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Home My WebLink AboutX2021-2998 - Permits (3)pop �x.Vrr;" City of Newport,Bengh - Building Division II III IIIIIIIIIII III II IIIIII I III I II COMB Permit: X2021-2998 ul',.""�' 100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 2 1 2 9 9 8 Profect No Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255Issued Date : 11I0412021 Combination Type NO CONSTRUCTION NOISE Inspection Area : I PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1110412024 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: 2129TIO(E) .5 SQ NB ON THE WEEKEND Description: SFR T/O (E) 4.5 SQ, INSTALL B.U.R, CLASS 'B'MIN. Legal Desc.: N TR 518 BLK E LOT 32 , Owner: BENNETT JANET JENSEN Contractor: TIM OUTZEN ROOFING Architect: Address: 2129 E OCEAN BLVD Address: 1059 S CLIFFORED AVE Address: NEWPORT BEACH CA 92661 RIALTO CA 92376 Phone: Phone: 626-792-5171 Phone: State Lic: Applicant: TIM OUTZEN ROOFING Con State Lie : 1017146 Engineer: Address: 1059 S CLIFFORED AVE Lie Expire: 08/3112022 Address: RIALTO CA 92376 Bus Lie: BT30076059 Phone: 626-792-5171 Lie Exp Date: 07131/2022 Phone: State Lie: Code Edit : 2019 Worker's Compensation Insurance Designer: -Type -of- Construction: - - -VB - Carrier.- - STATE COMP.-- Address: Occupancy Group: R3/U Policy No: 9144811 Added /New sq.ft. Bldg: 0 Expire: 11/01/2022 Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: I Special Conditions: HIGH DENSITY AREA No of Units : 1 Front: / Bldg Height: 0 Left: I Bldg Sprinklers: Right: I Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $2,400.00 - Building Permit Fee: $351.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee : $0.00 Fire Inspection: Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev 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 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department - General Service CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit Disabled Access : $0.00 PM Plan Check : $0.00 Grading Bond: 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: $352.00 PROCESSED BY: ZONING APPROVAL: e� Z rn i $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $352.00 , PI IULIC WORKS APPROVAL: PLAN CHECK BY: GRADING APPROVAL: _ - ,•.PrROVAL 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 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). ❑ 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 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 the applicable 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.htmi. 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 Sectio70,20) of 'visi n 3 of the Business and Pr es e, an lice a Is in full force and effect. License Class License No Date // / I Contractor Signature -s== � WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$100,0001, IN ADDITION TO THE COST 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: ❑ 1 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 the oerjormance of the work for which this permit is issued. Policy No. have and will al In workers' ycc "L�sensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' rance carrier a Do I v numberfa6e:) _ Date of Agent certify that, in the performance of thevvork for which this permit ik'issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre t, if I should become splol9tt to the wo rs' compens provi ns of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant Da /, At AJ--y CLARATION REGAR NG UCTION LENDING A EN Y :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 7, 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 city or cou y t nter the above fied p perty for inspection purposes. /— r nature of Prooertv Owner or Authorized Aoent�i...-r Print Prooertv Owner's or Authorized Aaent's Nan% 11"N r-t Eti, �,gI_ ACTION DATE BY / - EC TION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULAT INS PART 61 OF TITLE 40AND AQMD RULE 1403 _ PERMITEXPIRED I U I SUBMITIED ASBESTOS NOTIFICATIGN TO PERMITCANCELLED LJEPA PERMIT EXTENDED UQM D PERMITFINAL 1 SBEST S NOTIFICATION IS NOTAPPLICABLE TO CERTIFICATE OF V ROPOSE DE ITIO OCCUPANCY ISSUED SIGNAT RF: 0,� J .. �j al a� U .c Sr L.CO C[5 +I ' -.- 'a O O �y Z O d CC-) L ' In (U H fD �� d O C -a J aQ�. 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