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Home My WebLink Aboutx2011-2194 - Permits4` City of Newport Beach Building Division COMB Permit No: X2011-2194 PROJECT NUMBER: PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 �`5 Combination Type - SFP/ / / / Job Address: 3508 SURFVIEW LN NB Description:TIO (E) 30 SQ, INSTALL 7116 OSB, 2-LYRS G40F FELT, SAXONY 5.7, ESR-1647 CRRC 0942-0063, CLASS A Inspector Area: 5 Legal Desc.: N TR 6228 LOT 2 Owner: INDIEK VICTOR Contractor: HOYT ROOFS INC Architect: Address: 3508 SURFVIEW LN Address: 1809 N ORANGETHORPE PK Address: q CORONA DEL MAR 92625 ANAHEIM CA 92801 Phone: 949-769-6465 Phone: 714-773-1820 Phone: State Lic: Applicant: ACOSTA NICK Con State Lic: 606111 Engineer: - Address: 1809N ORANGETHORPE PK Lic Expire: 12131/2012 Address: - ANAHEIM CA 92801 Bus Lic: BT30001609 Phone: 714-773-1820 Lic Exp Date: 10/31/2011 Phone: State Lic: Code Edit : 2010 Worker's Compensation Insurance Designer: Type of Construction: VB Carrier: STATE COMP INS FUND Address: .. Occupancy Group: R3/U Policy No: 639-0000226 :�,,..... y_ Added /New sq.ft. Bldg: 0 Expire: 01101/2012 Phone: Added /New sq. ft. Garage: 0 - No of Stories: 1 Building Setbacks Rear: 6 Special Conditions: IM MLLOAVERIFY SMOKEAND CARBON No of Units : 1 Front: 10 MONOXIDE DEFECTORS ARE EXISTING Bldg Height: 0 Left: 6 PER CRCR 314.7 &5752 Bldg Sprinklers: Right: 6 Flood Zone: Use Zone: R-1-6000 Issued Date: 09/06/2011 Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $19,500.00 Building Permit Fee: $364.46 Solar System PC: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 Excise Tax: $0.00 Plan check Fee : $0.00 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Fair Share : $0.00 ` Fire Plan Rev $0.00 Investigation Fee: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $1.00 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 PAN Plan Check: $0.00 Fee Increase: Fee: $0.00 Electrical %: $0.00 San Dist: $0.00 Additional Fee : $0.00 Mechanical W $0.00 NMUSD Fee: - $0.00 $0.00 Hazardous Mat: $0.00 Plumbing %: $0.00 - $0.00 Building Green Fee: $1.00 TOTAL FEE: $356.46 V Plan Check Fee: $0.00 Fee Due at Permit Issuance : $356.46 PROCESSED BY: « o c o o 0 0 o PUBLIC WORKS APPROVAL: ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: c ` `o ` - APPROVAL TO ISSUE: - `"° PWMITy E,(F�IRE 1�0 JAYS AFTER �.1 ISSUANCE OR LAST VALID INSPECTION. 0 ae 01, - 0 "1 .y DWNER-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 the 134iness 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 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 legally 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 7 44 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:hftp://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent D LICENSED CONTRACTOR'S DECLARATION I hereby affirm under enalty of perjury that I am licensed under pr visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ro de, d m se-isirrtnl'rfprce and effect. y / %-6_`� License Class �� 1 License No 0401 DataContractor Signature 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 DOLLARS (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under penalty of perjury one of the following declarations: have and will' maintain -'a-certificate. of:consentJo self -insure for workers' compensation, Tn� ofthework for which this permit Is Issued. Policy No. §ve and will mainn[ahn'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' nce Carrier icy number are: n l .r V) . \ CdaliwAll�nner I n I"1 Expiration Date of Agent issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for certify that, in the performance of wo ch pe s hall note any pe in any manner so as to become subject to the workers' compensation laws of California, and agree i, if I should becom4suect tot w to ov s 0 of the Labor Code, I shall forthwith comply with those provisions. 9 / nature of Applicant Da CLARATION REGAC NST UCTION NDING AGENCY Ireby 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, Civil Code). Ider'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 prope rs alf I have read this application and the information I hav to i orr I agree to comply with all applicable city and cou or St I dirrg'censkuction. )`— I authorize representatives of this city or county to = nti rty for inspection purposes. 1r�'l / ri/1jV Date_ nature of Property Owner or Authorized Agent Print Property Owners or Authorized Agent's Name AC77DAI DATE BY DECLARATION OF COMPLIANCE MTN CODE OF •• • FOR OFFICE USEONLY FEDERAL REGULATIONS PART@118FTME400VP • e AQMORULE1403. . • • • • • • s .• PERM7TEKPdRED ❑ 1 SUBMITIED ASBESTOS AM) 4 CAZIDAFTO: ❑ EPA e • •• ❑ AQMD PERMITCANCELLED PERMtTEXTENDED PROPOSED D DEMOUTION ASBESTOS LION IS NOT APPLICABLE TO ee ees e• • ... s s• e e • e e e s w PERMIT FINAL -J Z r // D/�+ti �� CERTIFIC4TEOF SIGNATURE: °oo e OCCUPANCYISSUED eee 0 e eee e ewe