HomeMy WebLinkAboutX2019-1402 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIII�III�IIIIIIIIIIIIIII�III
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COMB Permit: X2019-1402'
100 Civic Center Drive, Newport Beach, CA 92660
X 2 0 1 9 1
4 0 2
Project No: .
Permit Counter Phone (949)644-3288
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inspection Requests Phone (949)644-3255
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Issued Date: 12019
,,44fms }� Combination Type - BLDG
rea
::
Inspection Area 3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Construction Hours: Monday - Friday T: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: 1381 GALAXY DR NB
Description: SFR - RE-ROOF OVER FRONT PORCH. TIO WOOD SHINGLE. INSTIL 72# GRANULATED. FELT. INSTIL CLASS'B' WOOD SHINGLES TO CREATE CLASS W RATING
Legal Desc.: N TR 4224 LOT 243
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Owner CONANT DAVID M
Contractor:. SHELLEY STEPHEN ROOFING CO
Architect:
-
Address: 1381 GALAXY OR
Address: P 0 BOX 1286
Address:
- NEWPORT BEACH, CA 92660
SAN CLEMENTE CA 92674 '.
Phone:
Phone: .949-292-2942 '
Phone:
State Lic:.
Applicant: SHELLEY STEPHEN ROOFING CO
Con State Lic 525478.. _
Engineer: _
Address: P 0 BOX 1286.:
Lic Expire: 09/30/2020
Address:
SAN. CLEMENTE CA 92674
Bus Lic: ' BT30003303
Phone: 949-292-2942
tic Exp Date: 0313112020
Phone:
State Lic:
'..
Code Edit: ° ° ° 2016
Worker's Compensation Insurance
Designer.'.
Type of 8' structiom 'V-B
Carrier: STATE COMP INS FUND
.Address:
0cctrpsr16y Stroup: R31U
Policy No: 1137303
Add�.d(Neq- sq.ft. E516g. ° 0
.. Expire:. 0610112019 .Phone:
Addeo, iIK6Wsq. ft. Gaoage,0
No of Sterns: 1
Building Setbacks Rear: I
Special Conditions:
.
No eftUnle°
Front
BIdgDHei0tt: a
° ° ° °
Left: I
Right: /
l5v
Bldg§trim tars: n D
t
.Flood zone: ° ° °
Use Zone: Parking Spaces: 0
Fire Hazard Zone : N
C&Lgrugtion Valuatibn: $5.600.00
d
Vis`
BCIVLng6Fermit Fie .'$324.00
Excise Tax: $0.00 Planning Department -
fire Department
_PI6n Cheek Fee: $0.00.
Additional Fee : $0.00. Plan check Fee :
$0.00
Fire Inspection:
$0.00
Overtime Plan Ck o $0.00
Grading Bonds Fee: $0.00 Fair Share :.
$0.00
Fire Plan Rev
$0.00'
onto
Investigation fee: S0.00
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
WQlnsp. 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 Feel
$0.00
'.
$0.00
Plumbing %: $0.00
$0.00
TOTAL FEE: $325.00
Plan 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 applicant for
1e 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
Irofessions 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
got 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,
lusiness 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
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
n roved for the purpose of sale).
1, as owner of the property, am exclusively contractingwith 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 improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors'. State License Law).
I am exempt from licensure under the Contractors' State License Law for the following reason:
ly 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 legalil
ell 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
Irofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
lignature 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 Section 7000) of Division 3 of the Business and Profes ions D 9 y 'c rise is full force
nd effect. License Class License No Da(q Contractor Signatu
VORKERS' COMPENSATION DECLARATION I X\
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED HOUSAND 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.
• • • •••o
hereby affirm under penalty of perjury one of the following declarations:
••uoo
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 Qf tw "bor Cpde, foroth
ance of the work for which this permit is issued. Policy No. ' • ; • •; o 0
ve 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' compewViol
I ur ce carrier and policy number are: :..... •.....
r' r Policy Number Expiration Date
lame of Agent Phone # ......
71 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 Wq afire
tat, if I should become subject to th w ers' com n tion pr Isions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
•.
ignatureofApplicagt � � Dat «� ... ..•�„�
,ECLARATION REGARD C Rl(. ON LENDING CY ....
hereby affirm under penalty of perjury that there is a con ction lending agency for the performance of the work for which this permit is issued (Section 309' I II Code). •....
ender's Name Lender's Address
y 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 haveread this application and the information I have provided is correct.
I agree to comply with all applicable city and count ordinances and state laws relatin to. building construction. -
I authorize representatives of this city or tour o enter e - enti ' op or inspection purposes.
i nature of Property Owner or Authorized Agent t Property Owner's or Authorized A ant's Name Date
1CTION DATE RY ECLARATION OF COMPLIANCE VRTH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE
1403
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