HomeMy WebLinkAboutX2019-2423 - PermitsCity of Newport Beach -Building Division IIIIIIIIIIIIIIIIIII�'lllllllllllllllllllll
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COMB Permit: X2019-2423
n 100 Civic Center Drive Newport Beach, CA 92660
a°
X 2 0 1 9
2 4 2 3
Planning Department -
Project NO
Permit Counter Phone (949)644-3288
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y, Inspection Requests Phone (949)644-3255
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Additional Fee :
$0.00
Issued Date : 0810512019
�'�txgnp� Combination Type - SFP
Fire Inspection:
$0.00
Overtime Plan Ck:
Inspection Area : 2
Grading Bonds Fee:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Fair Share :
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: 249 LA JOLLA DR NB
$0.00
Description: SFR T/O COMP. INSTIL 1 LAYER 30 # FELT. INSTIL 23 SQ COMP -
$0.00
-
Legal Desc.: N TR 444 LOT 33
$0.00
SJH Trans :.
Owner: : DUN CHARLES J Contractor:. CALIFORNIA ROOF LIFE CO INC
Architect:
-
Address: 249 LA JOLLA DR Address: 8941 MINT AVENUE
Address:
$0.00
92663 WESTMINSTER CA 92683
Grading Permit Fee:
$0.00
Phone: Phone:. 714.847-7663
Phone:
State Lic:
Applicant:. CALIFORNIAN ROOF LIFE CO INC Con State Lic: 509623
Engineer:
Energy Compliance:
Address: 8941 MINTAVENUE Lic Expire: 04/30/2021
Address:
Grading PC Fee:
WESTMINSTER CA 92663 Bus Lic: BT30068654
Public Works Department -
Phone: 714-847-7663 Lic Exp Date:. 04/30/2020
Phone:
State Lic:
Code Edit: 2016 Worker's Compensation Insurance
Designer.
Type of Construction: V-B - - Carrier:. STATE COMP INS FUND
Address:
Park Dedication : $0.00
Occupancy Group: R3/U Policy No: 9086375
Refund Deposit
$0.00
Added /New sq.ft. Bldg: 0 Expire: 01101/2020
Phone:
$0.00
.Added /New sq. ft. Garage: 0
-
No of Stories: 1. Building Setbacks Rear:' I
Special Conditions:
Grading Bond:
FLeft:.
Hazardous at
_
CTOR
Bldg Height: 0 /
Electrical %:
$0.00
i i � - E
Bldg Sprinklers: Right: /
Finnd 7nner Ilse 7nne- Pnrkinn Snanas- n
Fire Hazard 7nne : N
$1.00
Building Permit Fee:
$324.00
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
PM Plan Check: $0.00
Grading Bond:
$0.00
Hazardous at
$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 :
$325.00
Plan Check Fee
: $0.00 Fee
Due at Permit Issuance :
$325.00
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0 0 0
PROCESSED BY:
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-.- -
O C O O 6 C
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PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
-
PLAN CHECK BY:
GRADING APPROVAL:
o`c. `°�
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APPROVAL TO ISSUE:
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OWNER -BUILDER DECLARATION
'e
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 the Business 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 penalty of
not 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 (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).
❑ 1 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 resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal[,
sell 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.htm].
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of peI m licensed under provisions$2 ter (c mencing with Section 7000) of Di is. n 3 of the Business and Profes iD ode, a tl "cense' ' full force
and effect. License Class ( -- ,S License No ` �e5 Date Contractor Signatur G° -
WORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OLLARS ($100,000), IN ADDITION TO THE
COST 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:
I 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 th
Derf Wince of the work for which this permit is issued. Policy No.
2I npve 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
nSSurl;(nce carrier and polic number
ner/�. / Policy Number ii lC 6 / s ' C>� Expiration Date
Name of Agent Phone #
:1I certify that, in the performance 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
:hat, if I should become sy 1e a workers' c nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applica Date
DECLARATION REG D CONST TI LENDING AGENCY
hereby affirm under penalty of perju that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, it 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 owners behalf.
I have read this application and the information I have provide 's correct.
I agree to comply with all applicable city and county ordinan and state laws relating to building construction.
I authorize representatives of this city or count to er t ove-ide 4tif rop for inspection purposes..
Signature of Property Owner or Authorized A ent ` Print Property Owner's or Authorized A ent's Name Date
ACTION DATE BY DECLA ATIONCOMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS KRT61 OF TITLE 40 ANDAQMD RULE
1403
PERMIT EXPIRED L1 I SUBMITTED ASBESTOS NOTIFICATION TO • • • • '
• • • • • • ••
PERMIT CANCELLED EPA • ' • • .. • ••
PERMITEXTENDED
QMD
PERMITFINAL ASBESTOS NOTIFIC ION IS NOTAPP ICABLE TO
CERTIFICATE OF PROPOSEDE A I��• • • • ••• e•
OCCUPANCVISSUED SIGNATURE:
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