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Home My WebLink AboutX2019-0044 - Permitsr ,yLr� City of Newport Beach - Building Division 11111111111111111111111111111111111111111111111111111COMB Permit: X2019-0044 e '�• 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 0 0 4 4 Project No H ? Permit Counter Phone (949)644-3288 i) r Inspection Requests Phone (949)644-3255 Combination Type - MFP Issued Date : Inspection Arearea :2019 8 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: 204 HARTFORD DR NB Description: MFR APPLY SINGLE PLY FIBERTITE OVER (1) LYR OF EXTG (34 SQS) Legal Desc.: TR 11604 LOT 5 UNIT 120 OF PROJECT LOCATED ON AP 442-291-40 TOGETHER Owner: CALDERON JASMINE Address: 1855 W.KATELLA AVE #340 ORANGE CA 92867 Phone: 714-288-2620 Applicant: ROOFING STANDARDS INC Address: 930 LAWRENCE ST PLACENTIA CA 92870 Phone: 714.993-9715 Code Edit : 2016 Type of Construction: VB Occupancy Group: R21U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 2 No of Units : 7 Bldg Height: 0 Bldg Sprinklers: Construction Valuation: $23 500.00 Building Permit Fee: $324.00 Plan Check Fee: $0.00 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $0.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee : $1.00 TOTAL FEE: $325.00 PROCESSED BY: ZONING APPROVAL: Contractor: ROOFING STANDARDS INC Address: 930 LAWRENCE ST PLACENTIA CA 92870 Phone: 714-993-9715 Con State Lie: 741302 Lie Expire: 0513112019 Bus Lie: BT30064518 Lie Exp Date: 09130/2019 Worker's Compensation Insurance Carrier: EMPLYEE SERVICE GROUP Policy No: WC112577000 Expire: 12/31/2019 Building Setbacks Rear: I Front: I Left: I Right: I Excise Tax: $0.00 Additional Fee : $0.00 Grading Bonds Fee: $0.00 Grading PC Consultant : $0.00 Grading Permit Fee: $0.00 Grading PC Fee: $0.00 WQ Insp. Fee: $0.00 Electrical W $0.00 Mechanical %: $0.00 Plumbing %: $0.00 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: a.� F ' State Lie: State Lie: Special Conditions: UNITS 204-216 Planning Department - Plan check Fee Fair Share SJH Trans In -lieu Housing Fee: Public Works Department - Park Dedication : $0.00 PAN Plan Check : $0.00 San Dist: $0.00 NMUSD Fee: $0.00 Plan Check Fee: $0.00 Zone : N Fire Department $0.00 Fire Inspection: $0.00 Fire Plan Rev $0.00 Demolition Fee $0.00 Building Dept Adm General Service Refund Deposit Grading Bond: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Fee Due at Permit Issuance: $325.00 PUBLIC WORKS APPROVAL: PLAN CHECK BY: GRADING APPROVAL: 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 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 (_) 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). ❑ 1 am exempt from, licensure under the Contractors' State License Law for the following reason: By my signature below ' 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, 1 cannot legal) Pell 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 ✓loress-ons Code, is mailable upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date _ICEN-3ED CONTRACTOR'S DECLARATION I hereby affirm urCe, ?enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with tion DO) Div' ion 3 of the Bus! ss and Professions license is in full force ,,ind etrect. License Ciass License No a on or Signature ; WORKERS' COVPENSATION DECLARATION WARNING, FAILURE Tn 9FPURE WORKERS' COMPENSATION COVERAGE Is UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES U TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE 'JR 6F COMPENSATION, DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. affirm under penalty of perjury one of the following declarations: I have and whl nlrintain 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 ' Nance of the work for which this permit is issued. Policy No. Eve and will mrintain 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' compensatio nsuran carrier and policy number are: /-� �77 '` d I Z f3 1 /I q Carrier vd zU+IC PolicyNumber t l_ / / l/ Ex iration Date P 1 Name of Agent Phone # �_r/ certify 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 agre that, if I sh ome subject to the workers' comp nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. [� � Signature to l DECLARATION DING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued ( ction 97, Civil ode). Lender's Name Lender's Address By 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 representative Is y or county to enter ab - oparty for inspection purposes.` Signature of Property Owner Auth rued Agent Print Property Owners or Autho 'zed ome D ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED OEPA PERMIT EXTENDED LJAQMD PERMIT FINAL (-WSBESTOS NOTIFICATI N 15 NOT APPLICABLE TO CERTIFICATEOF D DEMOLITIO OCCUPANCYISSUED GN RE: