HomeMy WebLinkAboutM2018-0076 - Permitsa�wPr, City of Newport Beach; B 11gg.q.,!soon
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Job Address: 808 BAY AVE W Floor: Suite: Bldg: 0
Description of Work: SFR -REMOVE AND REPLACE EXTG DOCK
Inspector Area: 1
Legal Description: N TR 884 LOT 35
Owner: JACKSON TODD
Address: 808 E BAY AVE
NEWPORT BEACH CA 92661
Phone: 714-420-0377
State Lic:
Applicant: SHELLMAKER INC
Address: 837 WEST 17TH ST
COSTA MESA CA 92627
Phone: 949-548-5359
Special Cond:
Issued Date
HARBOR Permit: M2018-0076
Project No: 2949-2018
Inspection Requests Phone (949)644-3255
Con State Lic:797052
Lic Expire: 07/31/2019
Bus Lic: BT01122734
Lid Exp Date: 11/30/2019
Designer:
Address:
Phone:
Longshoremen's and Harbor Workers' Compensation Declaration -
Carrier : AMERICAN LONGSHOR
Policy No: ALMA01662-01
Expire : 12/31/2019
FEES
Valuation:
$62,000.00
Fire Inspection Fee:
$0.00
$0.00
Inspection Fee:
$287.00
Contractor:
SWIFT SLIP DOCK/PIER BUILDERS
Engineer:
JAFARI MASOUD
Plan Check Fee
Address:
6351 INDUSTRY WAY
Address:
23 ORCHARD #250
$0.00
OT Plan Check Fee:
WESTMINSTER CA 92683
Harbor Plan Check Fee:
LAKE FOREST CA 92630
Plan Dep - OverTime Plan Check:
Phone:
949-631-3121
Phone:
949-206-9929
S-003812
Building Green Fee :
$3.00
Con State Lic:797052
Lic Expire: 07/31/2019
Bus Lic: BT01122734
Lid Exp Date: 11/30/2019
Designer:
Address:
Phone:
Longshoremen's and Harbor Workers' Compensation Declaration -
Carrier : AMERICAN LONGSHOR
Policy No: ALMA01662-01
PROCESSED BY: IJ` HARBOR RESOURCES:
PLAN CHECK BY: 16 APPROVAL TO ISSUE:
OTHER DEPARTMENTS:
FINAL INSPECTION: _
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Expire : 12/31/2019
FEES
Valuation:
$62,000.00
Fire Inspection Fee:
$0.00
$0.00
Inspection Fee:
$287.00
Fire Plan Check Fee:
$0.00
Plan Dep - Counter Review:
$0.00
Plan Check Fee
$302.00
Records Mangement:
$10.00
Plan Dep - Zoning Plan Check:
$0.00
OT Plan Check Fee:
$0.00
Harbor Plan Check Fee:
$0.00
Plan Dep - OverTime Plan Check:
$0.00
Investigation Fee:
$0.00
Building Green Fee :
$3.00
TOTAL FEE :
$602.00
Plan Check Fee :
$602.00
Fee Due at permit Issuance:
$0.00
PROCESSED BY: IJ` HARBOR RESOURCES:
PLAN CHECK BY: 16 APPROVAL TO ISSUE:
OTHER DEPARTMENTS:
FINAL INSPECTION: _
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
INER-BUILDER DECLARATION „ ,o e m `°, °B° .°° •, .• .. •••
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Aa€e �9cense LA for yhe reason(s}Z Indioted Isekpf by iffe &4,kmark(s) I have placed next to the applicable item(s)
ction 7031.5, Business and Professions Code: Any city or county that requires'a'permtt to cen'strogt alter, improvQ, Qemoliah,•oreepaimarry atru�4ige, prior to its issuance, also requires the applicant fc
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors 'State LicenS@ LOW(Ch$pter 9 (commencing with Section 7000) of Division 3 of the Business ani
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 c
more than five hundred dollars ($500). •�• �•
I, as owner of the property, or my employees with wages as their ao a compensatidrr,- w:i do (_) all of cr (_) portions -of the w$rs, "gni strAtuL is not intended or offered for sale (Section 7044,
iness and Professions Code: The Contractors' State License Law does not: aonly to an.ovher of property wt o, tTrpLgh Amp%yees' ov pmrson¢I ejfoQ t uilds or improves the property, provided that th,
rovements are not intended or offered for sale. If, however, the building or improvement is "sold within one_. yearoJ FoglQl>rtion,%L? evmer-Bw der will•have the burden of proving that it was not built c
roved 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
ly 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
a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I un
ifessions Code, is available upon request when this application is submitted or at the following Web site: http://www.legin
nature of Property Owner or Authorized Agent
.ICENSED CONTRACTOR'S DECLARATION /�
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (com In th Se I n of Division 3 of the B sines d Profr
nd effect. License Class License No. Date Contractor Signatu
GSHOREMEN'S & HARBOR WORKERS' COMPENSATION DECLARATION
I R NG• FAILURE TO SECURE LONGSHOREMEN'S &HARBOR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE ANO CIVIL
100, DDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby ffimt ur
will maintain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for
workers' compensation insurance carrier and policy number are:
covered by this permit, I cannot Is
law, Section 7044 of the Business
Date
is in full
TO ONE HUNDRED THOUSAND DOLLARS
;Ity of perjury one of the following
of the work for which this permit
Expiration
Phone #
J - dify that n N e 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' compensatlo laws of California, an
;gree at, if I shout b�� bjec o the worke s' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
toe ofA I2acni % n
)EC REGARDI G CONSTRUCTION LENDING AGENCY
t hereb affirm under enalty 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).
lender's me Lender'sAddress
By my signatu belo I certify to each of the following:
I am the prop or authorized to act on the property owner's behalf.
I have re his applic I& and the information I have provided is correct.
I agree comply wit 11 ap !cable city and county ordinances and state laws relating to building construction
I authorze represen Ives of 's city o unty to enter the above -identified property for inspection purposes. //rte I I �/� In
ijgnat Print Name:P �� V �� ' I Dat{Ci / �u
AM0
DATE BY
DECLARATION OFC PIJANCEMT CODEOIF
FEDERAL REGULATIONSPART61 OF777LE40AND
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PROPOS€DDEMOLITION,
SIGNATURE. -
/ FOR OFFICE USE ONLY
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PERMIT:EXPIREU
PERMITCANCELLE
PERMIT EXTENDED
PERMIT FINAL .-1 % —1 7 ,�.rL
CERTIFICATE OF
OCCUPANCYISSUED
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