HomeMy WebLinkAboutX2021-2103 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Inspection Requests Phone (949)644-3255
Combination Type - SFP ELEC
IIIIIIIIII�IIIIIIIQIIIIIII�IIIIIIIIII II COMB Permit: X2021-2103
x 2 0 2 1 2 1 0 3 Project No: 1822-2021
Issued Date : 11102/2021
Inspection Area : 6
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST SE COMPLETED BY 1110212024 OR PERMIT WILL BE INVALID
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: 22 BELFORT NB
Description: SFR (1) ENERGY STORAGE SYSTEM (PV2021-138) '
Legal Desc.:
Owner:
SIEGAEL EVANMEAN
Contractor:
SUNRUN
Architect:
Address:
22 BELFORT
Address:
225 BUSH ST #1400
Address:
NEWPORT COAST CA 92657
SAN FRANCISCO, CA 94104
Phone:
Phone:
855-478-6786
Phone:
State Lic:
Applicant:
STANTON DEANA
Con State Lic:
750184
Engineer:
LOPEZ SAGE
Address:
20512 CRESCENT BAY
Lic Expire:
0613012022
Address:
133 TECHNOLOGY WAY
LAKE FOREST CA 92630
Bus Lic:
BT30066837
IRVINE CA 92618
Phone:
949-460-3433
Lic Exp Date:
0413012022
Phone:
949-3863-0993 State Lic:C-075870
Code Edit : 2019
Type of Construction: VB
Occupancy Group: R3/U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 2
No of Units : 1
Bldg Height: 0
Bldg Sprinklers: N
Valuation: $7,000.00
Building Permit Fee: $195.00
Plan Check Fee: $169.65
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$40.00
Energy Compliance:
$0.00
CA Seismic Safety :
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $531.68
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Worker's Compensation Insurance
Carrier: ZURICH AMERICAN INS CO
Policy No: WC614287600
Expire: 10/01/2022
Building Setbacks Rear: /
Front: /
Left: /
Right: /
Excise Tax:
$0.00
Additional Fee :
$0.00
Grading Bonds Fee:
$0.00
Grading PC Consultant:
$0.00
Grading Permit Fee:
$0.00
Grading PC Fee:
$0.00
WQ Insp. Fee:
$0.00
Electrical %:
$25.53
Mechanical %:
$0.00
Plumbing %:
$0.00
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Plan Check Fee
Designer: FORTES JOHNMAR
Address: 2051 CRESCENT BAY
LAKE FOREST CA 92630
Phone: 949-460-3433
Special Conditions
Fire Hazard
Planning Department -
Fire Department
Plan check Fee : $52.00
Fire Inspection:.
$0.00
Fair Share : $0.00
Fire Plan Rev
$48.50
SJH Trans : $0.00
Demolition Fee
In -lieu Housing Fee : $0.00
Building Dept Adm
$0.00
Public Works Department -
General Service
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
PAN Plan Check : $0.00
Grading Bond:
$0.00
San Dist'. $0.00
NMUSD Fee: $0.00
$0.00
$0.00
$282.03 Fee Due at Permit Issuance :
$249.65
�V 064
PUBLIC WORKS APPROVAL:
- -PLAN CHECK BY:
APPROVAL TO ISSUE:
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
ProfessionsCode) or that he or she is exempt from Iicensure 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-Builderwill have the burden of proving that it was not built or
Improved 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
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 Iicensure 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, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.govlcalaw.htm].
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 70H D"vi ioA 3 of the Business and Professions de my license is in full force
and effect. License Class License No Date Contractor Signatur
WORKERS' COMPENSATION DECLARATION
NARNING: 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
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
FI 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
e rmance of the 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:
Policy Number
of Agent
Date
certify that, in the performance of the work forwhich 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
I, if I should become subject to the wgrkHrs'�aplpensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant /(y//OF Date
CLARATION REGARDIN CO STRU TION LENDING AGENCY
:reby 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, Ci I Code).
Ider's Name Lender's Address
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.
1 authorize representatives of this city or county to ant r identified property for inspection purposes. ��j�
nature of Prnnertv Owner or Authorized ADente% // Print Property Owner's or Authorized Agent's Name r n YYY77/�1i� `t[ ll i Date
DATE I BY �( DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
r REGULATIONS PART 61 OF TITLE 40 AND AQM D RULE
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