HomeMy WebLinkAboutX2019-3500 - PermitsCity-of Newport Beach - Building Division
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COMB Permit: X2019-3500
100 Civic Center Drive Newport Beach, CA 92660
X 2 0 1 9 3 5 0 0
Project No
Permit Counter Phone (949)644-3288
a
Inspection Requests Phone (949)644-3255Combination
Type - CIP
:
Issued Date : 11/04/2019
Inspection Area : 7
'
PERMITS EXPIRE 160 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Construction Hours: Monday - Friday 7.,00 a.m. to 6:30 p.m. and Saturday from 6:00 a.m. to 6:00 p.m. No
work on Sundays or Holidays
Job Address:- 3400 IRVINE AVE NB'
Description: COMM TIO (E) 32 SQ, INSTALL COMP SHINGLE, CLASS'B'MIN. (OVER UNCONDITIONED SPACE)
Legal Desc.: N TR 706 LOT 76
�+..
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Owner: CAMPUS CENTER LLC
Contractor: CLIFF BROWN ROOFING INC Architect:
Address: 3400 CAMPUS AVE #212
Address 302 VIA ALEGRE Address:
CD
NEWPORT BEACH CA 92660
SAN CLEMENTE CA 92672
Phone:
Phone. 949-458-9440
Phone:
State Lic:
Applicant: CLIFF BROWN ROOFING INC
Con State Lice 506664
Engineer:
,! ,
Address: 302 VIA ALEGRE -
Lic Expire: 08131/2021
Address:
SAN CLEMENTE CA 92672
Bus Lic: BT30068171
-
Phone: 949-458-9440.
Lic Exp Date: - 07131/2020
Phone:
State Lic:.
Code Edit: 2016
Worker's Compensation Insurance
Designer:
Type of Construction'
Carrier STATE. COMP
FUND Address:
"t'9
Occupancy Group: B
Policy No: 9072710
daJ
Added/New sq.ft. Bldg: 0
Expire: 10/01/2020
Phone:
Added /New sq... ft. Garage: 0
No of Stories: 2
Building Setbacks Rear: / -..
Special Conditions:
No of Units: 0
Front:. / -.
..
-
Bldg Height: 0.
Left:J
- Bldg Sprinklers:
.Right: 1.
-
Flood Zone: X
Use Zone: Parking Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $12.000.00
Building Permit Fee: ,.. $264.00.
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
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 W $0.00
NMUSD Fee: $0.00
$0.00
Plumbing %: ` $0.00
-
$0.00.
TOTAL FEE : $265.00
Plan Check Fee
: $0.00 Fee Due at Permit Issuance : $265.00
PROCESSED BY:
c c v '
" `- n ° PilELQC VC.ORKS APPROVAL:
ZONING APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL:
"` <,a`
�.
oJc c,`.,a BVkbV&. TO ISSUE:
Y
\
OWNER -BUILDER DECLARATION Y , -
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable item(,)
(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).
❑ 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
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 1t 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.
rape ly 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).
LJ I 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, 1 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.html. -
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 Section 7011
00 p LOU'io f the Business and Profes io s ,ode, and my lice in full force
and effect. License Class License No Date" Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
11 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
pe ormance of the work for which. this permit is issued. Policy No.
I have and will mC�Int in 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
insurance carrier andXIJ number E16.)L'-�
carrier t \Pnliv.Nix her Expiration Date
Name of Agent �ts "• �j`X.4 Phone#
certify that, in the perforpaknce of the work f ich 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
that, if I should become s elto the workers' compe on provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. c�/� [/
Signature ofApp lican � a[
DECLARATION REG DING CONSTRUC NDING AGENCY -
I 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 3097, Civil Code).
Lender's Name Lender's Address
By rn signature below, I certify to each of the following:
am p
I am the property
perty 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 count t e above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Namik1 ate
ACTION - DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY if
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403 v•• •••.
PERMITEXPIRED(SUBMITTED ASBESTOS 4,TIFICATION TOS•• i e
PERMIT CANCELLED EPA - • • w•�• • • • • �• �•
PERMITFINAL \ i• 1Q.tc+ 'ioT••'— ASBESTOS NOTIFICATI 15 NOT APPLICABLE TO
CERTIFICATEOF OPOSED DETION •• ••• • • • •••
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