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HomeMy WebLinkAboutM2021-0037 - Permitswao City of Newport Beach -Building Division *M2021 -00 L«. 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 i� Job Address: 219 NORTH STAR LN Floor: Suite: Bldg: 0 Description of Work: REMOVE/REPLACE DECKING W/ AZEK COMPOSITE DECKING, REPLACE RUBSTRIP Inspector Area: 3 Legal Description: N TR 4224 LOT 104 Owner: CARR TIMOTHY WALTER T Address: 140 NEWPORT CENTER DR NEWPORT BEACH, CA 92660 Phone: State Lie: Applicant: MORALES MARISSA Address: 6351 INDUSTRY WAY WESTMINSTER, CA 92683 Phone: 949-631-3121 Special Cond: Issued Date 06/03/2021 Valuation: $9,000.00 Inspection Fee: $308.00 Plan Check Fee $322.00 OT Plan Check Fee: $0.00 Investigation Fee: $0.00 Building Green Fee: $1.00 Contractor: SWIFT SLIP DOCK/PIER BUILDERS Address: 6351 INDUSTRY WAY WESTMINSTER CA 92683 Phone: 949-6313121 C-066947 Con State Lic:797052 Lie Expire: 07/31/2021 Bus Lie: BT01122734 Lie Exp Date: 11/30/2021 HARBOR Permit: M2021-0037 Project No : 1243-2021 Inspection Requests Phone (949)644-3255 .. Engineer: PETROV PLAMEN o°°°°° Address: 28161 CASITAS CT .... ° ° a• ° LAGUNA NIGUEL CA 92677 Phone: 714-717-7542 Designer: °. a Address: ° Phone: Longshoremen's and Harbor Workers' Compensation Declaration - Carrier : AMERICAN EQUIT Policy No: WC173816804 FEES Fire Inspection Fee: $0.00 $0.00 Fire Plan Check Fee: $0.00 Plan Dep - Counter Review : $0.00 Records Mangement: $6.00 Plan Dep - Zoning Plan Check: $0.00 Harbor Plan Check Fee: $136.00 Plan Dep - OverTime Plan Check: $0.00 IITOTAL FEE: $773.00 Plan Check Fee PROCESSED BY: �/- PLAN CHECK BY: $0.00 Fee Due at permit Issuance: $773.00 PUBLIC WORKS: VUJ APPROVAL TO ISSUE: 1 C OTHER DEPARTMENTS: FINAL INSPECTION: PERMIT EXPIRES 190 DAVSAFTER ISSUANCE OR LAST VALID INSPECTION INER-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)� ction 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 fol 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 ano fessions 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 more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, iness 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 rovements 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 of roved 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 ly 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 awn exemplTr'orn licensure under the Contractors' State License Law for the following reason: "%-Vnatur a bV80 J 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 legally a structure Ehata-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 ant tes§ipns Code,•is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. n2tbre of Propepy Qwner or Authorized Agent Date ,%NSED COVMCTOR'S DECLARATION y4V affirm Crider b6nalty of perjury that 1 am licensed under provisions of Chapter 9 (co incin wi Se lion 7000) of Division 3 of the Bus o e si nse o e nd y license is in full forc( E:ffL tt. License VMS License No. Date Z Contractor Signature NGSHOREMEN'S & HARBOR WORKERS' COMPENSATION DECLA I VING:FAILURE 40 SScWRE LONGSHOREMEN'S & HARBOR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 0,0001-IN ADDftlpU 'fO?'HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following FIns have4t1S4ij maintain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is My workers' compensation insurance carrier and policy number are: Tier Policy Number Expiration Date ne of Agent.. Phone # I certify that, in the pe ormance 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, that, if I should beco a ubject to the workers' co a sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. rture of Applicant: ZDat(M3 I ARATION REGAR I CON TRUCTION 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 (Section 3097, Civil Code). Lender's Name Lender'sAddress By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable c and county ordinances and state laws relating to building con truction. I authorize spresent fives of this cif or c w to felt r the above -identified property for inspection p rposes. /� 151r,� / ,, (' signature: �� Print Name: \X/ Ira a SSA 6 v 4 Dyb (f Date: ACTION DATE BY DECLARATION C PLIANCEIMTHCOOEOF FOROf EONLY FEDERAL REG LATIONSPART61 OFTITLE40AND AQMDRULE1403. PERMITEXPMED ❑ ISUBMITTEDASBESTOSNODFICATIONTO: ❑ EPA ❑ AQMD ❑ ASBESTOS NORRCATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMITCANCEtLED PERMITEXTENDED P€RMiTRNAL C€R77FAH OE Q �7 11 Q•�� e OSSUED CCUPANCYf L-5