HomeMy WebLinkAboutX2020-0303 - Permits�wto City of Newport Beach - Building DivisionII COMB Permit: X2020-0303
IIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
100 Civic Center Drive, Newport Beach, CA 92660 III X 2 0 2 0 6 3 0 3 Project NO
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
'a6xrilu'�q Combination Type - SFP Issued Date: 02/03/2020
Inspection Area : B
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
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: 20152 CYPRESS ST NB
Description: SFR REROOF WICLS "A" COMP, T/O COMP (13 SQS)
Legal Desc.: TR 706 LOT 176 NELY1/2
Owner:
SLEVCOVE MARK
Contractor:
DIEGO'S ROOFING CORP
Address:
20152 CYPRESS ST
Address:
610 JOANN ST, APT C
CA Seismic Safety:
NEWPORT BEACH, CA 92660
Disabled Access :
COSTA MESA CA 92627
Phone:
$0.00
Phone:
949-903-3723
Applicant:
DIEGO'S ROOFING CORP
Con State Lic:
926665
Address:
610 JOANN ST, APT C
Lic Expire:
12131/2020
COSTA MESA CA 92627
Bus Lic:
BT30056607
Phone:
949-903-3723
Lic Exp Date:
09/3012020
Code Edit : 2019
Type of Construction: VB
Occupancy Group: R3
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:
Construction Valuation:
Building Permit Fee: $324.00
Plan Check Fee: $0.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $325.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9066321
Expire: 10/01/2020
Building Setbacks
Zone:
Excise Tax:
Additional Fee :
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: /
Front: /
Left: I
Right: /
king Spa
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
Planning Department -
Fire Department
Plan check Fee:
Fire Inspection:
Fair Share
Fire Plan Rev
SJH Trans
Demolition Fee
In -lieu Housing Fee:
Building Dept Adm
Public Works Department -
Park Dedication :
$0.00
PAN Plan Check :
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
I IVZA_4 U 11011
State Lic:
State Lic:
N
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$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee: $0.00 Fee Due at Permit Issuance : $325.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
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$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee: $0.00 Fee Due at Permit Issuance : $325.00
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 thwplicant 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 it was not built or
improved 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
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 theapplicable 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 Se 'on 7000) of Division 3 of the Busi ess and Proles ons Code, an my lic nse is i� full force
and effect. License Class License No D e �'� 3 'BYO% Cohtr r Signature �i
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE 7G URARE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
DOST OF OMPENS ATION4 DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I -hereby -affirm B nde P pr nalty of perjury one of the following declarations:
• 1 here and wilLmaintain 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
lierfo"ance of ttyalyprk for which this permit is issued. Policy No.
va and with wreintain 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.
su vc@:9 carrier and policy number are:
4arner•S�r=..iV\d- Policy Number Expiration Date
$-3t-`�O
that, jethe DErforman_ce 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 orkers' compensation laws of California, and
o`uld b�me• ct to the wo9rkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. .- 2 Lo
�_1"_! _ iL ,. ,,,.,., on/11 (�.! i 111.4 Date_
61 / 1R IIV1Y RCVNRVIIYV VVIYJ „�{/v „v• rr,�✓„-v �.v.-..�.
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 V
on 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 ci r county to/eenterrtthe � above -identified property for inspection purposes. ,�
nature of Property Owner or Auth Age' �wrnGl� .b 1�'"'Fr� Print Property Owner's or Authorizeg rgant's Name '
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED
U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED
EPA
PERMIT EXTENDED
QMI)
PERMITFINAL
CERTIFICATEOF
OCCUPANCY ISSUED
�-�d�
ASBESTOS NOTIFICATION ISNOT APPLICABLE TO
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