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HomeMy WebLinkAboutX2020-0015 - Permits�1xzo�. City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2020-0015 @ �` 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 0 0 0 1 s Project No: 1152-2019 Eo �. Permit Counter Phone(949)644-3288 vt* Inspection Requests Phone (949)644-3255 "drrw,a,a'` Combination Type - SFP Issued Date : 0110312020 Inspection Area: 1 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 wank on Sundays or Holidays Job Address: 112 -T/O SLATE, A Description: SFR - T/O SLATE, APPLY 40# FELT WILIKE FOR LIKE CORNERSTONE SLATE 110 CLASS "A!'22 SOS ��� OM Legal Desc.: TR 907 LOT 647(AND NELY1/2 LOT 646 Owner: KING MICHAEL 8: MARY Contractor: ATI Architect: Address: 112 VIA KORON Address: 3360 E LA PALMA AVE Address: NEWPORT BEACH, CA 92663 ANAHEIM CA 92806 Phone: 949.887.4155 Phone: 714-283-9990 Phone: �g L �„ 9slJil O T �i.�tl�9 Applicant: VILLA LOUIS Con State Lic: 571784 Engineer: t V Veal 9 f�690� & @Vi���� NOISE Address: 10447 EL BRARO OR Lie Expire: 06/3012021 Address: WHITTIERCA 90603 Bus Lie: BT30003010° °®O' m Phone: 714-401-6079 Lie Exp Date: 03/3112020 Phone: State Lie: _ 0*** o 2. Code Edit: 'eme-o(� Worker's Compensation Worker Insurance Designer: p� pppL 1„6 1 THE yf to M O0°" Type of Construction: V -B Carrier: ZURICH AMERICAN INS Address: Occupancy Group: RNU Policy No: WC444664100 °o , Added /New sq.ft. Bldg: 0 Expire: 08/0112020 Phone: ...... 9°°xo o Added /New sq. ft. Garage: 0 No of Stories: 2 Building Setbacks Rear: I Special Conditions: HIGH DENSITY AREA No of Units : 1 Front: I PRE -INSPECTION TO VERIFY Bldg Height: 0 Left: I EXTG MATERIAL WEIGHT Bldg Sprinklers: Right: I Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N , Construction Valuation: $20.000.00 .... x ooco °°xxa Building Permit Fee: $324.00 Excise Tax: $0.00 Planning Department - Fire Department 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: $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 P/W Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Iectrical %: $0.00 San Dist: $0.00 Building Green Fee : $1.00 echanical %: $0.00 NMUSD Fee: $0.00 $0.00 P umbing %: $0.00 $0.00 TOTAL FE : $325.00 Plan Check Fee: $0.00 Fee Due a iit Issu nce : $325.00 PROCESSED BY: PUBLIC WORKS APPRO AL: ZONING APPROVAL: Z 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 items) (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 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 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 U 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 im 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 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 legally 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 000) Div sio 3 of the Business and Profs� s' a ode, and my nse is in full force and effect. LicegW(!!lB§s License No Date 3 20 Contractor Signature k� V WARKERS' COM3FFNSATION DECLARATION F�: C N4011 AILURE J(:§W QE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - -- I�[ Baby affirm under penalty of perjury one of the following declarations: J have and vVjif FlfaUfain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for thl �Itce of theworic for which this permit is issued. Policy No. a and wid mainiain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatior ngl�ra r�'carrier!aTldp6licynum¢erare: / gG�L7Y'LC 'P✓�C�7 ccw' ,�(nC. Policy Number LJ I -N `i 66 L?j do Expiration Date e f t J26 N.me of Agent - Phone # Pdvtlft that, in Uipgerformance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre tha$ ifd should bocome uubect to the workers' cotnpensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applica D DECLARATION I ARDING NSTRUCTION LENDING AGENCY I hereby affirm and r 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). Lender's Name Lender's Address By 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 to enter the above -idem' d property for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED 11 Ll I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED IIASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION //no SIGNATURE: :�Ifys.. L_6X _