HomeMy WebLinkAboutX2020-2131 - PermitsCity of Newport Beach - Building Division
o$ ^2 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
u $ Inspection Requests Phone (949)644-3255
`iur •" Combination Type - CIP
IIIIIIIIIIIIII'IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IICOMB Permit X2020-2131
x 2 0 2 9 2 1 3 1 Project No:
Issued Date: 09/22/2020
Inspection Area : 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 09/23/2023 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 Holfcays
Job Address: 1441 W BALBOA BLVD NB
Description: COMM - TIO FLAT, APPLY BUR CAPSHEET 6 SCIS TO FLAT AREA CLASS "A"
Legal Desc.: TR 234 LOT 15 BILK 14 AND LOTS 16 TO 18 INC AND ALL-INCABAN ALLEY ADJ-
Owner:
OUR LADY OF MOUNT CARMEL
Address:
13280 CHAPMAN AVE
Record Management:
GARDEN GROVE CA 92840
Phone:
$0.00
Applicant:
CLAYTON DAREN
Address:
976 N LEMON ST
Hazardous Mat
ORANGE CA 92867
Phone:
714-639.7190
Code Edit: 2019
Type of Construction: VB
Occupancy Group: A2
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 1
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Construction Valuation:
Building Permit Fee: $212.00
Plan Check Fee: $0.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access:
$0.00
Hazardous Mat
$0.00
Building Green Fee:
$1.00
II TOTAL FE(: $213.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Contractor:
CLAYTON ROOFING INC
Address:
976 N LEMON ST
Fair Share :
ORANGE CA 92867
Phone:
714.639-7190
Con State Lie:
601226
Lie Expire:
02128/2022
Bus Lie: ,
BT30072987
Lie Exp Date:
0913012021
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9022682
Expire: 09/01/2021
Building Setbacks
Excise Tax:
Additional Fee:
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Rear: /
Front: /
Left: /
Right: /
°arkine Snaces
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee
0
Architect
Address:
Phone: - State Lie:
Engineer: -
Address:
Phone: State Lie:
Designer:
Address:
Phone:
Special Conditions:
Planning Department -
Fire Department
Plan check Fee
Fire Inspection:
Fair Share :
Fire Plan Rev
SJH Trans:
Demolition Fee
In -lieu Housing Fee
Building Dept Adm
Public Works Department -
Park Dedication :
$0.00
PM Plan Check :
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
$0.00
PUBLIC WORKS j
PLAN CHECK BY:
APPROVAL TO IS
11►�.�yahir]:i
at Permit
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
5213.00
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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:
at Permit
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
5213.00
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OWNER -BUILDER DECLARATION
I hereby affirm,underrartallyOf Padurythat J am exempt4ronilthe Contractors' Stats License Lawforthe .resson(s) Indicated belowby thwchaolurrark(p) i have placed nextio, the applicable Itern(s)
(Section 7031.6,8usines, andProfassions Code: Any, city or ccunty4haVrequireaa permM,construct, alter, Improve, demolish, or repair any sinticture;.pilbrto its Issuance, also raquires the applIcantfor
the parrot to file a signed statement that.hoorshe19�licansed pursuant to fhilLprovfilon&,,of.theC6ntractoral'ttate'.Ltoense LAW (Chapter 9'(commencingwith Section 7000),OfDVHOn 30fthe Business and
Professions Code) orthat he oraluris evemptfirom IlGansure and the basis forthe.alleged exemption. Anyviciation of Section 7031,6byany applIcantl[br apermit subjects the spoicant1c a civil ponailtyof
not more then five hundred dollars ($600).
M 1, as owner of the property, or my employees Whit wages as their sole compensation, will do L) all ofor U portions hof thevork,and the structure Is not intended or offered for sale. (Section 7044,
Business and Professions Code'. The Contractors' Stats,11cense Law does not apply to en owner of properlyi4ho,,through employees' ar-personal effort builds or improves:the pix tperty, provided that the
improvementsers not lnferided,or offered for able. If, however, the building or Imp, apply
sold.within one, kearpfbomp[jtlon, the Oviner-Buildawill haverthe,burden of proving that ftLWas not built or
ffI roved for the purpose if sale).
1, as owner of the property, am exclusively contracting with licensed Contraolors,Wconstruot the project (Section 7044, Business and Professions Code: The Contractors' State LicenseLowdoes not
apply to an owner of property who buildsor Improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors'Statvl.lcense Law).
ff I am exempt from llceiaure, under the Contractors' State LJoense Low for,the following reason;
By my signature below I acknowledge that except for my personal residence in which I must have ;resided for attleast one year priorAmcompletion of the. improvements;covered by this permit, I cannot legal�
sell a structure theft have built as an owner -builder If it his not been constructed1wits entirety by licansect.•contractors. 1,undeatand that,a copy of the appitcable law, SecffDn 7041, of the' Business and
Professions:COTIA,'14%lialIable upon request whan this application Is submitted,oratiliefollowhigWeb sftw.htfp-.[Ahww.leglnfo.ca.00V/caliaw.htmL
PignatuLe of Proilairly-Owr er or Authorized Agent Data
D fOF;VS DECLARATION
mencIna with Section 2t).=0fOiv=on3 of the Business and P ons and. myn se is in fu I#orca
hd 5 License No Z"ftal T29 �0,m pats
"dia"'Dem4ty of perjury thedlgrn licensed under provisions of Ch
rN E C�
I hereby� filan
-Iss'
of. fcanoe r
01�kERS =MP1jNZATJON DECLARATION
ITVITTMJitgp FAIL110%,79111151PP�; WORKERVOOMPENSAMON COVERAGPIS UNLAWFUL,-ANDTIML SUBJECT AN EMPLOYERTO cramINAL pENALT=AND,cmL PiNasup TO ONE nuNDRETo -rmousmv DOLLARS t$100"T� MAMMON TO THE
CO"Or COMPENS4'ftDN, DAN AGEWAsInRovioNo FOR IN secTION,3706 OF THE LABOR COVE, INTEREST, AND ATTORNEYS FEES -
A horeby affirm kindar%na Ity of palury one of the following,doolarallons:
0101?ave and "MUmaintain certificate of consentto eelf4neure for workers" compensation,: Issued by the Director of Industrial Relations as provided for byr Section 3700 of the Labor Code, for In(
awmairlarme Of the work f4miTich this permit Is Issued. PollcyMo.
1 I �arid 814tal: rworkers' oompansatfort'Insurance, as required by'Section, 3700 of the Labor Code, for the. performance of the work for which this p it I I sued. My workers' compensatfor
le cards policy numbevere;
4-P 417'L/MPolicy Number 0 2 �Z Expiration Data.
ate 7 Z
N me of Agent Phone#_
am
I carltry that, In the performance of the work forwhich this Is Issued, I shall not Employ any person in any manner so as to become subject to the workers' compensation liwe of California, and ogre
that, if I should become subject to the wo�ers' comp5pation provisions Section 3700 of the Labor Code, I shall conn ply with thoss provisions.
S Sign ITT Dat 7
ignature of AppilGen
DECLARATION RE RD ING CONSTRUCTION LENDING AGENCY
I hereby affirm under perrafty of pedurylliatthere Is a constructioiflandIng agency For the performance of the work for which this permit Is Issued (Section 3097, Civil':Code).
LeriderSNarna Lander'sAddiess
By my signature below, I certlfy to each.of the following:
I am the propartyr.owmo orauthorizedtolact on the property owner's behalf.
I have read this application and the Informallon I have provided falcorreot
I agree to comply with all aptillogbWorty and dounly,ordloancesandatate, Iowa relating to building construction.
Tauthorizarepreiien iveazlthis ItyOrcounly, eftiteMMbove-identified pr 4 fb I spection purposes.
isignatureotP.roperiyowr.arorAuthorlze-.._--.-,
— 22e EMT` "Print Frope4 Owners OrAuthortzed Agents•Name 6
ACTION DATE BY DECLARATION COMPLIA14CFMITH.CODEOF FEDERAL FOR OFFICE USE ONLY
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