HomeMy WebLinkAboutX2022-0916 - PermitsCity of Newport Beach - Building Division *X2022-0916* COMB Permit: X2022-0916
o 100 Civic Center Drive, Newport Beach, CA 92660 Project NO
Permit Counter Phone (949)644-3288
sa. Inspection Requests Phone (949)644-3255
r Issued Date : 03130/2022
uitraZa�'" Combination Type - SFP q �. q® ,�,f . r�
I - ` - S �'; : '' Inspection Area : 1
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0313012025 OR PERMIT WILL BE INVALID
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: 1617 E BAY AVE NB
Description: SFR REROOF: REMOVE (E) ROOFING & APPLY VERSICO ([CC-ESR 1463) PVC 70. SQUARES.
Legal Desc.: BALBOA TR EAST SIDE ADD BLK 25 LOT 8 POR OF LOT AND BLK 25 POR OF LOTS
Owner:
SEGERSTROM HENRY T & ELIZABETH
Address:
1617 BAY AVE E
NEWPORT BEACH, CA 92661
Phone:
Applicant:
INTEG ROOF CO
Address:
6331 CHERRY AVE
LONG BEACH CA 90805
Phone:
562-428-9808
Code Edit :
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 2
No of Units : 1
Bldg Height: 0
Bldg Sprinklers:
Contractor:
INTEG ROOF CO
Architect:
Address:
6331 CHERRY AVE
Address:
LONG BEACH CA 90805
Phone:
562-428-9808
Phone: State Lie:
Can State Lie:
752863
Engineer:
Lie Expire:
07/3112022
Address:
Bus Lie:
BT30078364
Lie Exp Date:
03/31/2023
Phone: State Lie:
2019 Worker's Compensation Insurance
V-B Carrier:
STATE COMPENSATION INS FUND
r3/u Policy No:
9246715
0 Expire:
03/0112023
0
Building Setbacks
Rear: I
Front: I
Left: /
Right: /
Valuation: $50,000.00
Building Permit Fee: $351.00
Plan Check Fee: $171.00
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
TOTAL FEE: $524.00
PROCESSED BY:
ZONING APPROVAL:
Designer:
Address:
Phone:
Special Conditions: HIGH DENSITY ZONE
AE FLOOD ZONE
LIQUEFACTION ZONE
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 W
$0.00
San Dist:
$0.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
Plumbing %:
$0.00
Plan Check Fee
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building bept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 Fee Due at Permit Issuance : $524.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL: 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)
:ction 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 U all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
;mass 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
)rovements 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
)[y 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 exernptTromdicensure under the Contractors' State License Law for the following reason:
my.signaturd'8elow 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 legal)
%- ltructurlthpt %ave 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 Co4e, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
n&`tyre of Property Owner or Authorized Agent Date
MNNSED CONTRACTOR'S DECLARATION
;rcby affirm,4yltlg6Qenalty of ear ury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions o , my license is in full force
J.eifect. License Class 1�" L �jCG License No `1 57 (o Date `� Contractor Signature
)RKERS' C{yyi£NSATION DECLARATION C' 3q T
IMMG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUS dD DOLL�000), IN ADDITION TO THE
jT QF� COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
!rebQ affirmpndgr%natty of perjury one of the following declarations:
khave and Vill rpiintain 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
�nce of the work for which this permit is issued. Policy No.
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' compensatio
trance carver and policy number ar$ /
le of Agent
certify that, in the pperformance of the
if I should becoml6 k bject to thew%
Policy Number
Date
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
ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
signature of Applicant Date_ �J -
30 22
)ECLARATION REGARD) STRUCTION LENDING AGENCY
hereby 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).
-ender's Name Lender's Address
3y 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,Jaws relating to building construction.
I authorize representatives of this city or county t ter the above-ide Ified roparty for inspection purposes. �/
signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name /� � Y O XT6-1 Date
ACTION DATE BY 0ECLARAZI04flOF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED
PERMITCANCELLED
CERTIFICATE OF ` ITFINAL(� �L „` PRO OSED
OCCUPANCY ISSUED IRGNIATUR
NOTIFICATION TO
NOTIFICATION IS NOT APPLICABLE TO
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