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Home My WebLink AboutX2021-1876 - Permits1"''Uf City of Newport Beach - Building Division �� COMB Permit: X2021-1876 o� r 100 Civic Center Drive, Newport Beach, CA 92660 Project No E+ r a Permit Counter Phone (949)644-3288 M�^,. Inspection Requests Phone (949)644-3255 °,� �tr#.T Combination Type - SFP Issued Date : 0711912021 Inspection Area : 5 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0711912024 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: 525 ROCKFORD PL NB Description: SFR - REPLACE (2) DOORS INTO EXTG Legal Desc.: N TR 3519 LOT 134 Owner: SULLIVAN KEVIN Address: 525 ROCKFORD PL Contractor: Address: RENEWAL BY ANDERSEN OF OC Architect: 22982 ALCALDE DR #100 Address: CORONA DEL MAR, CA 92625 LAGUNA HILLS CA 92653 Phone: 2131479-6657 Phone: 714-259.5120 Phone: State Lic: Applicant: RENEWAL BY ANOERSEN OF OC Con State Lic: 990416 Engineer: Address: 22982 ALCALDE DR #100 Lic Expire: 02/28/2022 Address: LAGUNA HILLS CA 92653 Bus Lic: BT30046925 Phone: 714-259-5120 Lic Exp Date: 0413012022 Phone: State Lic: Code Edit : 2019 Workers Compensation Insurance Designer: , Type of Construction: VB Carrier: OLD REPUBLIC INS CO Address: ' Occupancy Group: R3/U Policy No: MWC31415820 , Added /New sq.ft. Bldg: 0 Expire: 10101/2021 Phone: Added /New sq. ft. Garage: 0 .. , No of Stories: 1 Building Setbacks Rear: / Special Conditions: No of Units : 1 Front: / Bldg Height: 0 Left: / , Bldg Sprinklers: Right: / Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $4,500.00 r. Building Permit Fee: $161.00 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 WO Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 PAN 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 : $162.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $162.00 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: 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, 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 Iicensure 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). 111, as owner of the property, or my employees with wages as their sole compensation, will do U 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 Iicensure 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, Se tion 7 4 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent to ,LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm I Ibaer penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Di ision 3 of the Business and Profess' s , and ense is in full force and effect. Lice'Ilse Class License No Date! Contractor Signature ` ORKERS' GO.MPENSATION DECLARATION W%RNII:'G: FAILURE rO 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 '_O(.T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under prnaity of perjury one of the following declarations: I. 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 the performance of t iI wo,k for which this permit is issued. Policy No. 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' carrier an 5 uU-\A( are: YM C , �Z., Policy Number Expiration Date ere rf Agent r'none s JI certify that` Gi`tF1€ perfor ce of t 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 iat, if I should become sub' c the ra. compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ',ignature of Applicant Date_ IECLARATION REG DING 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 tinder's Name Lender's Address ly my signature below, I certify to each of the followin : I am the property owner or authorized to act on th prop rty owner's behalf. I have read this application and the information I e pr vided is correct. '_ 2i N I agree to comply with all applicable city and coun rdin nces and state laws relating to building construction. I •�i I authorize representatives of this city or county to r t nspection purposes. above -identified property for i Iianature of Prooertv Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED LJ ISUBMITTED ASB STOS OTIFICATION TO PERMIT CANCELLED EPA PERMIT EXTENDED L.JAQMD PERMIT FINAL �'3 A ESTOS NOTIFI TION IS T PPLICABLE TO CERTIFICATE OF OSED DEMOLITI OCCUPANCYISSUED SIGNA7UR� I Civil Code).