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XR2023-0639 - Permits
k�eWPoRr City of Newport Beach @ Community Development Department- Building Division `Sy' 100 Civic Center Drive, Newport Beach, CA 92660 T r1 - permit Counter Phone: (949) 644-3288 u Inspection Requests Phone: (949) 644-3255 01t,po newportbeachea.gov/inspections Combination Type - SFP Work Class - Other COMB Permit : XR2023-0639 X R 2 0 2 3 0 6 3 9�� Plan Check No: Issued Date : 0310812023 Inspection Area : 6 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS Job Address: 37 ANDIAMO Legal Desc : N TR..15337BLK LOT 59 Description: SFR -REMOVE EXIST'G SLATE TILE AND REPLACE WITH LIGHTWEIGHT CONCRETE TILE (7LBS/SO FT) 32 SO Owner: CRANDAL RAYMOND B TR Contractor: SIMPLE ROOFING Architect: Address : 37 ANDIAMO Address : 5572 ELM AVE Address: NEWPORT COAST, CA 92657 LONG BEACH, CA 90805 Phone : (562) 822-4518 Phone: Phone : Con State Lic : 1042545 State Lic Lic Expire : 08/31/2024 Applicant: SIMPLE ROOFING Bus Lic: BT30080632 Engineer Address: , Address : 5572 ELM AVE Bus Lic Expire : 02/29/2024 LONG BEACH, CA 90805 (562) 822-4518 Workers' Compensation Insurance Phone: ; Phone: Carrier: STATE COMP . Owner/Builder : Policy No: 9302631 Designer Address Address : W. C. Expire : 7/25/2023 Phone: Phone: 2022 Fire Sprinklers : NO Construction Valuation : $19,00U..00' Code Edition : Fire Hazard Zone : YES Added/New/TI sq. ft. Bldg : 0 Type of Construction : V-B 1 Alteration sq. ft. Bldg: Occupancy Groups : U,R-3 No of Units : 2 Added/New sq. ft. Garage : 0 Bldg Height : No of Stories : TOTAL sq. ft. 0 Building Setbacks : Front: 10, Side: 5, Side: 5, Rear: 10 Flood Zone : X Use Zone : PC - Newport Coast _ (Ze, PROCESSED BY: SPECIAL CONDITIONS: LANDSLIDE OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt hom the Contractors' State License Law far the reason(s) indicated below bythe checkmark(s) I have placed next to the applicable items) (Section 7031.5, Business and Professions Cade: Any city or county that requires a permit to construct, alter, improve, demolish. orrepair any structure, prior to its Issuance, also requires the applicant for the permit to file a signed statement that ho or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 mind Business and Professions Code,) or that he or she Is exempt from )!censure and the basis for tho alleged exemption Any violation of Section 7031 s5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). El I, as owner of the property, or myemployees with wages as their sole compensation, will do f_) 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 m 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 ContractorsState 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), © I am exempt from licensure 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 residedfor at least Ono year prior to completion of the improvements covered by this permit, i cannot iegali sell a structure that I have built as an owror-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;hitp:llwww.leginto.ca.gpviCalaw.html.- Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of penury that l am licensed under provisions of Chapter 9 (Commencing with Section 7000) of 'uision8-of the Business and Professions Code, an y license is In full force and effect License Class License No Date Contractor Signature NORKERS' COMPENSATION DECLARATION "e--- NARNING: FAILURE TO ScLQRR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES GP TO ONE HUNDRED THOUSAND [COLLARS ($100A001, IN ADDITION TO THE COST OF COMPENSATI"f% 7.1MAGES AS PROVIDED FOR IN SECTION 3T06 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FeES. her9i7 "i +irm un+ler penalty of perjury one of the following daclarations: I have and wit mbitdam a certificate of consent to self- insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th )erformance of the w xk for which this permit Is issued. Policy No, 111lihave and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued, My workers' compensation nsura,tce „arrier ar,J ,f po,icy numb ra lamer � 4Z ✓f ` Policy Number Expiration pet® dame of Agent. Phone ?f 910t, in the performance of the work for which this permit I$ issued. I shall not employ any person in any manner $o as to become subject to the workers' compensation laws of California, and agree hay, it I shnuld beromr, si'blect to the wodcers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. if areby al irm 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 properly owner's behalf, I have read this application and the Information I have provided is correct. �yviH /q I agree to comply With all applicable city and county ordinances and state laws relating to building construction. ( Z I authorize representatives of this city or couny to enferjha va-identified property or Inspection purposes, ACTION i`'S /17Tc„,,_I BY KFGll AT ONS PARTN OF hN PUANCF. W17H CODE 6.t OP TITLE 40 AND OMO RIF ill At FOR OFFICE USE 6NI.Y I PC ASBESTOS NOT IFICAVION IS NOT APPLICABLE TO CEA77FWATCC1f 7 2 vrw.Hp 9EMOL OCCUPANCY ISSUED A ITIO6 —