HomeMy WebLinkAboutX2016-0022 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0�'_ 0 2
rte+ ^• Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
�atr.�y,sa Combination Type - SFP MECH ELEC PLUM
...yam.::. �r '`t,i'v'�`•J �.
P PIRE 180 DAYS AFTER tSSU NC OR LAST1�4 t i
/NST ERIFY SMOKElCARBON M iODE DETEQ�L/BfNG' FIXTUF
Job Address: 4 CANYON FAIRWAY �--�' �,-:
Description: SFR ENCLOSgGbG0' BRED PATIO 186 SF, CONVERT-aOR RGE TO LIQ/ 8 F[$ REMODEL 3,190 SF
Legal Desc.: N TR 1;089OT 15
Owner:
PREMIE
Address:
4 CANY
Occupancy Group:
NEWPOF
Phone:
7r�se Tax:
Applicant:
BAILEY I
Address:
23187 LA
No of Units :
LAGUNA
Phone:
949-573-1
VIS�,�'?A'6Y6 G LTD �^ , , Cq`�tractor ' SE. ,AOI�F�$T,4�VEk�'PERS INC Architect:
1 FAIRWAY DR s , ��`� ,�Adoress 6 ` „ 6 VW�I71`i ST #A Address:
j BEACI{ l;A R. 60 n 14 /. 6Mpg `"+.t3 OSTA MESA CA,.%2k27
'ib 1aA, is }�, ho7fe 949-09 8,'k'j
TINA Phone:
Con =t LR NA)
4 •y„3 t;'� Engineer:
0 DEN ? 1 it Yid'v Qf/rr�7�/2 Address:
0 S CA 92653 ' , ust� Y i T3'"
15 ,vsmia �, Sr�Date:F /30/2016 Phonr
Code Edit :
21
Type of Construction:
Vi
Occupancy Group:
R
Added /New sq.ft. Bldg:
7r�se Tax:
Added /New sq. ft. Garage:
Plan Check Fee:
No of Stories:
2
No of Units :
1 -
Bldg Height:
0
Bldg Sprinklers:
N
Flood Zone:
X
S TO BE UPGR
BAILEY DAVID
23187 LA CADE
LAGUNA HILLS
949-573-1050
7L11hrJY1UYI
I �- worker's Compensation Insurance e' . y�g„4''i
Carrier: STATE FUNDS �;; a Addresg¢r3t�l
Policy No 9034365
267 Expire , 11/2016 `rV0 v�0Phone:
81 a fes;
415�iif, t S bgcis Rear: / Speci i ions LA
�y\ Front: /
l.. 1 Left: I t�+-.?'" a
Right: / ,,
Use Zone: Parkina-9 es: 0 _--�Firs+Iaf6 "d -Zone : N
COMB Permit: X2016-0022
Project No : 0009-2016
Issued Date : 01/12/2016
Inspection Area : 4
DED
t K)
JA R#101
CA 2653
State Lic:CO27404 ....
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S to Lic:C-075736
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Fire Department
v
X
Fire Inspection:
$0.00
Building Permit Fee:
$4,690.00
7r�se Tax:
0 tanning Department -
Plan Check Fee:
$4,080.30'.,°
AdrOfional Fe
°,„$Osiff)-
Plan check Fee
Overtime Plan Ck:
$0.00
�?+ , ,V., ^y'"'"�
Fair Share:
Investigation Fee:
$0.00
F
le5p
QOE Gra ir„Gorisultant:
$0.00
SJH Trans:
Record Management,
$60.00
rading Permit Fee:
-ra.'
$0.00
In -lieu Housing Fee
Energy Compliance:
$268.00
,�;;wro+
Grading PC Fee:
$0.00
Public Works Department -
CA Seismic Safety:
$110.50
WQ Insp. Fee:
$0.00
Park Dedication : $0.00
Disabled Access :
$0.00
PAN Plan Check: $152.00
Hazardous Mat
$0.00
Electrical %:
$328.30
San Dist : $0.00
Building Green Fee :
$34.00
Mechanical %:
$187.60
NMUSD Fee: $0.00
Plumbing %:
$422.10
COMB Permit: X2016-0022
Project No : 0009-2016
Issued Date : 01/12/2016
Inspection Area : 4
DED
t K)
JA R#101
CA 2653
State Lic:CO27404 ....
o °
.mee
0
VTE DR #200 mo•emm 000°on
3 ° m
S to Lic:C-075736
omemmm
e • o
• o °
em a oe c
0 0 0
° mo om000
,V m o eo•000
EA EA c0000°
°
oc ° ••eo
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
IITOTAL FEE: $10,3a30 ^ Plan Check Fee : $4,117.80 Fee Due at Permit Issuance: $6,252.50
PROCESSED BY: ii / I / PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
GRADING APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
Fire Department
$37.50
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
IITOTAL FEE: $10,3a30 ^ Plan Check Fee : $4,117.80 Fee Due at Permit Issuance: $6,252.50
PROCESSED BY: ii / I / PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
GRADING 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)
action 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
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
4essions 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 (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
siness 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 or
)roved for the purpose of sale).
1, 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
fly 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:
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 Iegall,
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
,fessions Od'db• L9 available upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.govlcalaw.html.
nature of Rmperty Owner or Authorized Agent Date
;e.NSED EOtilRACTOR'S DECLARATION
ereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se 'on 7 00) gf'61iv�'Isipq,3 of the Business and ro slo od d my license is in full force
l0effect. Licgnse Class License No D �7LL �t LLOO Contractor Signatu
N2KERS' COMPENSATION DECLARATION
041 G: FAILG..... RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDR THOUSAND DOLLARS ($100,0001, IN ADDITION TO THE
IT bF COMPE NSATI$y, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LAEOR CODE, INTEREST, AND ATTORNEY'S FEES.
,rgby affirm : nneer:)enalty of perjury one of the following declarations:
Ohave 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 the
•
ance ofahe wprk for which this permit is issued. Policy No.
h 6e and.will..ma..fitain 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
rce carries aadpolicy number are:
nAr 0..*Policy Number Expiration Date
of Agent
Phone #
:1I certify that, in the performs 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, and agre
)at, if I should becWnaltyof
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �/ 1 r t/(J-
ignatureofAppli Date /2
IECLARATION ETRUCTION LENDING AGENCY ' \
hereby affirm uy that there isa 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
y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property o nets behalf.
I have read this application and the information I have provid is correct.
I agree to comply with all applicable City and count in nd state laws relating to. building construction.
I authorize representatives of this city or county oyRter e a v -identified property for inspection purposes.
ignature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's N e TM rr Y)ato
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