HomeMy WebLinkAboutXR2023-0340 - Permitso�a.�Rr City of Newport Beach
6+ Community Development Department- Building Division
F 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone: (949) 644-3288
�xS Inspection Requests Phone: (949) 644-3255
C9�IFORH\P newportbeachca.gov/inspections
Combination Type -
Work Class - Other
COMB Permit : XR2023-0340
Plan Check No :
Issued Date : 02106/2023
Inspection Area : 6
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address: 612 MARIGOLD AVE Legal Desc : A TR CORONA DEL MAR BLK 640 LOT 14
Description: MFR REROOF (FRONT UNIT) T/O COMP SHINGLES AND REPLACE W/ COMP SHINGLES 12 SQS
Owner: HOLMES PATRICIA MC MICHAEL TR
Address: 604 VIA LA PALOMA
RIVERSIDE, CA 92507
Phone:
Applicant:
SIMPLE ROOFING
Address :
5572 ELM AVE
LONG BEACH, CA 90805
Phone:
(562)822-4518
Owner/Builder
:
Address :
Contractor:
SIMPLE ROOFING
Address `.
5572 ELM AVE
LONG BEACH, CA 90805
Phone:
(562)822-4518
Con State Lie:
1042545
Lie Expire :
08/31/2024
Bus Lie:
BT30080632
Bus Lie Expire : 02/28/2024
Workers' Compensation Insurance
Carrier: STATE
COMP
Policy No:
9302631
W. C. Expire :
7/25/2023
Architect: Nd'
Address
Phone :
State Lie
Engineer:
Address
Phone:
Designer:
Address
Phone:
Phone:
Code Edition :
2022
Fire Sprinklers :
NO
Construction Valuation :
$10,000.00
Type of Construction :
V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg :
0
Occupancy Groups :
U,R-3
No of Units :
2
Alteration sq. ft. Bldg :
Bldg Height:
No of Stories :
1
Added/New sq. ft. Garage:
0
TOTAL sq. ft.
0
Building Setbacks :
Front: 20, Side: 3, Side: 3, Rear: 5
Flood Zone :
X
Use Zone :
R-2 - Two -Unit Residential
PROCESSED BY :�-
SPECIAL CONDITIONS:
OWNER -BUILDER DECLARATION
I hereby SHIFT) under penally of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable items)
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
is 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
'rofessrons Code) or that he or she is exempt from licensors 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
of more than five hundred dollars ($500).
3 I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
iusiness and Professions Code: The ContractorsState License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
nprovements 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
nproved for the purpose of sale).
3 1, 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
pply to an owner of property who builds or improvesthereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law),
3 1 am exempt from licensure under the Contractors' State License Law for the following reason:
iy my signature below I acknowledge that, except for my personal residence in which I must have resided forat least one year prior to completion of 1h0 Improvements covered by this permit, I.cannot legal:
ell a structure that 1 have built as an owmor-builder if it has not boon constructed in its entirety by licensed contractors. I understand that a copy of theapplicable law, Section 7044 of the Business and
'roiessions Code, is available upon request when this application is submitted or at the following web site:hitp:flwww.ieginfo.ca.gov/calaw.htmi.
tignature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION /
hereby affirm under penalty of perjury that. I am licensed under provisions of Chapter 9 (commencing with Sectio ,7p00) of��'Div! � ion 3 of the Busines7ad Pro sions de nd my license is In full farce
nd effect. License Class License. No Da�VL2_3 _ Contractor ture
COMPENSATION DECLARATION
[ARNING: FAILURE TO SECURE WORXERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (1000,000), IN ADDITION TO THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR A SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm underpenally of perjuryone of the following declarations:
I I have and will maintain a certificate of consent to selGinsure for workers' compensation, Issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
4rformance of the work for which this permit is issued. Policy No.
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 permitis issued, My workers`
fiance carrier and policy number are'.
Policy Number
of Agent
Date
certify that, in the performance of the work for which this permit is Issued'.. I shall notemploy any person in any manner so as to become subject to the worker ' mpensaticn laws of Calffomia, and agre
t, if I should bee a object t e workers' compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions.
nature Of Applicant Dal/�
CLARATiON REGA CONSTRUCTION LENDING AGENCY
!Feby affirm under p nalty o perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
idere 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 property owner's behalf.
I have read this application and the Information I have provided is correct.
I agree to comply with all applicable city andVout"
ordinances and state laws relating to building construction.
I authorize representatives of this city or coomer t bcve-Identified property for Inspection purposes. I / y
nature of Property Owner or Authorized Agen( t Property Owner's or Authorized Aoeri NameLu,,, C`�Mr`Ot' Datdl
ACTION I DATE BY �V jkECLARATfCN OF COMPLIANCEWITH CODE OF FEDERAL I FOR OFFICE USE ONLY
r/ I REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED
PERMIT CANCELLED
FER,MiT EXTENDED
PERMIT FINAL — — _/�
CERTIFICATE OF b-04
OCCUPANCY ISSUED
1403
I SUBMITTED ASBESTOS NOTIFICATION TO
15 N07 APPLICABLE TO