �'O certify that, m1l a 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 agree t, if I should become subj/e)too I a y��cJa 'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant �` '�/ C C-/� Date CLARATION REGARDING CONSTRUCTION LENDING AGENCY )reby affirm undedpenalty 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 tate laws relating to building construction. -��—/ �ry q/Pv^�G�/� �(2—' -�1 1 authorize representatives of this city or cou ty to ant the de " " d property for inspection purposes. -_,..__ _. n-___.... r....__- _. n..,�,,..:_,.w n....... X / Drin} Dmnudv rTArno?e nr A,dhnri7od AnonYe N�maX � / DaW CE WITH CODE OF DATE BY DECLARATION OF I/ LIt REGULATIONS PA T061 OF IITLE 40 AND QMD RULE III FOR OFFICE USE ONLY NOTIFICATION TO PERMIT EXTENDED L JAC MD PERMIT FINAL S13ESTOS NOTIFICATION IS N APPLICABLE TO CERTIFICATE OF �S`'''z'�" Yam' PROPOSED DEMQLITIO� OCCUPANCY ISSUED SIGNATURE`.- d