HomeMy WebLinkAboutX2019-0261 - PermitsCity of Newport Beach - Building Division IIIIIIIIIII�IIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIII
`- 100 Civic Center Drive, Newport Beach, CA 92660 : X 2 0 1 9 9
Permit
xi} ` Inspection Req Requests Phonnter Phone e (949)644-3255
Combination Type - MFP :
2 6 1 IICOMB
Permit: X2019-0261
Project No: 1393-2018
Issued Date : 0112312019
Inspection Area: 8
PERMITS EXPIRE 100 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: 310 AVENIDA CUMBRE NB
Description; MFR REMOVE EXISTING CLAY TILE, REPLACE OLD FELT, REINSTALL
CLAY TILE (20 SCIS)
Legal Desc.: : TR 5435 (L L 84-214024) PAR 19 AND PAR 19G
Owner NORTHRIDGE JR DAVID C Contractor
LUIS MENDOZA ROOFING
Architect:
N!
9
TU'
Address 310 AVENIDA CUMBRE Address:
.2323 W 12TH ST
Address:
NEWPORT BEACH, CA 92660
SANTA ANA CA 92703
-. Phone: Phone`.
.714.785-3545
Phone:
State Lir
Applicant; LUIS MENDOZA ROOFING Con State Lica.
972859
Engineer:
Address: 2323 W 12TH ST Lie Expire:
08/31/2019 `
Address:
-
SANTA ANA CA 92703 Bus Lie:
BT30039447
Phone 714-785-3545 ' Lie Exp Date:
0513112019.
Phone:
State Lic:
0000
Code Edit: 2016 Worker's Compensation Insurance
Designer:
°....°
Type of Construction: VB - barrier:
STATE COMP
Address;
Occupancy Group: R2/U - Policy No:
9011200
ommmmo m °
Added /New sq.ft. Bldg: 0 Expire:
04/20/2019
Phone:
°
Added /New sq. ft. Garage: 0
No of Stories: 2 Building Setbacks. '.
Reari. l
Special Conditions:
No of Units: 4
Front J
Bldg Height: 0
Left: l
O° °
Bldg Sprinklers:
Right: l
Flood Zone:. Use Zone: Parking Spaces: 0
Fire Hazard Zone: N
Construction Valuation: .$9.000.00
Building Permit Fee: $324.00 Excise Tax:
$0.00 Planning Department-
Fire Department
°
Plan Check Fee: $0.00 Additional Fee :
$0.00_ Plan check Fee:
$0.00
Fire Inspection:
:$O.N. °....
Overtime Plan Ck $0.00 Grading Bonds Fee:..
$0.00 Fair Share :
$0.00
Fire Plan Rev
$ AT
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. Feer
$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 : $325.00 Plan
1___�
Check Fee: $0.00
Fee Due at Permit Issuance :
$325.00
PROCESSED BY:
ZONING APPROVAL;
GRADING APPROVAL:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
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 appr6nt 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).
❑ 1, 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
im roved 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 7044 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 Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sf EtN 70 0) IF Divisi n 3 of the Business a d Prof essio ode, and my license is in full force
and effect. License Class License No 1 Date. j61 Contra cto ature
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 ($100,000), IN ADDITION TO THE
COST OF COMPENSMM, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
.hevebf affirm under Qenalty of perjury one of the following declarations:
D 14rave 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
3elfpVflance of tffB work for which this permit is issued. Policy No.
•!
ve and w
ill 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' compensatior
arta carrier and bolicy number are:
7aryar Policy Number Expiration Date
ibtI54ify that, N 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 :wo:rka' compensation laws of California, and agree
:hat, if heW ecome subject t the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
�Igria�Lire o pp ant / Z 3
dECL'ARATION.R�GARD109,01ONSTRUCTION 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 0 , Civil Code).
_ender'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 ordin es and state laws relating to building construction.
I authorize representatives of this cit f or coun toe above -identified property for inspection purposes. z3
Signature of Property Owner or Autho e t Print Property Owner's or Authorized Agent's
ACTION DATE VY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED L1 I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED UEPA
PERMIT EXTENDED qMD
PERMITFINALRESTOS NOTIFI TION IS NOT APPLICABLE TO
CERTIFICATE OF I�,(A`I�I C P DDEM ON
OCCUPANCY ISSUED ASI _ —
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