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PERMIT
wport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit: X2022-1586
r Drive, Newport Beach, CA 92660 Project No
Phone(949)644-3288
jests Phone (949)644-3255 Issued Date : 0610612022
Fype - SFP Inspection Area : 7
ERMIT LL BE
onSHourrs: Monday 180 DAYS AFTER'Friday 7.00 a.m. to 6:30 p.m. andSSUANSaturdayfrom 8.00 a.m. o 6 00 p.m. No work on Sundays)or Holidays
Job Address: 2322 BRISTOL ST �B
Description: SFR REROOF TIO OMP SHINGLES AND REPLACE W/ COMP SHINGLES 28 SOS
Legal Desc.: TR 1499 LOT 2 PO OF LOT
Owner: LONG CRAIG
Address: 2322 BRISTOL ST
NEWPORT BEACH,
A 92660
Phone:
Applicant: LONG CRAIG
Address: 2322 BRISTOL ST
NEWPORT BEACH,
CA 92660
Phone: 949-378.0527
Code Edit: 2019
Type of Construction: V-B
Occupancy Group: R3
Added /New sq.ft. Bldg:
Added/New sq. ft. Garage:
No of Stories: 1
No of Units : 1
Bldg Height: 0
Bldg Sprinklers:
Construction Valuation:
Building Permit Fee:
$351,
Plan Check Fee: $0.00
Overtime Plan Ck:
$0
Investigation Fee:
$0
Record Management:
$0
Energy Compliance:
$0
CA Seismic Safety :
$0
Disabled Access:
$0
Hazardous Mat
$0
Building Green Fee :
$1
TOTAL FEES: $362.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Contractor: O W NER/BLDR
Address:
Phone
Con State Lic: O/B
Lic Expire:
Bus Lic:
Lic Exp Date:
Worker's Compensation Insurance
Carrier:
Policy No:
Expire:
Building Setbacks Rear: 1
Front: I
Left: /
Right: I
a
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
State Lic:
State Lic:
Phone:
Special Conditions: 01B FORM ATTACHED
Excise Tax:
$0.00
PlanningDepartment-
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
$0.00
In -lieu Housing Fee
Public Works Department
-
Grading PC Fee:
WO Insp. Fee:
$0.00
Park Dedication :
$0.00
Plan Check:
$0.00
Electrical %:
$0.00
San Dist:
$0.00
$0.00
Mechanical %:
$0.00
NMUSD Fee:
Plumbing %:
$0.00
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
p70
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance : $352.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
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
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 theBusiness 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 r-nalty of
yrjL�nore 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).
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
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 l;censure under the Contractors' State License Law for the following reason:
Ry 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 Iegall
eli a sbucture fha+ I heve built as an owner -build r if ¢ 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 CoJe, is dvailable upon request whe 'S app iY}ation is Ibmitted or t following Web site:http://www.leginfo.ca.gov/cafaw.html. Sig7atur_ of Prope: ty Owner or Authorized Agen oat 6-6-2 (� 2 Z.
LICENSED CONTRACTOR'S DECLARAT ON O
hereby affirm uMe ',enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
end eF,ect. License Class License No Date Contractor Signature
/vORKPRS' COMPENSATION DECLARATION
NARNINU: 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 ($10(3,000), IN ADDITION TO THE
'CST D-'OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
-hereby affirm under penalty of perjury one of the following declarations:
I nave 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
Ie:Pa,n,ance of ''he work for which this permit is issued. Policy No.
I 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'
urance carrier and policy number are:
Policy Number
of Agent
Date
I 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
It, if I should become subject
the wor rs' compensatio provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature CLAR of Applicant's / .r/stt� .0 D 6-6� Z
CLARATION REc_y�tRD1t�G CONS'S` TION LENDING AGENCT
areby affirm under enalty off perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
tder'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 o my ordinances and state laws relating to building construction.
I authorize representatives of this city or cou toe er the alive -identified p oparty for inspection purposes. A i
nature of Property Owner or Authorized Aoen —��..ia-..'1___... ?,f ._. _ „-._. ,. - i C /1....
DECLAAA
N OF COMPLIANCE WITH CODE OF
DATE BY I REGULATIONS PART 61 OF TITLE 40 AND AOMO RULERAL FOR OFFICE USE ONLY
PERMITEXPIRED I SUBMITTED ASBESTOS NOTIFICATION
PERMITCANCELLED EPA
PERMIT EXTENDED AC MD
CERTIFICATE
^� /STOS N IFICATION 15 NOT PPLI
CERTIFICATE OF ��!/�-� (///yyS PROPOSED DE LITIO )/p
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