HomeMy WebLinkAboutX2017-0261 - Permits (2)wrgr� City of Newport Beach - Building Division "X20170261* COMB Permit: X2017-0261
. 100 Civic Center Drive, Newport Beach, CA 92660 Project No : 0177-2017
H Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
`"krroa`s Combination Type - BLDG Issued Date : 01/25/2017
Inspection Area : 1
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
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Job Address: 5219 LIDO SANDS DR NB
Description: BLOCK WALL 6'H1 X 135' LONG,
ON PROPERTY LINE, CITY STANDARD PLAN
"AS BUILT -116-6018" (MARKERS ON SITE)rw;
Legal Desc.: N TR 3162 LOT 73
Owner: POLHEMUS II W EDWARD
Contractor:
OWNER/BLDR
Architect
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Address: 5219 LIDO SANDS DR
Address:
POLHEMUS WILLAIM E Address:,„^
NEWPORT BEACH CA 92626
Phone: 424-226-8590
Phone:
424.226.8590
Phone:
State Lic:
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Applicant: POLHEMUS II W EDWARD
Con State Lic:
O/B
Engineer:
°
Address: 5219 LIDO SANDS DR
Lic Expire:
Address:
NEWPORT BEACH CA 92626
Bus Lic:
®oom
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Phone: 424-226.8590
Lic Exp Date:
Phone:
State Lic:
m000
Code Edit: 2016
Worker's Compensation Insurance
Designer:
Type of Construction:
Carrier:
Address:
Occupancy Group: U
Policy No:
Added /New/TI sq.ft. Bldg: 0
Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 0
Building Setbacks
Rear: I
Special Conditions:
LIQUEFACTION AREA
No of Units -: 0
Front: I
NEIGHBOR PROP LINE
Bldg Height: 0
Left: /
AGRMNT ATT TO PLANS
Bldg Sprinklers:
Right: /
Flood Zone: 0.2
Use Zone: Parking Spaces:
0 Fire Hazard Zone :
N
Construction Valuation: $5,000.00
Building Permit Fee: $386.00
Excise Tax:
$0.00
Planning Department-
Fire Department
Plan Check Fee: $342.50
Additional Fee :
$0.00
Plan check Fee : $37.50
Fire Inspection:
$0.00
Overtime Plan Ck: $0.00
Grading Bonds Fee:
$0.00
Fair Share : $0.00
Fire Plan Rev
$0.00
Investigation Fee: $386.00
Grading PC Consultant:
$0.00
SJH Trans : $0.00
Demolition Fee
Record Management: $0.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee : $0.00
Building Dept Adm
$0.00
Energy Compliance: $0.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety: $0.00
WQ Insp. Fee:
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
Disabled Access: $0.00
PAN Plan Check : $0.00
Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical %:
$0.00
San Dist: $0.00
Building Green Fee : $1-.00
Mechanical %:
$0.00
NMUSD Fee: $0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE: $1,153.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance :
$1,153.00
PROCESSED BY:
- I 1
PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL:
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)
Iction 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
)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).
t owne®oof the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
�rleb's and Profftfbns 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
vgmentsa�g 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
)j4 d for the, purpose of sale).
J as owner o►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
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 exer4M ifroni licensure under the Contractors' State License Law for the following reason:
mv-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 legal
a structur@ jhdt j),ave 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
9gysions Code, is available upon request whenahapplication is submitted or at the f-o�owing Web site:http://www.leginfo.ca.gov/calaw.html.
rr9ture of Property Owner or Authorized Agent
X W moo, 4646& 0 n& Date K01 I 'LSI 2017
`CNCCII L`AN'I'QA/`Tl1D,C nGr`I AOATI u
under'penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
Idmg.Class License No Date Contractor Signature
ttNIFIENSATION DECLARATION
IARNING: 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
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby 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 3700 of the Labor Code, for th,
erformance of the work for which this permit is issued. Policy No.
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'
rance carrier and policy number are:
of Agent
of
Policy Number
Date
in the performance 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
become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date d S,2 S /20\'1
ereby 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).
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.
I authorize representatives of this city or county tp enter the above-idenXied property for inspection purposes.
of
PERMIT EXPIRED
PERMITCANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYISSUED
Owner or Authorized
I DATE I BY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
I SUBMITTED ASBESTOS NOTIFICATION TO
e.- r— UASBESTOS NOTIFICATION IS NOT APPLICABLE TO
I �(Olti PROPOSED DEMOLITION
Sia SIGNATURE:
FOR OFFICE USE ONLY
All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall
be in place prior to approval to fill pool/spa & shall remain in place & be maintained for the
life of the pool.