HomeMy WebLinkAboutX2021-1910 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII� II COMB Permit: X2021-1910
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 1 9 1 0 Project No : 1656-2021
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255 NO CONSTRUCTION WORK Issued Date: 0712212021
Combination Type - GRAD
Inspection Area : 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0712212024 OR PERMIT WILL BE INVALID
Construction Hours:
Monday- Friday 7:00 a.m. to 6:30 p.m. andd��eR18�OPdvft.VD�:00
S �� vV'II'IvJ/A ii aa77
p.m. No work on Sundays or Holidays
Job Address: 813 E BALBOA BLVD NB
Description: MFR YARD DRAINAGE (CITY STD PLAN)
Legal Desc.: BALBOA TR BLK 12 LOT 7
Owner: WALLACEILOWERY
Contractor:
OWNER/BLDR
Architect:
cc
Address: 11702 VIA RANCHO
Address:
JILL WALLACE
Address:
SANTA ANA CA 92705
Phone:
Phone:
Phone:
State Lic:
L
Applicant: WALLACE JILL
Can State Lic:
O/B
Engineer:
Address: 11702 VIA RANCHO
Lic Expire:
Address:
SANTA ANA CA 92705
Bus Lic:
�1
U
Phone: 714-514-6455
Lic Exp Date:
Phone:
State Lic:
0-
Code Edit: 2019
Worker's Compensation Insurance
Designer:
WALLACE JILL
CFO
Type of Construction:
Carrier:
Address:
11702 VIA RANCHO
Occupancy Group: U
Policy No:
SANTA ANA CA 92705
Added /New sq.ft. Bldg: 0
Expire:
Phone:
714-514-6455
Added /New sq. ft. Garage: 0
No of Stories: 0
Building Setbacks
Rear: I
Special Conditions: LIQUEFACTION & HIGH
No of Units : 0
Front: /
DENSITY AREA
Bldg Height: 0
Left: /
Bldg Sprinklers:
Right: /
Flood Zone: X
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
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: $2.00
Grading Permit Fee:
$237.00
In -lieu Housing Fee :
$0.00 Building Dept Adm
$0.00
Energy Compliance: $0.00
Grading PC Fee:
$199.00
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: $50.75
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
Plumbing %:
$0.00
$0.00
IITOTAL FEE: $540.75 Plan Check Fee
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
$0.00 Fee Due
PU3LIC WORKS APPROVAI
PLAN CHi-CK BY:
APPROVAL TO ISSUE:
Issuance: $540.75
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)
(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 U 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
N rovements 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
Dm ed for the purpose of sale).
I, 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 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 legalh
sell a structure that I have built as an owner -builder if it has not been con tructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Bu ness and
Professions Code, is available upon request whe is b itt J{r at jhe following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent / I /�J Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice ed under provisions of Chapter 9 (commencing with Section 0) of Division 3 of the Business and ProfLspKnsPode, and my license is in full force
and effect. License Class License No Date` Contractor Si natur
WORKERS' COMPENSATION DECLARATION
NARNING: 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
COST 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:
1 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
Dertormance 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' compensatici
uance carrier and policy number are:
Tier Policy Number Expiration Date
ne of Agent Phone # �
certify that, in thOING
Drinaof the work for which this permit is issued, I shall not employ y person in any manner so as to become subject to the workers' compensation laws of Ca lfornia, a agre
[; if I should becoew o ensation provisions ' 3700 of th abor Cade, I shall forthwith comply with those provisions.
nature of Applica D e4,
CLARATION RE CIO LE G A NCY
:reby affirm undeury 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 Lenders Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the pr owner's behalf.
I have read this application and the information I haVA provided is correct.
I agree to comply with all applicable city and count ordina Be and state laws relating to building construction.
I authorize representatives of this city or county niter t a ov -identified property fo inspection purposes. J I VL �LLR �� Date nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name
TON DATE BY DEC ATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY If 1 REG TIONS PART 61 OFTITLE 40 ANDAQMD RULE
PERMIT EXPIRED
U 1 SUBMITTED ASBESTOS NOTIFICATIO'V TO
PERMITCANCELLED
LJEPA
PERMITEXTENDED
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PERMITRIVAL
CERTIFICATEOF
OCCUPANCYISSUED
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❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION
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