HomeMy WebLinkAboutX2019-1008 - PermitsCity of Newport Beach -Building Division *X2019-1008*
$0.00
COMB Permit: X2019-1008
` cr'
100 Civic Center Drive, Newport Beach, CA 92660
$0.00
.Project No
.'
Permit Counter Phone (949)644-3288
$0.00
Disabled Access;.
.:
Inspection Requests Phone (949)644-3255
' $0.00
Building Green Fee :
$1.00.
Combination Type- MFP
$0.00
Issued Date: 0312912019
la v
San Dist:
$0.00
Inspection Area : 8
NMUSD Fee:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
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:
2654 VISTA ORNADA NB
Description:'
MFR REMOVE EXTG TILE, REPLACE (2) LYRS OF FELT, RE-INSTL TILE (28 SQS)
-
Legal Desc.:
N TR 7082 LOT 46
6 n is F a
Owner.
RUMBELLOW PETER Contractor LUIS MENDOZA ROOFING
Architect:
v��
Address:
434 VISTA GRANDE Address 2323 W 12TH ST
Address:.
:+ 0 l
NEWPORT BEACH, CA 92660 .SANTA ANA CA 92703
• • e
Phone:
Phone: 714.785-3545
Phone:
State Lie: • '
Applicant:
LUIS MENDOZA ROOFING . Con State Lie: 972859
Engineer.
Address:
2323 W 12TH ST Lie Expire: 08/31/2019
Address:
_
SANTA ANA CA 92703 Bus tic: BT30039447
• m e e
Phone:
714-786-3645 - Lie Exp Date: 05I3112019
Phone:
•e o
State Lie:
Code Edit:
2015 Workers Com f I
D
m ae eese o
Type of Construction: VB
Occupancy Group: R21U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 2.
No of Units : 4
Bldg. Height: 0 .
Bldg Sprinklers: -
Flood Zone:
Building Permit Fee: $324.00
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 :
$1.00.
TOTALFEE::
ompena ion nsurance
Carrier..
STATE COMP
Policy No:
9011200
Expire:
04120/2019
Building Setbacks
Rear: /
$0.00
Front: /
$0.00
Left: I.
$0.00.
Right:
Excise Tax:
$0.00.
Additional Fee :
$0.00
Grading Bonds Fee:
$0.00
Grading PC Consultant:
$0.00
Grading. Permit Fee:
$0.00
Grading PC Fee:
$0.00
WQ Insp. Fee:
$0.00.
Electrical %:
$0.00
Mechanical %:
$0.00
Plumbing %:
$0.00
asigner.
Address:
Phone:
Special Conditions:
Planning Department -
Plan check Fee :
$0.00
Fair Share :
Doom
$0.00
SJH Trans :
000•o
$0.00
In -lieu Housing Fee:
General Service
$0.00
Public Works Department -
o 0 0
Park Dedication'.
$0.00
0
PAN Plan Check:
$0.00.
$0.00 -
San Dist:
$0.00
_
NMUSD Fee:
$0.00
m me
• o o
ooemo
Doom
o
Demolition Fee
000•o
m
$0.00
General Service
000e•o
o m
o 0 0
000000
0 •
0
$0.00.
$0.00 -
o mo
0 0
0 0 0
00.0
0000
Fire Department
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
Building Dept Adm
$0.00
General Service
$0.00
Refund Deposit
$0.00
'Grading Bond:
$0.00
$0.00.
$0.00 -
Check Fee : $0.00 Fee Due at Permit Issuance : $325.00
PRocE55EfJ BY: PUBLIC WORKS APPROVAL:
ZONING APPROVAL: PLAN CHECK BY:
GRADING APPROVAL: 'APPROVAL TO ISSUE:
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 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).
11 I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or (_) 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).
13 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).
IJ I am exempt from licensure under the Contractors' Slate 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 legal
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! it -mailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Propariy.Owner or Authorized Agent Date
IJSCENr+ED CONTRACTOR'S DECLARATION
I hereby'affirm dd8r Whalty of perjury that I am licensed under provisions of Chapter 9 (commencing with ion 70 ) of ivi 3 of the Business Professions CRde, and my license is in full force
V8.effegt. Licensg Class License No Contrac Ignature
VCORMERS' CCyVIPEDISATION DECLARATION
WRItdIN&FAILURE'TQ.AC0RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THI
DOST ONCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
d6y affirm mUr pepalty of perjury one of the following declarations:
94 a and will maintain a certificate of consent to self -insure for workers' compensation, issued by the
Mance of the work for which this permit is issued. Policy No.
ave and w1iPrhaih4ain workers' compensation insurance, as required by Section 3700 of the Labor Code,
tr`ii.2arrier gqd pglicy number are:
V ' ' ' Policy Number
of Agent
Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for
for the performance of the work for which this permit is issued. My workers'
Date
certify 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
, if I should become subject to th rkers' com ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ��11 +�
lature of [#plisao_t / `Date V J /2-
I hereby.affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permlf is issued (Section 3097, Civil 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 owner's 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.
I authorize representatives of t is ci rObunty to er the abo - Ifi property for inspection purposes. n � r
Signature of Property Owner on d -A ent Print Pro ertOwner's or Authoriz ent's Name "kes 111C 75 D 3 2 F
ACTION DATE BY DECIJkRAT COMPLIANCE WITH CODE OF FEDERAL FOR E USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED 0 1suBMITTE ASBESTOS NOTIFICATION TO
PERMITCANCELLED ONATURE:
PERMIT EXTENDED
PERMITFINAL + ��/jamNOTIFICATION IS
NOT APPLICABLE TO
CERTIFICATE OF �. lo�� / GN� /MOUTf,ON
OCCUPANCYISSUED / /I
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