HomeMy WebLinkAboutX2021-0520 - Permitsh City of Newport Beach - Building Division IIIIIIIIIIII'I''�IIIIIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 x 2 0
p,. Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - SFP
PCKIVIII CAVIKCJ "IOU UA TO API CK /JJUANUC UK LAO VALID INSPCGIIUN. PKUJCGI J MU51 BC r;UMPLCICU BY 0
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.
Job Address: 100 LINDA ISLE NB
Description: SFR TIO SLATE ROOF. USE (E) SHEATHING, REPLACE AS NEEDED. INSTIL 2 LAYERS BORAL SEAL UNDERLAYMENT. INSTL 32
Legal Desc.: TR 4003 LOT 100 AND POR SW114 SEC 26 T6 R 10 AND FOR IRVINE SUB
Owner: THE WM D SHAPIRO TRUST
Address: 893 E BRIER DR
SAN BERNARDINO CA 92408
Phone: 909.519-3370
Applicant: SHAPIRO SUSAN
Address: 100 LINDA ISLE
NEWPORT BEACH CA 92660
Phone: 951-212-3828
Code Edit:
2019
Type of Construction:
V -B
Occupancy Group:
R311)
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
2
No of Units :
1
Bldg Height:
0
Bldg Sprinklers:
N
Flood Zone:
X
Construction Valuation: $30.000.00
Building Permit Fee:
$343.00
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:
$2.00
TOTAL FEE: $345.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
COMB Permit: X2021-0520
Project No:
Issued Date : 03/0412021
Inspection Area : 2
OR PERMIT WILL BE INV
n Sundays or Holidays
(new tile 318", lighter than
Contractor:
Address:
OWNERIBLDR
SHAPIRO SUSAN
Architect:
Address:E,
Fire. Inspection:
Phone:
Con State Lie:
951-212-3838
OIB
Phone:�ate
Engineer:
Lic:fjy
Lie Expire:
Building Dept Adm
Address:
4
Bus Lie:
P/W Plan Check:
$0.00
San Dist:
Lie Exp Date:
NMUSD Fee:
Phone:
State Lie:
Worker's Compensation Insurance
Designer:
Carrier:
Address:
Policy No:
Expire:
Phone:
Building Setbacks
Use
Excise Tax:
Additional Fee
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: I
Front: I
Left: /
Right: /
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee
Special Conditions: HIGH DENSITY
FORM SIGNED
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
P/W Plan Check:
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
$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
$345.00
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:
$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
$345.00
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 it®m(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 L) all of or L) 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).
JI, 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
a ly 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).
m exempt from licensure under the Contractors' State License Law for the following reason:
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
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 Ill 1 a f�G�np its sugn itled or at the following Web site:http://www.leginfo.ca.gov/calaw.html. l z��
Signature of Property Owner or Authorized AgentI �N�t`I \ - Date�V'T
LICENSED CONTRACTOR'S DECLARATION)
I 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
and effect. License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: 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 THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
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
perfo nce of the work for which this permit is issued. Policy No.
ve 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
sur carrier and policy number are:
arrier Policy Number Expiration Date
e of Agent Phone #
I rtify 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
I should becomes bject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions-
Signature
rovisions.Sgature of Applicant s Q Y Dat _L� IMt KA 202
DECLARATION REGARDING C NST�O LENDING AGENCY
I hereby affirm 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, ivil Code).
Lender's Name Lender's Address
By 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 provided is correct. ✓
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.--
[
onstruction.✓I authorize representatives of this city or coun to n the above-identified property for inspection purposes. ✓ �Yti(N\iU2�
Signature of Property Owner or Authorized Agent a Print Property Owner's or Authorized Agent's Name 12. Date
ACTION DATE BY DECLARATI&W OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403 +
PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO ••• • e i ••: • ••
• • • • a
PERMIT CANCELLEDEIEPA + • • • • , . ,
PERMIT EXTENDED aQMD
PERMITFINAL ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
CERTIFICATE OF g/�i PR POSED DEMOLITI •e• •' • • ••• •.
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