HomeMy WebLinkAboutX2019-1315 - PermitsCity of Newport Beach - Building Division "X2019-1315'
Use Lone:
COMB Permit. X2019-1315
100 Civic Center Drive, Newport Beach, CA 92660
Fire Hazard Zone: N
Project No
W i Permit Counter Phone (949)644-3288
0
Construction Valuation: $11.500.00
Inspection Requests Phone (949)644-3255
Issued Date : 04/2512019
�'vc rr,a�"¢ Combination Type - SFP..
Inspection Area :*4'3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
$0.00
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: 504 CANAL ST NB
Description: SFR T/O (E) 14 SQ, INSALL COMP. SHINGLE, REMOVE/REPLACE 7 SQ B.U.R, CLASS'B' MIN.
Additional Fee :
$0.00
Legal Desc.: TR 8406 LOT 1 UNIT 32 OF PROJECT LOCATED ON AP 458-311-04 TOGETHER -
$0.00
Fire Inspection:
$0.00
{
5 (F
Owner.. JELKE RICHARD Contractor. LEMUS ROOFING
Architect:
$0.00
Address: -152492 62ND ST Address: 19881 BROOKHURST ST #C
Address:
$0.00
NEWPORT BEACH CA 92663 HUNTINGTON BEACH CA 92646"�`�,�'
o $0.Q0
.....
Phone: Phone: 949-735-2377
Phone:
State Lie:
Applicant: LEMUS. ROOFING Con State Lie: 826813
Engineer:
$0.00
Address: 19881 BROOKHURST ST#C-152 Lie Expire: 10/31/2019
Address:
HUNTINGTON BEACH CA 92646 Bus Lie: BT30066951
Grading Permit Fee:
$0.00
Phone: 949-735-2377 Lie Exp Date: 04/3012019
Phone:
State Lie:
Code Edit : 2016. Worker's Compensation Insurance
Designer:.
....
Type of Construction: VB Carrier: STATE COMP
Address:
$0.00
Occupancy Group: R3IU Policy No: 1845899 -
General Service
Added /New sq.ft. Bldg: 0 Expire: 05/27/2019
Phone:
....
Added /New sq. ft. Garage: b
$0.00
° .... °
No of Stories: 2 Building Setbacks Rear: I
Special Conditions:
• °
LIQUEFACTION AREA .... °o••oo
No of Units : 1 Front: I
Disabled Access : $0.00
- Bldg Height: 0 Left: I
....
Bldg Sprinklers: Right: I
Grading Bond:
Flood Zone:. X
Use Lone:
Parking 5 aces:
0
Fire Hazard Zone: N
Construction Valuation: $11.500.00
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:
$0.00
• o. o
Overtime Plan Ck: $0.00
Grading Bonds Fee:
$0.00
Fair Share:
$0.00
Fire Plan Rev
o $0.Q0
.....
Investigation Fee: $0.00
Grading PC Consultant :
$0.00
SJH Trans :
$0.00
Demolition Fee
o • ° ®° °
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
o TO. ft
°oo° °
CA Seismic Safety: $0.00
WQ Insp. Fee:
$0.00
Park Dedication :
$0.00
Refund Deposit
°$0:00
Disabled Access : $0.00
PNV 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 Check Fee:
$325.00
Fee Due at Permit Issuance :
$0.00
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) 1 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
:he 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
iot 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 (_) 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
mprovements 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
mproved for the purpose of sale).
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
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
Drofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7JDM of Di isio 3 of the B sin ss and Profes I s ode, negmy license i in full force.
and effect. License Class License No D e Con ra r Signature i -M1
NORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for IN
joif,ormance of gee wo�kfor which. this permit is issued. Policy No.
....
• nd wj)I•rjI$intain workers' compensation insurance, as required by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compensatior
nsu ce 6rrrrier and.policy number are:
ietr�er-- T • • • +�c� Polic Number P ' I-�
Policy �(bj r{ $!3 q Expiration Date �W
damdOf Agent Phone #
a certify that, rode;%Performa the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the wnet c pensation laws of California, and agree
Rat, f eD0 t e work�(ers' clomp nsation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions.
3i4... Q of—Ap Pt• • 1 l' d Dy. l�
yC•UjRATION RGARDING CONSTRUCTION LENDING AGENCY
iefeby�ffirm
lir 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).
inder's•Name ..... • Lender's Address
Pr1i9 Sonature IIejow, J certify to each of the following:
• 1 ShI the prdpipat 9*ner or authorized to act on the property owners 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 this city or county to�9te the pbQp- entified property for inspection purposes. �% { _
ooaN ve of Prnnr=dv nw _ nrna�A hnri , ADent KIn *e4 vitl w L Print Prooertv Owner's or Authorized A ' Name L�•
ACTIONffBY
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
IONS PART 61 OFTITLE 40AND AQMD RULE
1403
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