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HomeMy WebLinkAboutM2018-0077 - Permits�wwtrk' City of Newport Beach - Building Division IIII�IIII�IIIIIIIIIII�II�I��IIIILIIIIIII II 04 100 Civic Center Drive, Newport aac[T, CA 9Z660e o o e e e e, 2' �' 6' Permit Counter Phone (949)644-3j88 e p � o•• e e • ooe e• ' ' - C'�SIVUYM�D e e• e s o e e , e- _ o e• o m o o• a s' 'o `o -' - ^ • e o• m a e• m� ` m '' ' Job Address: 810 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 34 Owner: MARSHALL PAUL Address: 810 BAY AVE W a NEWPORT BEACH, CA 92661 Phone: 949-631-3121 S-003812 State Lie: Applicant: SHELLMAKER INC Address: 837 WEST 17TH ST Fire Inspection Fee: COSTA MESA CA 92627 Phone: 949-548-5359 Special Cond: Issued Date 06/05/2019 Contractor: SWIFT SLIP DOCK/PIER BUILDERS Address: 6351 INDUSTRY WAY a WESTMINSTER CA 92683 Phone: 949-631-3121 S-003812 FEES Con State Lic:797052 Lie Expire: 07/31/2019 Bus Lie: BT01122734 Lie Exp Date: 11/30/2019 HARBOR Permit: M2018-0077 Project No: 2950-2018 Inspection Requests Phone (949)644-3255 Designer: Address: Phone: Longshoremen's and Harbor Workers' Compensation Declaration - Carrier : AMERICAN LONGSHOR Policy No: ALMA01662-01 Y5!l 0�40W ' a lk FEES MASOUD $62,000.00 Fire Inspection Fee: Engineer: JAFARI $0.00 Inspection Fee: Address: 23 ORCHARD #250 $0.00 Plan Dep - Counter Review: $0.00 LAKE FOREST CA 92630 $302.00 Records Mangement: Phone: 949-206-9929 $0.00 OT Plan Check Fee: Designer: Address: Phone: Longshoremen's and Harbor Workers' Compensation Declaration - Carrier : AMERICAN LONGSHOR Policy No: ALMA01662-01 PROCESSED BY: dl PLAN CHECK BY: t6 HARBOR RESOURCES: 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: dl PLAN CHECK BY: t6 HARBOR RESOURCES: APPROVAL TO ISSUE: OTHER DEPARTMENTS: FINAL INSPECTION: _ PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION INER-BUILDER DECLARATION ea pee eo •n ui • • •• •• ••• I hereby affirm under penalty of perjury that I am exempt from the Contractors' State Licence few 4T t6 geae6n0ir1ndlgptedt1bd1ow b; the.chedmark(s) I have placed next to the applicable item(s7 :tion 7031.5, Business and Professions Code: Any city or county that requires a permit to constf±tct, Aer; Irrprd•denoligi ; Qr rspJr anytstrNetute, prior to its issuance, also requires the applicant foi permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contrac4ars' State Licenspi.aw4�hapter fcomrnenckt-with Section 7000) of Division 3 of the Business anc 'essions 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 o, more than five hundred dollars ($500). - I, as owner of the property, or my employees with wages as their sole compensation, well du r_) 0 -of or U pojltows l fhe-wdiA: arO the structure.ismot intended or offered for sale (Section 7044, iness and Professions Code: The Contractors' State License Law does not apply to an owne or property who, thnuyh empk%iegVorpetsollal cB$44lds or improves the property, provided that the rovements are not intended or offered for sale. If, however, the building or improvement is srld within.one year cl compiation, tie OvmerBuildet $vill•1194e the burden of proving that it was not built of 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). LJ I am exempt from licensure under the Contractors' State License Law for the following reason: By 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 legall, sell 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 aable lav, Section 7044 of the Business am Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent ate LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commel 69 g 5 St ) of Division 3 of the Business nd Pro ss' ns C d lit nse is in full fora and effect. License Class License No. Date ' .J 6�/ Contractor Signature L SHORN'S & HARBOR WORKERS' COMPENSATION DECLA ION R ILUR €€CURE LONGSHOREMEN'S 8 HARBOR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CI L FIJUPTOE HUNDRED THOUSAND DOLLARS $1 0 ), DD N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm und perjury one of the following iecl ation . I h v and will mai tain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pe ormwork for which this permit is s e My workers compensation insurance carrier and policy number are: -aryl Policy Number Expiration Date lame f gen Phone # I rtify that, in a perto ante of the work for w f(ch 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, an agree that, if I should come je the kers' co ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 3ignatur of App' ant: Date: L DECLARA REG DING N TRUCTION LENDING AGENCY I hereby affirm nder pen Ity perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lende s Name Lender'sAddress By my signature be Ify to each of the following: I am the prope owne r tho d to act on the property owner's behalf. I have read thi applicatio and the in mation I have provided is correct. I agree to corn ly with all pplicable city d county ordinances and state laws relating to building construction. 'ty I authorize rep sentath, s of th' c nt to enter he above -identified property for inspection purposes. ' I I I, //�/ iignatu Print Name: V Y v Dater "� AC77ON DA BY DECLARATIDN U1- CUMP1IANCLwIIHKVL&UF FOROFFICEUSEONtY FEDERAL REGULA71ONSPART OI OF 777LE40AND AQMDRULE14al PERNIITEXPIR€D 1 SUBWITEDASBEST05 N077FfCATION TO., EPA 13 AQMD PERWITCANCELLED P£RMITEXT€NDED ASBESTOS N077RCA ©OP05EDD€MOUTION,RONISNOT APPLICABLE TO PERMITFINAL CERTIFICATEOF OCCUPANCYISSUED. 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