HomeMy WebLinkAboutXR2023-1239 - Permits��wvo�T City of Newport Beach IIIIIIII'IIIIIIIIIIIIIIIIIIIII II COMB Permit : XR2O23-1239
c4 Community Development Department- Building Division X R 2 0 2 3 1 2 3 9
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2023-1098
Permit Counter Phone: (949) 718-1888 Issued Date : 05/25/2023
newportbeachca.gov/civic Inspection Area : 4
°"gcoa`"P Combination Type - SFP ELEC
Work Class - Alteration
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 18 RUE CHANTILLY Legal Desc : N TR.7519 BLK LOT 33
Description: SFR INSTALL (N) POLLOCK ELEVATOR LIFT AT (E) LIVING ROOM TO HALLWAY.
Owner: SIMOVICH EDWIN A TR
Address : 18 RUE CHANTILLY
NEWPORT BEACH, CA 92660
Phone: (626)222-2046
Applicant: PRYN HAHN
Address: 34167 PACIFIC COAST HWY, D
DANA POINTE, CA 92629
Phone: (949) 226-7130
Owner/Builder :
Address :
Contractor: ACCESS TO FREEDOM
Address 9272 JERONIMA RD #111
IRVINE, CA92618
Phone:
(949)472-4900
Con State Lie
: 786659
Lie Expire :
10/31/2024
Bus Lie:
BT30067117
Bus Lie Expire : 04/30/2024
Workers' Compensation Insurance
Carrier: AMGUARD+INSURANCE+COMPANY
Policy NO: ACWC301235
W. C. Expire : 3/1/2024
Architect
Address
Phone:
!
State Lie :
a
Engineer:
BURKE LEO
Address:
34167 PACIFIC COAST HWY #D
DANA POINT, CA 92629
Phone :
(949) 226-7130
Designer:
Address :
Phone:
Phone:
Code Edition :
2022
Fire Sprinklers :
NO
Construction Valuation :
$30,000.00
Type of Construction :
V-B
Fire Hazard Zone :
NO
Added/New/Ti sq. ft. Bldg :
0
Occupancy Groups :
U,R-3
No of Units :
1
Alteration sq. ft. Bldg :
65
Bldg Height:
No of Stories ;
2
Added/New sq. ft. Garage :
0
TOTAL sq. ft. :
0
Building Setbacks :
Front: 10, Side: 5, Side: 5, Rear: 15
Flood Zone :
X
Use Zone:
PC - Big Canyon
PROCESSED BY:
SPECIAL CONDITIONS:
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 applicablettem(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
me permit to file a signed statement that he or she is licensed pursuant to theprovisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
'rofesstans Code) or that he or she is exempt from licensors and the beats for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit Subjects the applicant to a civil penalty of
of more than five hundred dollars ($500),,
3 I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or C_) 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,
nprovements are not intended or offered for sale. It, 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 builtor
nproved 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
pply to an owner of property who builds or improvesthereon, 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: _
ly my signature below I acknowledge that, except for my personal residence in which I must have residedfor at least one year prior to Completion of the improvements covered by this permit, I cannot legally
all a structure that I have built as an owner -builder if it has not boon constructed in itsontlraty by licensed contractors. I understand that a copy of the applicable taw, Section 7044 of tho Business and
Yofesslons Code, is available upon request when this application is submitted or at the following Web site:htfpatwww.taglnfo.oa,gov/dalraw.htmi.
agnature, of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am tcensed under provisions Gf Chapter 9 (commencing with Section 0) Diy!' ion 3 of the Business and Pm i de, arts my license is in full force
nd effect. License Class C_'I i license No 1 $ 1, IF+SI oat Zj Contractor Signatur
PORKERS' 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 15100,0001, UN ADDITION TO THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LAaOR CODE, INTEREST, AND ATTDRNEY'S FEES,
hapby 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 370D of the Labor Code, forth,
erformance of the work for which €his 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'
carder and policy number are:
Policy Number
Date
na of Agent Phone S,
certify that, in the pert m D o the work for which this permit is Issued, I shall not employ any parson in any manner so as to become subject to the workers compensation laws ofCallfomta and agree
t, if I should becomes bjeC workers' compensation provisions of Section.3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant DatrZS,�L�
CLARATIGN REGA DIN UGTIGN LENDING AGENCY
Ireby 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)Code).
Ider'a 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 1 have provided. is Correct.
I agree to comply with all applicable city and coon anancas and state Taws relating to building construction. ,,t{
I authorize representatives of this oily Dr coo ha above -identified property for Inspection purposes. , r"1 s-Z5.- L�
nature of Property Owner or Authorized Adan�i Phot Prooemv Owner's or Authorized Anent's Name lvl Date
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF Tr?LF 40 AND AQMD RULE
NOVICATIONTO
PERMi7 EXTENDED
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PERNfli'FIrdA£
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8a5T05NOT1�IQk ON. IS NOT'APPLIGA9tf TO
CEANFICATE Of
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OCCUPANCY ISSUED
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