HomeMy WebLinkAboutX2017-2359 - PermitsEwrr�r City of Newport Beach - Building Division II IIIIIIIIIIII I IIIII IIIIII IIIII I I II COMB Permit: X2017-2359
100 Civic Center Drive; Newport Beach, CA 92660 X 2 0 1 7 2 3 5 9 Project No : 2029-2016
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255 - '
Issued Date: 07/27/2017
`"c,,.w•",' Combination Type - BLDG
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: 20352 KLINE DR NB
Description: SFR REROOF R/R COMP SHINGLES 7 BOB CLASS A (X2016-2929)
Legal Desc.: y
Owner: GOLSON GARY Contractor: JASON GOLSON CONSTR INC Architect:
Address: 7924 DALEN ST Address: 20352 KLINE DR Address: t
DOWNEY CA 90242 NEWPORT BEACH CA 92660�-
Phone: Phone: 714.391-1392 Phone: State Lic:
Applicant: GOLSON JASON Con State Lic: 993270 Engineer:
Address: 20352 KLINE DR Lic Expire: 05/31/2018 Address:
NEWPORT BEACH CA 92660 Bus Lic: ST30056465
Phone: 714-723-8499 Lic Exp Date: 09/30/2017 Phone: State Lic:
Code Edit: 2016 Worker's Compensation Insurance Designer:
Type of Construction: V-B Carrier: NO EMPLOYEES Address:
Occupancy Group: R3 Policy No:
Added /New sq.ft. Bldg: 0 Expire: Phone:
Added /New sq. ft. Garage: 0
No of Stories: 1 Building Setbacks Rear: / Special Conditions:
No of Units : 1 Front: /
Bldg Height: 0 Left: /
Bldg Sprinklers: Right: /
Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N
Construction Valuation: $2,400.00
Building Permit Fee: $304.00 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 P/W Plan Check: $0.00 Grading Bond: $0.00
Hazardous Mat $0.00 Electrical W $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 : $305.00 Plan Check Fee : $305.00 Fee Due at Permit Issuance : $0.00
PROCESSED BY: PUBLIC WORKS APPROVAL:
ZONING APPROVAL: PLAN CHECK BY:
GRADING APPROVAL: APPROVAL TO ISSUE:
OWNER-BUIL-DER DECLARATION
I hel eby 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.C, Eusiness 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
th= pemlit 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
PrOesslons 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 fiva hu'oured dollars ($500).
Jr
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 Frofe.siiuns 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 -r3 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
iaipruved for the p11 pose of sale).
❑, I, ac owner o` the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not
H^pply to an owner rn ut pperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
`J 1 am exempt from F-ensure under the Contractors' State License Law for the following reason:
By rly signature• h6low 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 legal)
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:llw .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 Sectio 7 0) of ' 'sion IF the Business and Pr f si s Cod license is in full force
and effect. License Class License No Date Contractor Signatur
WORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T OUSAND DOLLARS ($100,000(, 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
performance of the work for which this permit is issued. Policy No.
have and will 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'
rance carrier and policy number are:
Policy Number
of Agent
Date
ertify that, in the performance 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 workers' compensation laws of California, and agree
if I should become subject tW the workers>efnpensati ions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
of
D -7-2? -1 1
hereby affirm under penalty bf perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ender's Name Lender's Address
y 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 ord ces and a laws relating to building construction.
I authorize representatives of this city or coupty�to ent r t a e-i ntified property for inspection purposes.
".,____1.. .,..."_'_ "...�'_'_'. "_".1! "--- v_ I iL e
ACTION DATE BYfRE,GLLA.RATT1CnNqS
OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
PART 61 OF TITLE 40 AND AQMD RULE
3
PERMIT EXPIRED u I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
NOTIFICATION IS NOT APPLICABLE TO