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X2019-0601 - Permits
City of Newport Beach -Building Division IIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIII Construction Valuation: $0.00 COMB Permit: X2019-0601 6 100 Civic Center Drive, Newport Beach, CA 92660 '-. X 2 0 1 9 0 6 0 1 Overtime Plan Ck: $0.00 Project No : 0181-2019 o InvestigationFear ° $0.00 Permit Counter Phone (949)644-3288 Risord tanagem4ni : ° $0.00 Grading. Bonds Fee: v. -.. Inspection Requests Phone (949)644-3255. C�,Ae!VZic Safety,: ° $0.00 $0.00 Doso bl°eo Access: o .$0.00 Combination Type - SFP ELEC MECH PLUM Hazardous Mat - $0.00- Issued Date : 02125/2019 .°• Build•ing Green Fero ° ° $0.00 $0.00 Demolition Fee Inspection Area: 4 © ao a • ° TOTAL FEE: $35.00 . • - PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION: ZONING APPROVAIL° ° 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: 34 MONTGOMERY NB $0.00 Public Works Department- Description: SFR ADD 155 SF (GARAGE CONVERTED INTO PANTRY) REMODEL 380 SF (KITCHEN) "CHG OF CONTRACTOR" WQ Insp. Fee: Legal Desc.: N TR 15517 LOT 68 $0.00 Owner: GOLDBERG CLIVE Contractor: URBAN -CA INC Architect: PM Plan Check: Address: 32 VALERIO Address: PO BOX 10818 Address: Electrical %: $0.00 NEWPORT BEACH CA 92660 NEWPORT BEACH CA 92658 $0.00 Phone: - Phone: 657-900-2150 Phone: State Lic: Applicant: TAWADKOUS FADY Con State Lic: 1017845 Engineer: AZIZ MOURAD Address. 335 NUTTWOOD ST Lic Expire: 09130/2020 Address: 331 W DORAN ST #121 'BREA CA 92821 Bus Lia `*rtf oD tsb Plan Check Fee: GLENDALE CA 91203 - Phone: 760-885-5951 Lic Exp Date: =I }q 119L„ Phone: 818.913.8002 State Lic:C-076916. '.., Code Edit: 2016 Worker's Compensation Insurance Designer:. Type of Construction: VB Carrier: STATE FUND Address: - Occupancy Group: R3/U Policy No: 9203854 .Added /New sq.ft. Bldg: 0 Expire: 01/28/2020 Phone: Added /New sq. ft. Garage: -155 No of Stories: 2 Building Setbacks Rear: 5 Special Conditions:. No of Units : 1 Front: 15 Bldg Height: 0 Left:.. 5 `- Bldg Sprinklers: N Right: 5 Flood Zone: X Use Zone: Parkin Soaces: 0 Fire Hazard Zane : N GRADING APPROVAL: Excise Tax: Construction Valuation: $0.00 Planning Department- Building Permit Fee: $0.00 Plan Check Fee: $0.00 Additional Fee: Overtime Plan Ck: $0.00 Plan check Fee: o InvestigationFear ° $0.00 $0.00 Risord tanagem4ni : ° $0.00 Grading. Bonds Fee: Eoergy Cnmpliagcn� ° ° $0.00 Fair Share : C�,Ae!VZic Safety,: ° $0.00 $0.00 Doso bl°eo Access: o .$0.00 Grading PC Consultant: Hazardous Mat - $0.00- SJH Trans : .°• Build•ing Green Fero ° ° $0.00 $0.00 Demolition Fee Grading Permit Fee: © ao a • ° TOTAL FEE: $35.00 . • PRO°CftMD BY: ° °.O.... ZONING APPROVAIL° ° GRADING APPROVAL: Excise Tax: $0.00. Planning Department- Fire Department Additional Fee: - $35.00 Plan check Fee: $0.00 Fire Inspection: Grading. Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm. Grading PC Fee: $0.00 Public Works Department- General Service WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit PM Plan Check: $0.00 Grading Bond: Electrical %: $0.00 San Dist: $0.00 Mechanical %: $0.00 NMUSD Fee: $0.00 Plumbing %: $0.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $35.00 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 he 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 lot 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, 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 Tlprovements 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 reproved for the purpose of sale). 3 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 Ipply 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). I am exempt from licensure under the Contractors' State License Law for the following reason: iy 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 legallt 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 under penalty of peI am licensed under provisions of .ha a (c p7�encing with Section 70 O) o� Di ision 3 qj the Business and Professi ode and my is in full force Ind effect. License Class 7 License No - Y 55`1 Da B tll iS Contractor Signal U& YORKERS' COMPENSATION DECLARATION IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE :OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 07DG OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I 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 th rmance of the work for which this permit is issued. Policy No. ]I 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' compensatiol 1s rance cGarrier and olicy number are: 1 / ,arnerPolicy Number �i`��� 1� Expiration Date - D 2 f `"l lame of Agent Phone # certify that, in the pi , if I should become of I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre ction 3700 of the Labor Code, I shall forthwith comply with those provisions. _ 2 z s ton IECLARATION REGARDING CONSTRUCTION LENDING AGENCY 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 (Section 3097, Civil Code). ender's Name Lender's 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. I have read this application and the information I have provided is correct. 1 agree to comply with all applicable city ani m ces and statws_re�}mg to building construction. I authorize representatives of this city or clvo�unty tb r the above-identifi d pert for inspection purposes. 1 / lianature of Prooertv Owner or Authorized Ag4t. _.. `� ``print Property Owner's or Authorized Agent's Name V & til06Z L 'TS, PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATEOF OCCUPANCYISSUED WITH CODE OF FEDERAL REGULATIONS PART 610 F TITLE 40 AND AQMD RULE 1403 PROPOSED ASBESTOS NOTIFICATION TO TO FOR OFFICE USE ONLY . • • •000 • • • • o 0 •w000 • •oo 0 •date Z �3 _ •c o • • a u •• • ueeoo • o LL)