HomeMy WebLinkAboutX2020-1440 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
�'rtrr�.,as Combination Type - SFP
*X20201440* COMB Permit: X2020-1440
Project No :
Issued Date : 06/23/2020
Inspection Area : 2
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 06/24/2023 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 ays
Job Address: 623 ST JAMES PL NB
Description: REROOF DETACHED GARAGE (COMB20.0215)11 SQ T/0 WOOD SHAKE, APPLY BORAL CEDAR LITE TILE
Legal Desc.: N TR 1218 LOT 36
Owner: INSLEY DONALD F Contractor: FOX GARY Architect: 0
Address: 623 ST JAMES PL Address: 221 ABALONE AVE Address:
NEWPORT BEACH, CA 92663 NEWPORT BEACH, CA 92660
Phone: - Phone: 949-290-4856 Phone: State Lic:
Applicant: FOX GARY
Address: 221 ABALONE AVE
NEWPORT BEACH, CA 92660
Phone: 949.290-4856
Code Edit: 2019
Type of Construction:
Occupancy Group: U
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 0
No of Units: 0
Bldg Height: 0
Bldg Sprinklers:
Con State Lic:
685119
Lic Expire:
05131/2022
Bus tic:
BT30050697
Lic Exp Date:
03/31/2020
Worker's Compensation Insurance
Carrier: STATE COMP
Policy No: 9077462
Expire: 1013112020
Building Setbacks Rear: /
Front: /
Left: /
Right: I
Engineer:
Address:
Phone: State Lic:
Designer:
Address:
Phone:
Special Conditions:
Construction Valuation:
$0.00
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
Building Permit Fee:
$0.00
Excise Tax:
$0.00
Planning Department -
General Service
Plan Check Fee: $0.00
Refund Deposit
Additional Fee :
$35.00
Plan check Fee
ccc, r�
Overtime Plan Ck:
$0.00
Grading Bonds Fee:
$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
PNV Plan Check:
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
San Dist:
$0.00
Building Green Fee :
$0.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
Plumbing %: �,
$0.00
TOTAL FEE: $35.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Plan Check Fee
emoe
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
o e
General Service
0
Refund Deposit
0 0 0
Grading Bond:
emoe
e o
0000
0000
0o e
rcccr-.
o e
0
0 0 0
om oo
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0
co o
eoeo
oeme
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 Fee Due at Permit Issuance : $35.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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i rc, _d for the pi,mose of $are},
y� I is ZNme, of me crorerry, am nx 'ilsF:siy c nt ac g vuh censaa Cantn ,ars to tons n the . 4 _t vS C :l Sus'ness and Fate c :s Coce e Cct. F_ -!-w. _ a o. ce r _tw o:^es -.ct
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1�0 t am .1c.71of I = hoariSGra Under the COM MCWTS StaleRnSe--La'w for the following reason:
' y m} 5 GFalLre eC G V I aCkr p Pledge that, e2 i ( o, mY pe.($ena.tee{deeCC '11YF1 h t Thus, f1a\a feSrae,'I for at Ie35( Ont yea Friar." v'0I'10 t M1 ne .2R5 ,:,3 'E .5 f "+ 2 'fJd
#,S l a sFu'ruic Oral I nava hurt as an OWPe{bUrA.erif it has not been constNGaO in its enJrelt OV l GenSlid t,.Jt[r3t1015. I understand that a COy1 Of the aCh' wO e lacy_ SeCi.,r "icA T. t",. , . :a5 e."
�i P.D�assl'ans Code is rtVa%Iaout Upon rageeSt.Ahen this ""I"ll" is "Dated oT at the f01 111 ng Web e7(e'h!ip ff+lwW.lEgin O.La-P *t^.:dialY.mN..
Sgratce O!PTDD rte O,vner or Authouled Agent role
LICENSED CONTRACTORS DECLARATION
I he ery aYrm underpenalty at pel]UP/ (hat I am l CenSed under provisions Of Chapter (commencing Wail Sectio q p nl t O:viston ' f the 8uslress and and s e and T:C r C- Dse ' ^alUsa:a
a���f�,.t License Class License No net d�%y Ccara,.Fcr S'ignatdre
WORKERS' COMPENSATION DECLARATION C
• • Y.,1 AA..FAILUBP..TO. SECUAEYPOfiHERs' COMPENSATION COVERAGEIIS UNLAWTUL AND SHALL SUBJECT AN EMPLOIER TOCGMIN LPENAITIESANOCMLTINES UP TO ONSHpNDRED THOUSANDVOLLaR5iF 1 Mirei), r5 AOLw�ON To T:f
••u•e C%VJFCOY,PENSATON,DASIAGES AS PROVIDED FOR IN SECTION ""OF TIte LABORCODE,INTEREST, AND ATTORrisre FESS.
• ° �heT Eby effirn under Nnalty of Perjury one ofthe followhia declarations:
• • • • ve and will maintain a cenifiwle of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as ptavided for by Selian 370p of 'the Labor Code. %%r 1h.
pe Orri+once of the work rorwhich this permh ie issued. Policy No.
• • ( t)rivsr and will RuthI.ln workers' componsmion insurance, as required by Section 3700 of the Labor Code, for the performance of the wank for which Ibis Fermi( is issued- MY wi:.^
oNrrrs' Pe-sato
° • • ° anch camerand policy numbor are:
• • • • • amen Policy Number Eapira hm Data
••••••
Ilei CrAgent Phones
• • • • • • certify that, in the Fedbrmm� f he work for within this permit Is issued, 1 shall not employ any person In any manner so as to became subject to the workers' cmnpenSaTION laws of CaFTomla, ano aero
• • • gat, it.1 should become Sub' D Porkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions, ry ��
SfgPaluo, of AFpbeant� _ Dat J
° • ° ° • ° DECLARATION REGAF}OING CONSTRUCTION LENDING. AGENCY
• • • • . ° IIIt$6Yaffem under o ally of petlury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3091, It Codof
beinial`s Name Lender's Address
By Tiny 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 infamiation I have provided is correct,
I agree to comply with allapplicable city and county ord as and slate laws refinfing to building construction.
I authorize representatives of this city or cou tty o a ve-identlfier,pr0f' rty (or inspection purposes. ` �fn
Signature of Property Owner or Authorized A ort Print Property Owner's or Authorized Agent's Nam ':2Q94 Oa( .L4
I ACTION I DATE BY FOR OFFICE USE ONLY
j f f REGIRAN0115 PARTG1 OF TITLE -10 AND AOMD nti.E
?Lrti.ff.'FIi JAL W'-4 a E5 TOS NOTIFIyfpfi jLSt TA1R011�. bIf TO
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