HomeMy WebLinkAboutX2021-3234 - Permitsaxt„T City of Newport Beach - Building Division *X2021-3234* COMB Permit: X2021-3234
Jam' 100 Civic Center Drive, Newport Beach, CA 92660 Project No
F~ .i 5,�- n Permit Counter Phone (949)644-3288
�s.. Inspection Requests Phone (949)644-3255
.hx Issued Date
`,tara,ti<N'% Combination Type - MFP 1 LC- r
Inspection Area : 4
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 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: 545 VISTA FLORA NB
Description: MFR TILE -RELAY: REPLACE UNDERLAYMENT WI 30# FELT
UNDERLAYMENT. REPLACE (E) TILES. 18
SQUARES.
Legal Desc.: TR 5740 (L.L.84-214028) PAR 31
Owner: SANDERS MARY
Contractor:
CLIFF BROWN ROOFING INC
Architect:
Address: PO BOX 8134
Address:
32742 ALIPAZ STREET 124
Address:
NEWPORT BEACH, CA 92659
SAN JUAN CAPISTRANO, CA 92675
Phone: 949-903-1041
Phone:
949-458-9440
Phone: State Lic: ..
Applicant: SANDERSMARY
Con State Lie:
506664
Engineer:
Address: PO BOX 8134
Lie Expire:
0813112023
Address: . , .-
NEWPORT BEACH, CA 92659
Bus Lie:
BT30077354
Phone: 949-903-1041
Lie Exp Date:
11130/2022
Phone: State Lie: '
Code Edit: 2019
Worker's Compensation Insurance
Designer: -
Type of Construction: V-B
Carrier:
STATE COMP
Address: -
Occupancy Group: R3IU
Policy No:
9072710
- - -
Added /New sq.ft. Bldg: 0
Expire:
10101/2022
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2
Building Setbacks
Rear: /
Special Conditions:
No of Units : 2
Front: /
'
Bldg Height: 0
Left: I
Bldg Sprinklers:
Right: I
-iaoa 4one. A
Construction valuation: $21,200.00
Building Permit Fee:
$351.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $0.00
Additional Fee :
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
Overtime Plan Ck:
$0.00
Grading Bonds Fee:
$0.00
Fair Share :
$0.00
Fire Plan Rev
$0.00
Investigation Fee:
$0.00
Grading PC Consultant :
$0.00
SJH Trans :
$0.00
Demolition Fee
Record Management :
$0.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee :
$0.00
Building Dept Adm
$0.00
Energy Compliance:
$0.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety:
$0.00
WQ Insp. Fee:
$0.00
Park Dedication :
$0.00
Refund Deposit
$0.00
Disabled Access :
$0.00
P/W Plan Check :
$0.00
Grading Bond:
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
San Dist :
$0.00
Building Green Fee :
$1.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL
FEE: $352.00
Plan Check Fee
: $352.00
Fee Due at Permit Issuance :
$0.00
PROCESSED BY:
ZONING APPROVAL:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL: 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 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).
D 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,
'usiness 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
nproved for the purpose of sale).
D 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).
7 1 am exempt from licensure under the Contractors' State License Law for the following reason:
ly my signature helrv' 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
'riEsJions Cope, is ,.vailable 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
.ICEMSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of p ury that am licensed under provisions of Chapter 9 (commencing with Section 700 ) pf Division oche Business and Profes\sio Co and my license is in full force
nd Effect. Lioecse Glass ('�— 3 g License No C ( to Date / Contractor Signature -.q'
VGKKERS' COMPENSATION DECLARATION
ARMNG: 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
CST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
he•eb, affirm under penalty of perjury one of the following declarations:
J I hove 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 IN
Airkmance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
Policy Number
of Agent
Date
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
if I should become subject WAS wo*rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
of Applicant
121
IECLARATION REGARDING CONSTRUCTION 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
y 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 county to ant. th9e bove-identified pro rty for inspection purposes.
ignature of Property Owner or Authorized Agent i�( 1l Print Property Owner's or Authorized Agent's Name V
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED IJ SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED EPA
PEMITEXTENDED I ❑AQMD
PERMITFINAL (�� p/Z`L IL�KA
PROPOSED DEMOLITI NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATE OF // '(/ // �j
OCCUPANCYISSUED AIA. -{ SIGNATURE: Y'