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HomeMy WebLinkAboutX2017-1941 - Permitswt� Division City of Newport Beach - Building 100 Civic Center Drive, Newport Beach, CA 92660 H �^ Permit Counter Phone (949)644-3288 Inspection Requests PhorIU4;(94 `"" '^" as xa Combination Type - SF#J, MECH PLUM T,. Date:- ate:_ Division *X20171941* COMB Permit: X2017-1941 Project No: 0177-2017 Inspection Area : 1 S53�t PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction Hou da day 00 a. :A Sa rd m 0 6:OO�rr$�®gg(�[pS p�ay� or �JLida�(s Job Address: 5219 LIDO SANDS DR NB V f (JYUU"/0r iUdaDescription: SFR KITCHEN& (2) BATHROd{t!R L'S (CTY S BA 00 L Legal Desc.: N TR 3162 LOT 73 �1j5 t °.., r"� to whom: € Owner: POLHEMUS II W EDWARD Contractor: OWNER/BLDR Architect: Address: 5219 LIDO SANDS DR ress: L NEWPORT BEACH CA 92626 ' �' 1 Phone: 424.226-8590 ; : ne: P ne: State Lie: PIR Applicant: POLHEMUS II W EDWARD a, State ic. /B E . Address: 5219 LIDO SANDS DR t Lie Expire: Address: NEWPORT BEACH CA 92626. Bus Lie: Phone: 424-226-8590 = LicW Date: Phone: State Lie: ..... Type Ia i c r plea ° Code Edit: 2016 Wo er' I sur n esi ner T e of Construction: VB Carrier: dd ° °: o ° • ° ° ° o Occupancy Group: R3/U Polic�t() rk started) Added /New sq.ft. Bldg: 0 Expi�'" Phon(�no work started) •- °° °°° Added /New sq. ft. Garage: 0 No of Stories: 1 Nott i ding Setbacks Rear: I Special Conditions: No of Units : 1 Q Bldg Height: 0 ' Left: I Bldg Sprinklers: - Richt' 1 {!1^p, lnitlaiS: Flood Zone: Parkin S aces: 0 --Fire Hszane : Construction Valuation: $25,000.00 Building Permit Fee: $442.00 Excise Tax: $0.00 Planning Department- Fire Department Plan Check Fee: $384.54 Additional Fee: $127.00 Plan check Fee: $37.50 Fire Inspection: $0.E0 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: $2.00 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 PAN Plan Check : $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $30.94 San Dist: $0.00 Building Green as: $1.00 Mechanical %: $17.68 NMUSD Fee: $0.00 $0.00 Plumbing %: $39.78 $0.00 TOTAL FEE : $1,082.44 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $1,082.44 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: �s�t-OLO PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: V� 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 iRv - the purpose of sale). s 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 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 legall, 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, Sect i n 7044 of the Business and Professions Code, is available upon requesn'th'Is�application is s�u�ttepdt the following Website:http://www.leginfo.ca.gov/calaw.htmL Signature of Property Owner or Authorized \ nt .va 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 Professions Code, and my license is in full force and effect. License Class License No Date Contractor Signature :RS' GOENSATION DECLARATION FAILURE 701 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00D(, IN ADDITION TO THE OMPENSJTION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. affir"urMgtpenalty of perjury one of the following declarations: Have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the emlance of ttpe wok far which this permit is issued. Policy No. ... halts and will.mai..ntain workers' compensation insurance, as required by Section 3700 of the Labor Code, rahce carrier and -policy number are: Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for for the performance of the work for which this permit is issued. My workers' 2t. •. Policy Number Expiration Date iAfif Anent . - Phone# il;certi that, $Ltba performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the work rs' compensation laws of California, and agree at, if I should become object to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ...•• "n�'' 9gpture of Appl nt WkyyA Q"% a ECLARATIO . GARDING CONSTRUCTION LENDING AGENCY Iereb a under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). ander' a e Lender's Address 1 my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of t4'I�yi or county to enter the above��-�ii e��ntti�if„„led roperty for inspection purposes. \ E \�7prr� Q®1�1e 0150,11(.11 onature of Prooertv Owner orn4u or ed Anent It” =w Print Prooertv Owner's or Authorized Agent' NameW ®4010 0' at ACTION DATE. BY DECLARATION OF IREGULATIONS PA PART OF IITLE 40 AND QMD RULECE WITH CODE OF FOR OFFICE USE ONL PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED OEPA PERMITEXTENDED E3AQMD PERMITFINAL CERTIFICATE OF OCCUPANCYISSUED OASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION SIGNATURE: LO O) F aD xz Lo N H m Y U o W a Om W m t A z r 0 0) FD am � Zc 00 ac�1-L Fa X U w�Am� Woo 0 > U Uo � o 0 ' O c L m m L m m N N m m T c m L J c J m ca c N a) c rz U,a V N J C L G w Ev Aw o c cHwy m NCc cm '=- ° o� moo m`0 a)0 0 aa)iy € ° m ��m Z .0 w LL y o c E o N o 3 3 3 w= a c m 3 y$ z a) a E o Q� mao o z m Ca y m� m me a c m 3 m x M .0 E C m L Z = m m V L m N m e Y N - U N N a) m N N r ° a w 3 0 a N N m 0 0 c U p �p C wM a) y N y a'C, o> J m m .� )n O w '- m C 01 N w wm N G 'a 0 Q T N >. 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