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Home My WebLink Aboutx2022-0608 - Permitsyaw City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 F`arxi" Combination Type - MFP PLUM 111111111111111111111111111111111111111 it COMB Permit: X2022-060811111111 Project No Issued Date : 03/02/2022 Inspection Area : 4 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 03/02/2025 OR PERMIT WILL BE INVALID 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: 12 HILLSDALE DR NB Description: MFR RE -PIPE (25) FIXTURES Legal Desc.: TR 11785 LOT 1 UNIT 10 OF PROJECT LOCATED ON AP 442.301-69 TOGETHER Owner: Ck ROLLANS JOANNE GANTT Contractor: AMERICAN WEST SERVICES Architect: Address: 12 HILLSDALE DR Address: 921 BAYWOOD DRIVE Address: NEWPORT BEACH, CA 92660 NEWPORT BEACH CA 92660 Phone: Phone: 949-683-7410 Phone: State Lie: Applicant: Vi WENNEN GLENN Con State Lic: 748965 Engineer: Address: 921 BAYWOOD DRIVE Lie Expire: 0513112022 Address: NEWPORT BEACH CA 92660 Bus Lie: BT98041665 Phone: 949-683-7410 Lie Exp Date: 0313112022 Phone: State Lie: iJ Code Edit: 2019 Worker's Compensation Insurance Designer: Type of Construction: VB Carrier: STATE FARM Address: Occupancy Group: R3/U Policy No: 92GKH3474 Added /New sq.ft. Bldg: 0 Expire: 03/08/2022 Phone: Added /New sq. ft. Garage: 0 No of Stories: 2 Building Setbacks Rear: / Special Conditions: No of Units : 1 Front: I Bldg Height: 0 Left: I Bldg Sprinklers: Right: I Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $6 000.00 Building Permit Fee: $178.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $154.86 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 PAN Plan Check : $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $16.02 $0.00 TOTAL FEE : $349.88 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $349.88 PROCESSED BY: , `-PUBkIC WORKS APPROVAL: `PLAN ZONING APPROVAL: CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: x ., e OWNER -BUILDER 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 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 1t was not built or improved 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.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalt of perjury that I am hoped under provisions ofChapter 9 (commencing with Sectio 70 ) of Division 3 of the Business and Pr s ens C e, and n y li ense is in full force and effect. License Class - L License No � )��yc Date J Contractor Sig nat WORKERS' COMPENSA ION DE ARATION WARNING: 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. I hereby affirm under penalty of perjury one of the following declarations: - ❑ I 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 thl per ermance of the work for which this permit is issued. Policy No. have and w' ma main workers�Qmpensation insurance, As required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' 1e of Agen G �*'^ certify that, in the performance of th work for which this if I should l: su act to the w kers' compens do lature of Applicant Date issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and ns of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Z..L nr®I,A/n n. 3� Z CLARATION REG*DING CONSTRUCTION LENDING AGENCY areby affirm under p nalty 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). Ider's Name Lender's Address 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. 1 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. Levu ✓V 1 „ I n PNOP I authorize representatives of this city or county to mer the above -identified property for inspection purposes. G 1(v l: ' Y nature of Prooertv Owner or Authorized Aoent V. — Print Property Owner's or Authorized Agent's Nam ACTION DATE BY r DEC TION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGU LATI NS PART 610E TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED 0 ISUBMIT_�D ASBESTOS NOTIFICATIQN•TO • •• PERMITCANCELLED LIEPA • • • ' • • « ••• ••• PERMIT EXTENDED QMDI " • •• q •s PERMITFINAL ( �(L ASBESTO NOTIFICA I NIS NOTAPPLICABLE TO CERTIFICATE OF PROPOSED EM LIT •• OCCUPANCY ISSUED SIGNATU ( • " • s • • • c • o o e o � .2_ZL