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Home My WebLink AboutX2019-1668 - Permits�o City of Newport Beach - Building Division *X2019-1668* COMB Permit: X2019-1668 100 Civic Center Drive, Newport Beach, CA 92660 Project NO : 1553-2018 i -.. Permit Counter Phone (949)644-3268 Inspection Requests Phone (949)644-3255 Combination Type - GRAD issued Date 2079 Inspection Arearea : 3 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 1401 GALAXY DR NB Description: DRAINAGE PER CITY STANDARDS Legal Desc.: N TR 4224 LOT 249 ' Owner MILLER GORDON WAYNE Contractor: BROWN DAVE MASONRY. Architect: a Address: 1401 GALAXY DR Address: 720 NORTH IST AVENUE .Address: NEWPORT BEACH, CA 92660. UPLAND CA 91786 Phone: Phone: 909-981.6290 Phone: State Lie: < Applicant: DOBBIE STEVE Con State Lic: 708860 - Engineer: ROSS SCOTT WILLIAM Address: 668 COAST HWY # 1390 - Lie Expire: 0613012019 Address: 1800 E 16TH STREET #B LAGUNA BEACH, CA 92651 Bus Lie: BT30067465 SANTA ANA CA 92701 Phone: 949.322-6784 Lie Exp Date: .05/3112020 Phone: 714-835-2800 State Lic:C-045309 • Code Edit 2016 Workers Compensation Insurance Designer. Type of Construction: - Carrier: W/C EXEMPT Address: Occupancy Group: U Policy No`. NO EMPLOYEES Added /New sq.ft. Bldg: 0 Expire: Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: I Special Conditions: No of Units : 0 Front: I Bldg Height: 0 Left: I ° Bldg Sprinklers: Right: mmmao Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone; N Construction Valuation: $0.00 Building Permit Fee: $0.00 Excise Tax: $0.00 Planning Department - Fire Department ®m �, ° m• " ° Plan Check Fee: $0.00 Additional Fee: $0.00 - Plan check Fee ; $0.00 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: $0.00 Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $1.00 Grading Permit Fee: $312.00 In -lieu Housing Fee: $0.00 Building Dept Adm $0.00. Energy Compliance: $0.00 Grading PC Fee: $312.00 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 : $0.00 Mechanical %: $0.00 NMUSD Fee: - $0.00 $0.00 lumbing °/m: 00 TOTAL FEE: $625.00 Check Fee: $0.00 Plan Fee Due at Permit Issuance: $625.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: OWNER -BUILDER DECLARATION I hereby affirm under penally 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) (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 the 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 Professions Code) or that he or she is exempt from [!censure 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 not 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 L) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business 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 improvements 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 improved 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 apply 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). ❑ 1 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 applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 i of the Business and Pr e ' s , and my license is in full force and effect. License Class License No DateContractor Signatur INORKERS' C(5&ftNSATION DECLARATION yARNINGi 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 ($700,000), IN ADDITION TO THE GWOUCOMPENSAinOWDAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ['hereby affirm linderpenalty of perjury one of the following declarations: 2 f r;Je and wilrmaintain 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 ierformance of t.ht %&t for which this permit is issued. Policy No. • I hgYe• 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' compensator n.%�V.ce carrielP6n policy number are: ..a[r • .... Policy Number Expiration Date Va , Agent Phone# e f4 that, !rt Wi (hjfOrman of the work;gr 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 agree ' .Isliould be c ome ju 'ect t wor ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ^ 3ighlfth of App(lor�F a D e3(—J S yT DECLARATION REGA I NSTRUCTTON LENDING AGENCY hereby affirm under pe Ity 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). -ender's Name Lender's Address 3y 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 prMe ed is c I agree to comply with all applicable city and county ordV1Jes an laws lating to building construction. I authorize representatives of this city or county to a ve-!de rty for Inspection purposes. 3i nature of PropertyOwner or Authorized Agent artOwner's or Authorized Agent's Name to ACTION DATE BY RATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED L1 I SUBMITTED ASBESTOS NOTIFICATION TO PERMITC4NCELLED UEPA PERMIT EXTENDED OAQMD PERMITFINAL T I`) JK,15 FDO UASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEMOLITION OCCUPANCYISSUED �� SIGNATURE: