HomeMy WebLinkAboutX2019-1139 - Permits� �wt,ect F City of Newport Beach - Building Division ill 11111111111p11111111111111111111p111p11111111� Jill
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 1 1 3 9
Permit Counter Phone (949)644-3288
Inspection Requests Phone(949)644-3255
rw rnw"' Combination Type - SFP
COMB Permit: X2019-1139
Project No
Issued Date: 04/10/2019
Inspection Area: 8
Left: I
Right: /
Excise Tax:
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
JobAddress: 424 VISTA ROMA NB
p1dgc8prinklets: °
$0.00
Description: SFR- RE -ROOF 22 SQ BORAL CLAY TILE 6 PSF. ESR 1647
Flood Zone: °
Legal Desc.: N TR 6996 LOT 21
co
° ®
,Collstructioh WWI= $24.797.00
Owner: ALEAND LLC
Contractor: OWNERIBLDR
Architect:
Address: 6 HORIZON -
Address: ASTIN RICHARD
Address:
NEWPORT COAST CA 92667
In -lieu Housing Fee:
\'
Phone: -
Phone:
Phone: ", State ldc:�
Investigation
$0.00
°
Applicant: ASTIN RICHARD
Con State Lie: O/B
Engineer:
Address: 1048 IRVINE AV #374:
Lie Expire: -
Address:'
NEWPORT BEACH CA 92660
Bus Lie:
$0.00
Phone:
Lie Exp Date:
Phone: State Lie:
Code Edit: 2016.
Worker's Compensation Insurance
Designer:
Type of Construction:
Carrier.
Address:
Occupancy Group: R3/U
Policy No:
' Added /New sq.ft. Bldg: 0
Expire:
Phone:
Added /New gq, k°Garage: 0
° No -of Stories:: m 0
Building Setbacks Rear: /.
Special Conditions: 018 AUTH FORM
�.° Nmo? Units: 1
Front: /
ATTACHED
Left: I
Right: /
Excise Tax:
Bldg°Height:.°°°°° 0
Planning Department -
°
p1dgc8prinklets: °
$0.00
Plan check Fee
Flood Zone: °
Grading Bonds Fee:
co
° ®
,Collstructioh WWI= $24.797.00
General Service
Grading PC Consultant:
$0.00
0
4�bjJding Permit Fee: $324.00..
°
Plan Check:FW c $0.00
In -lieu Housing Fee:
°
Cvertime Plat Ck:
$0.00
Public Works Department -
Investigation
$0.00
°
°Fee:o
Record Management:.
$0.00
o °
€f (lrgy CoinpSience:
$0.00
Electrical %:
CA Seismip`Safe4y,:
$0.00
$0.00
Disabled AcaesEsl�
$0.00
NMUSD Fee:
Hazardous Mat
$0.00
$0.00
Building Green Fee :
$1.00
Left: I
Right: /
Excise Tax:
$0.00
Planning Department -
Fire Inspection:
Additional Fee :
$0.00
Plan check Fee
Demolition Fee
Grading Bonds Fee:
$0.00
Fair Share :
General Service
Grading PC Consultant:
$0.00
SJH Trans:
Grading Bond:
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
TOTAL FEE: $325.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Plan Check Fee: $0.00 Fee Due at Permit Issuance :
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$325.00
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:
Plan Check Fee: $0.00 Fee Due at Permit Issuance :
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$325.00
OWNER -BUILDER DECLARATION
I hereby affirm under penally 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(l)
lection 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).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Secticn7044,
lusiness 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
oproved for the purpose of sale).
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
p an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' Slate License Law).
JA a exempt from licensure under the Contractors' State License Law for the following reason:
Iymy s gnature 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 legall,
ell a s ucture that I have built as an owner -builder if it has W been constructed in it b- licensed contractors. I understand that a copy of the applicable law, Section 7044 of t e Business and
fe ions Code, is available upon request wh t is ap t' Is s 1t at the following Web site:http://www.leginfo.ca.gov/calaw.html.
'ignature of Property Owner or Authorized Agerr��^'
.ICENSED CONTRACTOR'S DECLARATION\
hereby affirm under penalty 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
nd effect. License Class License No Date Contractor Signature
COMPENSATION DECLARATION
'ARNING: 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 T
OST OF COMPENSATION, 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:
] 1 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
arformance 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 worlteril'.cc
ranca carrier and policy number are:
:.....
Policy Number
Date
of Agent rnane s
¢ Ify 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 CalitorBia, and
/if I should become subject tG he workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith. comply with those provisions. „„'
�- Date
ture of Appllcan
:LARATION REGIfG CONSTRUCTION LENDING AGENCY
17�—
,eby affirm under penally 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).
Jer's Name Lender's Address
ny signature below, 1 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.
1 authorize representatives of this city or county_ to nt�Pc�thrbove-id ntifi� i d property for inspection purposes.
nature of ProOertv Owner or Authorized ADent, )—)�-- - Print Properly Owner's or Authorized Agent's Name
ACTION DATE BY DECLARATION OF X
REGULATIONS PART61OF IIT E 40AN AQMD RULE CE WITH CODE OF AL FOR OFFICE USE ONLY -
L-1 I SUBMITTED ASBESTOS NOTIFICATION TO
L I{dASBESTOS NOTIFICATION IS NOT APPLICABLEc TO
OF S -I1. 11 PROPOSEDYDEMOLITION
ISSUED SIGNATUR
Date
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