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Home My WebLink AboutX2016-3430 - PermitsCity of Newport Beach - Building Division *X2016-3430* COMB Permit: X2016-3430 a4 ', 100 Civic Center Drive, Newport Beach, CA 92660 Project NO : 0950-2014 ee'�^ Permit Counter Phone (949)644-3288 cx Inspection Requests Phone (949)644-3255 Combination Type - SFP Issued Date : 10/20/2016 ' Inspection ArapL3 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. INSTALL OR VERIFY SMOKE(CARBON MONOXIDE DETECTORS /PLUMBING FIXTURES TO BE UPGRADED Job Address: 1701 SKYLARK LN NB Description: SFR REROOF T/O WOOD SHINGLES REPLACE W/ CEDAR SHAKE W/CLASS A ROOF ASSEMBLY 38 SQ ESR# 1410 Legal Desc.: N TR 3082 LOT 65 Owner: PALMQUIST TIM Contractor: OWNER/BLDR Architect: Address: 1701 SKYLARK LN Address: KELLY LEEPER AUTHORIZED Address: NEWPORT BEACH, CA 92660 BY TIM PALMQUIST Phone: Phone: Phone: State Lie: Applicant: KELLY Con State Lie: O/B Engineer: • ° ° • • • ° ° Address: Lie Expire: Address: • ° ° . ° Phone: C(,L(ct- S3 7j _ 0050 Bus Lie: °• • °• Lie Exp Date: Phone: State Lie: °•.° ° °°, •0° Code Edit: 2013 Worker's Compensation Insurance p Designer: °°•• ° Type of Construction: V-B Carrier: Address: • .oc• • • ° • Occupancy Group: R3/U Policy No: . Added /New sq.ft. Bldg: 0 Expire: Phone: ° ....... Added /New sq. ft. Garage: 0 . ° ° ° a ° . ° No of Stories: 1 No of Units : 1 Building Setbacks Rear: / Special Conditions: OWNER/BLDR FORM ATTACH ..... Bldg Height: 0 Front: / Left: / . ° • �.. ° Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $3,800.00 Building Permit Fee: $124.00 Excise Tax: $0.00 Planning Department- Fire Department Plan Check Fee: $107.88 Overtime Plan Ck: $0.00 Additional Fee : Grading Bonds Fee: $0.00 Plan check Fee : $0.00 $37.50 Fire Inspection: $0.00 Investigation Fee: $0.00 Grading PC Consultant : Fair Share : $0.00 SJH Trans : $0.00 $0.00 Fire Plan Rev Demolition Fee $0.00 Record Management: $0.00 Energy Compliance: $0.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 CA Seismic Safety: $0.00 Grading PC Fee: WQ Insp. Fee: $0.00 Public Works Department - $0.00 General Service $0.00 Disabled Access : $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Hazardous Mat $0.00 Electrical %: PAN Plan Check: $0.00 San Dist: $0.00 $0.00 Grading Bond: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE: $270.38 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Plan Check Fee: $270.38 Fee Due at Permit Issuance : $0.00 PUBLIC WORKS APPROVAL: r \ PLAN CHECK BY: CC l/ APPROVAL TO ISSUE: �_& OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(S) I have placed next to the applicable items) ($ection 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 0 ore than five hundred dollars ($500). n ❑ 1 as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of, the work, and the structure is not intended or offered for sale (Section 7044, B ess and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ I am exempt ¢om Iicensure under the Contractors' State License Law for the following reason: By my signatur"aI&A 0 acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legalh sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 004 of the Business and pl'bfB9Sipns Cory, l5 gVilable upon request when th ap licatio is suq �� qr at tie following Web site:hftp://www.leginfo.ca.gov/calaw.html. O /Z0A 6 Signature of Propefty'Owner or Authorized Agent / /L Date L•IOENSED CON -TRACTOR'S DECLARATI I*hereVy affirm under penalty of perjury that I am Icensed under provisions of Chapter 9 (commencing with Section 7000)lof Division 3 of the Business and Professions Cod , and my license is in full force anUjeff$ct. Licer4s¢'Class License No Date Contractor Signature VERS' COMP€NSATION DECLARATION N8:1FAILURE 1C.SE6URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (9100,000), IN ADDITION TO THE DP COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hq®ffirm under penalty of perjury one of the following declarations: have and livirMiatain 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 V*ce of thg!Mk for which this permit is issued. Policy ND.. ave and wAl 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' wmpensa once carrier and policy number are: Policy Number 1e of Agent certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any . if I should become subject to_ttjgWrkers' compensation provisions of Section 3700 of the Labor Code, I shall of Date so as to become subject to the workers' compensation laws of California, and agre h comply with those provisions. Date/ CLARATION REGA DING CONSTRUCTION LENDING AGENCY -reby affirm under nalty 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 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 count ordinances and state laws relating to building construction. I authorize representatives of this city or county enter rhPJy�io e-identified property for inspection purposes. /� f/C/ /J L��Da. (nature of Prooertv Owner or Authorized Agent �=' L,_� Print Property Owner's or Authorized Agent's Name / 7"[/4—'r 3e DATE I BY PERMITCANCELLED PERMIT EXTENDED PERMITFINAL CERTIFICATE OF OCCUPANCY ISSUED D6X0fARATION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 SI IRMITTED ASBESTOS NOTIFICATION TO )S NOTIFICATION IS N,QTtPPLICABLE TO DEMOLITION FOR OFFICE USE ONLY All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall be in place prior to approval to fill pool/spa & shall remain in place & be maintained for the life of the pool.