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HomeMy WebLinkAboutXR2022-2650 - PermitsaEvwaoRT. City of Newport Beach II III I I I II I II I III III II II II Community Development Department- Building Division COMB Permit:XR2022-2650 �j. 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: N T Permit Counter Phone: (949) 644-3288 Issued Date : Inspection Requests Phone: (949) 644-3255 CqG/pppN�¢ newportbeachca.gov/inspections Inspection Area : 1 Combination Type - MFP Work Class - Alteration PERMITS 180 DAYS AFTER ISSUANCE LAST VALID INSPECTN, UT NO LATER THAN YEA NO CONSTRUCTION ERELA RELATED NOISE ON SATURDAYROR SUNDAY IN HIGH DIEO SIBTY AREAS AND �V(�UW 3 19 JCtIV DI HOLIDAYS INN ALL ATREAS �*, . `3, Job Address: 1411 BAY AVE W Legal Desc : N TR 626 BLK 10 LOT 9 Description: MFR-RETURN CONVERTED BEDROOM BACK TO 1 CAR GARAGE (122 2405)/REMOVE BATHROOM CLOSET OSET AND PROCESSED BY Y mza ay„ s •zc Y a 6 am aa° SPECIAL CONDITIONS: rw a r n, Ct• Aok ( hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the Peasants) indicated below by the checkmark(s) I have placed next to (heapplicable Iterate) c(lon 7031.5, Business and Professions Code: Any city or county that requires a permit to Construct, alter, improve; demolish, or repair any structure, prior toits issuance, also requires the applicant for- permit to file a signedstatement that lie or she Is licensed pursuantto tho:provisions of the Contractors' State License Low (Chapter 9 (commencing with Section 7000) of Division 3 of the Busmdss and feastons Code) or that he or she is exempt from licensors 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 perialty of owner of the property, or my employees with wages as their sole compensation sand Professions Code: The Contractors' State License Law does not apply to.a marts are not Intended or offered for sale, If, however, file building of Improvem d for the purpose of saga). - ownerof the property, am exclusively contracting with licensed Contractors to c an owner of property who builds or Improves thereon, and who contracts for, the I exempt from licensur€ under tire. Contractors' Stato License Law for the followtr ignature below I acknowledge that, except for my personal residence in which I n Ticturothat I have built as an owner -builder if it has not been constructed in its or will do (_) all of or U portions of the work, and the structure is not Intended or offered for sale (Section 7044, 1 owner of property who, through>empioyees',or personal effort, builds or improves the property, provided that the int is sold within one year of completion, the owner -Builder will have the burden of proving that it not built or onstmct the project.(Section 7044, Business and Professions Code: The Contractors' State License. Law does not. projects with a licensed Contractor pursuant. to the Contractors' State License Law).. ofessions Code, is available upon request Wan this applicati is subm rat the t tOwln _ pre0 s te: up: fM'ww.ie mro.ca.gowcaiaw.nrml. ignatureofProperty Owner orAuthorized, .....V��----------- ICIENSED CONTRACTOR'S DECLAR ION 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 andProfessionsCode, and my license is in full force nd effect. License Class. License. No Date - Contractor. Signature VORKERS' COMPENSATION DECLARATION ARNING: 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 (Si D0,000), IN ADDITION TO THE DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3100 OF THE LABOR CODE, INTEREST, AND ATTORNEYS. FEES. hereby affirm underpenalty of perjuryone of the following declarations: I 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 thi orformance of the work for which this permit is issued, Policy No. _ 11 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' compensatfor Isurance, carder and policy number are: 'bier Policy Number Expiration Date pe of Agent. Phone # fifty that, In the performance of the work for which this perm t is issued, I tall not em°pl y any parsnI) n any manner so as to become subject to the workers' compensation laws Of California, and egret ietFif I should become subject to th workers' compensation pro ions of c D 700 of Labor Cade; I snail forthwith comply with these provisions. lgnalure of Applicant ..._ .. __.. ^.. te.__, !reby affirm under penalty of perjury that there is a construction tending agent ider's Name' 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 (have provided incorrect. i agree to. comply with at( applicable city and county ordinances and state la I authorize representatives of thiscity or court y)o-enter tif*bove.tderiltfied ACTION I DATE I By 1,01W7T MENDER of the. work for which this permit Is issued (Section 3097, Civil Code). construction. n purposes. TO FOR OFFICE USE.