HomeMy WebLinkAboutX2019-1468 - PermitsCity of Newport,Beanh epyiiplincg Division
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COMB Permit: X2019-1468
cs 100 Civic Center Drive, Npwport.@eaah, CA t26Q o o
X 2 0 1 9 1 4 6 6
Project No:
Permit Counter Phone (.99)644-«288 : ; 0
Inspection Requests Phone .00
(949)644=3255•
Combination Type - CIP
Issued Date : 0 510 7/2 01 9
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Inspection Area : 7
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• • • s o e •PERMIT EX M
180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Construction Hours' Monday - Priday 740 a•rp'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: 5160 CAMPUS. DR NB
Description:. COMM RE -ROOF. TIO SINGLE PLY. INSTIL 54 SQ FIRESTONE TPO. ESR 2831.
CRRC 0608-0008
Legal Desc.: PBK112PG14PAR3
Owner: ENVIRONMENTAL DEVELOPERS Contractor:
CALIFORNIA
CONST & ROOFING INCArchitect:
Address: 5160 CAMPUS DR Address:
2651 AVALON STREET Address:
NEWPORT BEACH, CA 92660
RIVERSIDE CA 92509
Phone: Phone:
951-352.0809
Phone:
State Lic:
Applicant: CALIFORNIA CONST & ROOFING INC Con State Lie:
776538
Engineer:
Address: 2651 AVALON STREET Lie Expire:
0313112020
Address:
RIVERSIDE CA 92509 Bus Lic:
BT30022963
Phone: 951.352-0809. Lic Exp Date:.
03/31/2020
Phone:
State Lic:
Code Edit: 2016 Worker's Compensation
Insurance
Designer.
Type of Construction:. V -B Carrier:
STATE COMP
INS FUND Address:
.Occupancy Group: B Policy No:
1954370
!
Added /New sq.ft. Bldg; 0 Expire:
01/01/2020
Phone:
.d .pryy L'A
Added /New sq. ft. Garage: 0
No of Stories: 2 Building Setbacks
Rear: I
Special Conditions:
No of Units : 0
Front: I
Bldg Height: 0
Left: /
Bldg Sprinklers:
Right: /
Flood Zone: Use Zone: Parking Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $34.177.00
Building Permit Fee: $581.00 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 WQ Insp. Fee:
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
Disabled Access : $0.00
P/W Plan Check: $0.00
Grading Bond:
$0.00
Hazardous Mat $0.00 Electrical %:
$0.00
San Dist: $0.00
Building Green Fee ; $2.00 Mechanical %:
$0.00
NMUSD Fee: $0.00
-
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $58 .00 Plan
Check Fee:
$0.00 Fee Due at Permit Issuance : $583.00
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 Mjhgc*c(f0hark4s� 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, demolistyor repainarfyI1ru0jp1e, %8r tp ytc 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 (CdaptW(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
lot more than five hundred dollars ($500). • • •.
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) portions of the woq an§ th%St&Wture is not intended o;offered for sale (Section 7044,
3usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through emplyees' or persona►,efjprt; bulk$ os 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 completiofi•t4 eLihllner-Builder will have tIR burden of proving that it was not built or
mproved 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
Ipply 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:
3y 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 legall)
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
)rofessions Code, is available upon request when this application is submitted or at the following Web site:hffp://www.leginfo.ca.gov/calaw.htmi.
signature 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 Professions Code, a d my license is in full force
Ind effect. License Class License No Tr�,'�e5�7'i Contractor Signature
VORKERS' COMPENSATION DECLARATION (J `
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T OUSAND DOLLARS ($100,000), IN ADDITION TO THE
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 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 th
�errformance of the work for which this permit is issued. Policy No.
21ave 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' compensatiol
isu ance carrier and policy number are:
Policy Number Expiration Date
of Agent
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
I, if I should becomesubject to Vers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. f— —7
nature of Applicant C �\ Date's/ .7 / 6�
CLARATION REGARD( ONSTRI CTION LEND( G r�
Ireby 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, Civil Code).
Ider's Name Lender's Address
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 this city or coun y to ent ovs;-idenfifi roperty for inspection purposes. ,f L
nature of Prooertv Owner or Authorized ADe �ir it°�r Print Property Owner's or Authorized Agent's NaO /�L'�9 i4 L.,' —. Date
ACTIONI DATE I 8r �. ,{ DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
' 1 REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
TO
PERMITFINAL (b .�'�.,Q L13 ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFIC4 TE OFOCCUPANCYISEMOLI
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