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HomeMy WebLinkAboutX2015-2924 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIII II 04 O 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 5 2 9 2 4 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 na<amx�`s Combination Type - SFP COMB Permit: X2015-2924 Project No : Issued Date : 10/06/2015 Inspection Area : 3 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. INSTALL OR VERIFY SMOKE(CARBON MONOXIDE DETECTORS /PLUMBING FIXTURES TO BE UPGRADED Job Address: 1901 COMMODORE RD NB Description: SFR - REROOF W/30YR COMP SHINGLE, CL"A", 44 SQS, 1-LYR 30# FELT, TEAR -OFF COMP Legal Desc.: N TR 3763 LOT 3 Owner: ULLMAN JACOB/XANDI CRAIG Contractor: JSL ROOFING INC Address: 1901 COMMODORE RD Address: 2415 MARGARET ST NEWPORT BEACH, CA 92660 NEWPORT BEACH CA 92663 Phone: Phone: 949.646-3571 Applicant: JEFF/JSL ROOFING INC Can State Lic: 747706 Address: 2415 MARGARET ST Lic Expire: 04/30/2016 NEWPORT BEACH CA 92663 Bus Lic: BT98036946 Phone: 949-646-3571 Lic Exp Date: 0813112016 Code Edit : 2013 Type of Construction: VB occupancy Group: R3/U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 1 Bldg Height: 0 Bldg Sprinklers: Flood Zone: X Worker's Compensation Insurance Carrier: STATE COMP INS FUND Policy No: 1913768 Expire: 06/18/2016 Building Setbacks Rear: / Front: / Left: / Right: / Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: Fire Hazard Zone : Building Permit Fee: $309.00 Excise Tax: $0.00 Planning Department - Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee Overtime Plan Ck: $0.00 Fair Share Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans Record Management: $0.00 Grading Permit Fee: $0.00 In -lieu Housing Fee Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department - CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Disabled Access : $0.00 P/W Plan Check: $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 Plumbing %: $0.00 TOTAL FEE: $310.00 PROCESSED BY: ZONING APPROVAL: State Lic: State Lic: Fire Department $0.00 Fire Inspection: $0.00 Fire Plan Rev $0.00 Demolition Fee $0.00 Building Dept Adm General Service Refund Deposit Plan Check Fee : $0.00 Fee Due at Permit Issuance PUBLIC WORKS APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $310.00 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 is 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 'rofessions 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 of more than five hundred dollars ($500). 1 I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or nproved for the purpose of sale). 1 I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). 7 I am exempt from licensure under the Contractors' State License Law for the following reason: ly my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal) ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www,leginfo.ca.gov/calaw.html. ignature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION hereby affirm uroer penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 0 of Diy�'sion 3pf the Business and Profes s e d my license' in full force nd efiect. License Class License No Date D `$ / Contractor Signature ✓ORKERS' ^^C1?=NSATION DECLARATION 414: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED OF COMPENSA. ION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. nereb� affirm under penalty of perjury one of the following declarations: IN ADDITION TO THE I have a III 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 pgy.ifrce of toe work for which this permit is issued. Policy No. 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' carrier and policy number are: Number Date is or Agent Phone # certify that, in the p=rformanc f e work ich 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 if I should become subject t workers' c nsation Ions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. tatureofApplicant Date�� 6 �5 ECLARATION REG DI CT ENDING AGENCY hereby affirm under penal of u that Are 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 o is beh I have read this application and the information I have provid is correc I agree to comply with all applicable city and county ordi s and at ws relating to building construction. I authorize representatives of this city or county t ent t bove--'den 'led grope ebtion purposes. �J ignature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name ACT11ON nATF /'/ v DECLARA norf O/-((AMPLIMC:E t4RTHCODE OF FUIi UI-Hr2 Wk UNLT FEDERAL RE TIO,NS PART Of OF TITLE4fr AN(} PFRI,drT FYPIP� r1 A©MDR 403. e ❑ IS I "7TrnASI'll W)Tf1-fCATMN M PLI&FT EPA 2EAfvTld c7i TEdu'L1E�� AQfA'C TO5 W BRCIRON 6 NOT APPf Iii TO PERMIT FINAL Z -/G - 6(� � p�- POSEDGEMDUTXA1_ CER RC4TECF V�/ OGCUPANCYiSROED 51GNA1 UR{Y-- �\�/ —Ir