HomeMy WebLinkAboutX2020-0725 - Permits�lr City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
' a Permit Counter Phone (949)644-3288
�. Inspection Requests Phone (949)644-3255
Combination Type - SFP
IIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIII� IICOMB Permit: X2020-0725
X 2 0 2 0 0 7 2 5 Project No:
Issued Date: 03/16/2020
Inspection Area : 3
PERMITEXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY OR PERMIT WILL BE INVALID
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: 2201 HOLLY LN NB
Description: SFR TIO (E) 25 SQ, INSTALL COMP. SHINGLE, REMOVEIREPLACE 6 SQ OF HOT MOP, CLASS'S'
Legal Desc.: P BK 166 PG 42 PAR 3
PROCESSED BY:
ZONING APPROVAL:
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PUBLIC WORK'TAPPROVAL:
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L . PLAN CH6&0: `
GRADING APPROVAL: APPROVAL TO ISSUE:
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Owner: VALLEJO FLORENCE
Contractor:
MC CORMACK ROOFING ENERGY
Architect:
Address: 2201 HOLLY LN
Address:
1260 N HANCOCK #108
Address:
NEWPORT BEACH, CA 92663
ANAHEIM CA
92807"7
Phone: -
Phone:
714-777.4040
Phone:
State Lie:
�o l
Applicant: MC CORMACK ROOFING ENERGY
Con State Lie:
643700
Engineer:
Address: 1260 N HANCOCK #108
Lie Expire:
06/3012020
Address:
M
ANAHEIM CA 92807
Bus Lie:
BT30064748
-....a.9
Phone: 714-777.4040
Lie Exp Date:
10/3112020
Phone:
State Lie:
Code Edit: 2019
Worker's Compensation Insurance
Designer:
Type of Construction: VB
Carrier:
EMPLOYEE SVC GRP
Address:
Occupancy Group: R3/U
Policy No:
WC900085108
Added /New sq.ft. Bldg: 0
Expire:
12131/2020
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 1
Building Setbacks
Rear: /
Special Conditions:
No of Units : 1
Front: I
Bldg Height: 0
Left: I
Bldg Sprinklers: N
Right: /
_
Flood Zone: X
Use Zone: Parking Spaces:
0
Fire Hazard Zone : N
Construction Valuation: $10.756.00
Building Permit Fee: $324.00
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 %:
$0.00
NMUSD Fee:
$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:
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PUBLIC WORK'TAPPROVAL:
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GRADING APPROVAL: APPROVAL TO ISSUE:
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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)
lection 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
ie 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
'rofessions 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
of more than five hundred dollars ($500).
1 I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U 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
nproved for the purpose of sale).
1 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
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 legally
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:http://www.leginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent D t
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 0Isl 3P� e Business and Profs n d f is in full force
nd effect. License Class License No Date�l¢ontractor Signature
VORKERS' COMPENSATION DECLARATION
IARNING: 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
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
I 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
,e{�formance of the work for which this permit is issued. Policy No.
t7I have and will mainf n 1 prkers' 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' compensatioi
Isurance carrier and policy n rnber are: , _ _ !
Date
ne of Agent s"mss-. a ruunee
certify that, in the performance e r hich this permit is Ifued, 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 become s bjec c nsation rovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applican D
CLARATION REG RDIN LENDING AGENCY
)reby 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 owarif.
I have read this application and the information 1 have pro i I agree to comply with all applicable city and county or ' ea elatin to building construction.
I authorize representatives of this city or county t e tl p perty for in coon purposes. qX��//� ¢�
nature of PrODertv Owner or Authorized Agent Pri t Property Owners or Authorized Agent's N Il%L i"lrk=�-Ccl Er e\ o- Y/ 0'q
ACTION DATE BY 1D—fC-LMqT1JF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED U I SUBMITTED ASBESTOS IyQTJFICATIQN TQi• Y
PERMIT CANCELLED EPA a +• + !
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PERMIT EXTENDED OMD • • • `
PERMITFINAL f' (/:��i r ASBESTOS NOTIF ICABLE TO
CERTIFICATEOF P OPOS
OCCUPANCYISSUED SIGNA RE: + • • +
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