HomeMy WebLinkAboutX2021-2406 - PermitsCity of Newport Beach - Building Division
*X2021-2406*
COMB Permit: X2021-2406
100 Civic Center Drive, Newport Beach, CA 92660
PfOJOCt NO
Permit Counter Phone (949)644-3288
Inspection Requests Phone
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(949)644-3255
VM
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Combination Type - MFP
Issued Date: 0910912021
Inspection Area : 3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 09/09/2024 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 Holidays
Job Address: 117 54TH ST NB
Description: MFR REROOF T/O COMP SHINGLES
& REPLACE W/ COMP SHINGLES 13 BOB CLASS B
Legal Desc.: RIVER SECTION LOT 8 BLK 54
POR IN SEC 29 T 6 R 10
oeee'/1
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Owner: CARNECCHIA SCIPIO M
Contractor: REFINED ROOFING
Architect:
0
Address: 2484 RAMONA ST
Address: 309 MARWOOD AVE
Address:
Z
PALO ALTO, CA 94301
FULLERTON, CA 92832
"
"
Phone:
Phone: 714-737-2282
Phone:
State Lie:
Applicant: BIADINO MIKE
Con State Lie: 1062926
Engineer:
M
Address: 309 MARWOOD AVE
Lie Expire: 02/28/2022
Address:
FULLERTON, CA 92832
Bus Lie: BT30076549
Phone: 714-737-2282
Lie Exp Date: 09/3012022
Phone:
State Lie: jj'j
m
Code Edit: 2019
Worker's Compensation Insurance
Designer:
Type of Construction: V-B
Carrier: CAROLINA CASUALTY INS
Address:
e o
Occupancy Group: R3/U
Policy No: BNUWC0154706
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Added /New sq.ft. Bldg: 0
Expire: 07/23/2022
Phone:
Z
Added /New sq. ft. Garage: 0
C) ^ ^
No of Stories: 2
Building Setbacks Rear: I
Special Conditions:
No of Units : 2
Front: /
Bldg Height: 0
Left: /
rn
Bldg Sprinklers:
Right: 1
Flood Zone:
Use Zone: Parking Spaces: 0 '
Fire Hazard Zone : N
11 Construction Valuation: $3,800.00
Building Permit Fee:
$351.00
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
PAW Plan Check:
$0.00
Grading Bond:
$0.00
Hazardous Mat
$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 : $352.00
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$352.00
PROCESSED BY:
PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
GRADING APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE: l
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 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, priorto 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 Cade: 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).
I am exempt irsn licensure under the Contractors' State License Law for the following reason:
By my signature bclov 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
^ell e rt ucture th3` 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, in available upon request when this application is submitted or at the following Web site:http:/Aw .leginfo.ca.gov/calaw.html.
SignaWre of Property Owner or Authorized Agent Date
:.ICENSED CONTRACTOR'S DECLARATION
I hereby affirm ender pn.nalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 00 of Di ision 3 of the Business and PrVione, and my license is in full force
ana Pffect. License Class License No Date 2 Contractor Signature
_PORKERS' COMPENSATION DECLARATION
-VJ'N'VG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO SANO DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSAT:ON, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm ur.der penalty of perjury one of the following declarations:
I ha',e 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 the
ierfor mance of,the worn for which this permit is issued. Policy No.
I 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 workers' compensatiol
nce carrier and policy number are:
carrier Policy Number Expiration Date
'Jame of Agent Phone #
I certify that, in the performs a 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 agree
:hat, if I should become uuto c e the rs' tom ensa n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant I / X Date 2
DECLARATION REGA G CONSTRUCTION LENDING AGENCY
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, Civil 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 owner's behalf.
I have read this application and the information I have pr vided is correct.
I agree to comply with all applicable city and cou y or antes and state laws relating to building construction.
I authorize representatives of this city or coun t e tlVthe above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name r/-" U7a� �`ro Da 9�2
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OE FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQM D RULE
PERMIT EXPIRED
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED
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PERMIT EXTENDED
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PERMITFINAL
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