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Home My WebLink AboutX2015-3432 - Permits (2)xwlo4 City of Newport Beach - Building Division IIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIII COMB Permit: X2015-3432 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 5 3 4 3 2 Project No 1~ Permit Counter Phone (949)644-3288 ' Inspection Requests Phone (949)644-3255 -�a4iro4 > Combination Type - SFP Issued Date : Inspection Arearea :2015 4 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. INSTALL OR VERIFY SMOKECARBON MONOXIDE DETECTORS /PLUMBING FIXTURES TO BE UPGRADED Job Address: 900 BELLIS ST NB Description: SFR REROOF W/ COMP, T10 WOOD (35 SQ) Legal Desc.: N TR 4893 LOT 13 Owner: DEVIN PETER HAYES Address: 900 BELLIS ST Lic Exp Date: NEWPORT BEACH, CA 92660 Phone: Carrier: Applicant: PERFORMANCE ROOFING CO Address: 2506 S BROADWAY 04/01/2016 SANTA ANA CA 92707 Phone: 949.645-2382 Code Edit : 2013 Type of Construction: VB Occupancy Group: R31U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 1 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Contractor: PERFORMANCE ROOFING CO Address: 2506 S BROADWAY SANTA ANA CA 92707 Phone: 949.645-2362 Con State Lic: 797003 Lic Expire: 07/31/2017 Bus Lic: BT000006327 Lic Exp Date: 0 5131 /2 01 6 Worker's Compensation Insurance Carrier: STATE COMP Policy No: 9094635 Expire: 04/01/2016 Building Setbacks Rear: / Front: 1 Left: / Right: / 0 Architect: IMPECTOR Address: Phone: State Lic: Engineer: Address: Phone: State Lic: Designer: Address: Phone: Special Conditions: Fire Hazard Zone : Construction Valuation: $18.950.00 Fire Department $0.00 Fire Inspection: $0.00 Building Permit Fee: $354.00 Excise Tax: $0.00 Planning Department - Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee Overtime Plan Ck: $0.00 Fair Share Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans Record Management: $0.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department - CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Disabled Access: $0.00 PAN Plan Check: $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 Plumbing %: $0.00 TOTAL FEE: $355.00 PROCESSED BY: ZONING APPROVAL: ommmoo 0 ° c eommoo 0 0 • 0. 0 ° •. c < ° 0 ° o c°000° ° $0.00 m'$Otl°04m •• • $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $355.00 PUBLIC WORKS APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: ceomec o m ° e o 0 0 0 o e •• . Fire Department $0.00 Fire Inspection: $0.00 Fire Plan Rev $0.00 Demolition Fee $0.00 Building Dept Adm General Service Refund Deposit ommmoo 0 ° c eommoo 0 0 • 0. 0 ° •. c < ° 0 ° o c°000° ° $0.00 m'$Otl°04m •• • $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $355.00 PUBLIC WORKS APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: ceomec o m ° e o 0 0 0 o e •• . 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 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 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 improved 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 buildsor improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). J 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 cover ell a structure that 1 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 'rofessions 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 . .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with SET 7 00) of Wi ? of the Business anCre o e, nd effect: License Class License No a 5 Contractor Sign ✓ORKERS' COMPENSATION DECLARATION of the Business and is in full force /ARNING: FAILURE TO 5CURE 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 :OST OF COMPF�Sta DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm underpenalty of perjury one of the following declarations: 314ve and 44 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 Nonce of the work for which this permit is issued. Policy No. ;Phil and wjll 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' compensation Isurance carder B oolicy - n-umberr are: �� /'lp [�0 ,?1Sw/� :ardar*---Z[.T2i Policy Number Expiration Date T4/'�'�'6 BI Agent• • • Phone# 3? W;,fy that, in the performance of the work for whi this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' C mpensation laws of California, and agree fet •iPl.shou s subje the e o provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. iggnature ofA ca Dat /l—/%-�.� �ECLAItAT1ON R f DING CONSTRUCTI LENDING AGENCY tdF€tiy affirm under pe pity 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). ander'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 have read this application and the information I have provided is corre t: I agree to comply with all applicable city and county or finances an �ws relating to building construction. ,� I authorize representatives of s ity or countt t o -i d. roperty for inspection purposes. �/ ignature of Property Owner or orized Agent Print Property Owner's or Authorized Agenti Name D� Z ACnMII't ))AIF AV OECLARRTION OFGOMPLUINCEKffHCODE OF IUN UFHLk. ink (my FEDERAL RE6 AATIORS PART 8f OF TITLEA0 AND AOMORULL740, PFRbf1TFxP[RF13 j❑ 1S[N7kgTFrAA;W-4;TOSNf)TffIC4TSINTO. ❑ EPA . QQMD / FER101TC4PICLLLED P€RAMTEYT€A(DEO SBESTOSNOiRCA IS N APPLNABLE TO POS�MT PERUIT TMAL \'2 15 �✓✓� CERTfFCAT£GF l� OCCUPANCYISSUED tn&