HomeMy WebLinkAboutXR2023-2004 - Permits"; WPo?T City of Newport Beach II IIIII IIIIIIII IIIIIIIIIIIII IIIII II III II
CoCOMB Permit : XR2U23-2UU4
Ae mmunity Development Department- Building Division X R 2 0 2 3 2 0 0 4
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No
o > = Permit Counter Phone: (949) 718-1888 Issued Date : 07/21/2023
newportbeachca.gov/civic Final Date:
Combination Type - SFP Permit Status: Issued
Work Class - Repair Inspection Area : 8
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 30 CAPE ANDOVER Legal Desc : N TR 15012 BLK LOT 112
Description: SFR REROOF, T/O WOOD SHAKE, INSTL 1 LYR 30# FELT, R/R SHEATHING AS NEEDED, INSTL 30 SO OF COMP SHINGLES
Owner: SMITH CLARKE A TR C & K
Address : 30 CAPE ANDOVER
NEWPORT BEACH, CA 92660
Phone
Applicant: V O LAREY
Address : 1742 PINE ST
HUNTINGTON BEACH, CA 92648
Phone: (714)305-4955
Owner/Builder :
Address :
Contractor: V 0 LAREY
Address : 1742 PINE ST
HUNTINGTON BEACH, CA 92648
Phone: (714)305-4955
Con State Lic :
514239
Lic Expire :
07/31/2025
Bus Lic :
BT30058476
Bus Lic Expire :
03/31/2024
Workers' Compensation Insurance
Carrier: STATE COMPENSATION INSURANCE FUND
Policy No: 1868014
W. C. Expire : 11/23/2023
Architect
Address
Phone :
State Lic
Engineer:
Address:
Phone :
Designer:
Address
Phone: Phone
Code Edition :
2022
Fire Sprinklers :
NO
Construction Valuation :
$22,000.00
Type of Construction :
V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg :
0
Occupancy Groups :
U,R-3
No of Units :
1
Alteration sq. ft. Bldg :
Bldg Height :
No of Stories :
2
Added/New sq. ft. Garage:
0
TOTAL sq. ft. :
0
Building Setbacks :
Front: 10, Side: 5, Side: 5, Rear: 10
Flood Zone :
X
Use Zone :
PC - Upper Castaways
PROCESSED BY:
SPECIAL CONDITIONS:
INSPECTOR
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable Items)
(Section 7031.5, Business and Professions Cade: Arty city or county that requires a call to construct, alter. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
the permit to fie 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).
❑ 1, 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, huilds or improves the property, provided thRt 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).
0 1, 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 ContractorsState License Law).
Ell am exempt from licensure under the Contractors' State License Law for this following reason _
By my signature bslow 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 ownor-builder if Ithas not been constructed in its entirely 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:liwww.leginfo.ca.gov/calow.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 Section 7000)of Division 3 of the Business and Profess''pt de. arviroFllcense is In full force
and effect. License Class License No Date 7� Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUa3E0T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS IEt0D,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3TOS OF THE LASOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm underpenally, of perjuryone of the following declarations:
❑ 1 have and will maintain a Dariitica(e 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 In
pl�erfopTnnce of the work for which this permit is issued. Policy No,
peat 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' compensadoi
insurance carrier and policy number are:
Policy Number
of Agent
Date
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
if I should become subject tezthe worke(s' c"ensat]on provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
of Applicant
Date,,.,__ Zw Z. /- Z -z_
hereby affirm under penalty of perjury that there is a cri0struction lending agency for the performance of the work for which this permit Is issued (Section 3097, Civil Code)
Enders Name _ _ Lenders Address
ly 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.
1 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 county to ant r t abov -Ir`� jfied property for inspection purposes.
lionature of Property Owner or Authorized Age)t. j� Print Property Owner's or Authorized Agents Name ;'/CTG� �%r L.✓> Date
ACTION DATE f; BY i DECLARATION OF COMPLIAWFIAvIT}I CODE OF FEDERAL FOR OFFICE USE ONLY >>
3 REGULATIONS PART 51 OF TITLE 40 AND AQNID RULE
L1 I SUBMITTED ASBESTOS NOTIFICATION TO
...._. .... ....___ __. _... ._._.._ __. ..._-
PERMIT FXTEN'7FD QM D
PERMIT INAt O✓—I ASBESTOS NO17F A O'IN IS N T AP [CABLE '10
CERTIFICATE OF JrIry1 PROPOSED DEM �R/j.
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