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Home My WebLink AboutX2021-3053 - Permits�s�,p City of Newport Beach - Building Division 'X2021-3053* COMB Permit: X2021-3053 o- d 100 Civic Center Drive, Newport Beach, CA 92660 s �! Permit Counter Phone (949)644-3288 a Project No : 2652-2021 �: - Inspection Requests Phone (949)644-3255 �Uiximu `a Combination Type - MFP - 11 Issued Date : 11/09/2021 9 Inspection Area : 4 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 11/09/2024 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: 715 BAY HILL DR NB Description: MFR DECK REPAIRS Legal Desc.: TRACT 12105 LOT 1 OF PROJECT 931-79 LOCATED ON AP 442-033-04 Owner: PALMER KEITHIMILDRED Contractor: SHIELDS BUILDING SERVICES Architect: Address: 715 BAY HILL DR Address: 303 BROADWAY SUITE 104-10 Address: BEWPORT BEACG CA 92660 LAGUNA BEACH, CA 92661 Phone: Phone: (949) 795-6000 Phone: State Lic: ° ° ...... • Applicant: SHIELDS ANDRE Con State Lic: 792405 Engineer: GOMEZ GEORGE • ° o ° ° ° „ o Address: 303 BROADWAY #104-10 Lic Expire: 0313112023 Address: 1500 AVOLENCIA DR ° ° ° ° ° LAGUNA BEACH, CA 92651 Bus Lic: BT30077198 FULLERTON, CA 92835 • ° ° °, Phone: 949-795-6000 Lic Exp Date: 11/3012022 Phone: 562-659-3403 State Lic:C-092845 .... ° • ° ° Code Edit: 2019 Worker's Compensation Insurance Designer: °°OO•° Type of Construction: Carrier: NATIONAL LIABILITY Address: Occupancy Group: U Policy No: V9WC237548 Added /New sq.ft. Bldg: 0 Expire: 02/2612022 Phone: • C ° J ° " Added /New sq. ft. Garage: 0 o • ° a ° ° No of Stories: 0 Building Setbacks Rear: I Special Conditions: ° o ° °, • ° o No of Units : 0 Front: / ° ...... Bldg Height: 0 Left: I Bldg Sprinklers: Right: I Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $7,800.00 Building Permit Fee: $212.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $184.44 Additional Fee : $0.00 Plan check Fee : $52.00 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: $12.00 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 %: $0.00 $0.00 TOTAL FEE : $461.44 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $461.44 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: N��/ J r 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 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 it 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). 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 legalll 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:hftp://www.leginfo.ca.gov/calaw.htm]. Signature oilrropeky Owner or Authorized Agent Date .IMNSED.CONTRACTOR'S DECLARATION I hetl:by a"rAlfi&2r penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 0 f D � irn 3 of the Business and Pro �r 'nd m i se is in full force •• and effect. License Class License No Date (� LI Contractor Signature ORKERS.QPXPENSATION DECLARATION • WARNING: FAIEW.TQSECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$100,0001, IN ADDITION TO THE •PCP§fOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affie ulider penalty of perjury one of the following declarations: ••-1 have and• • 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 • paa fork for which this permit is issued. Policy No. • I n , ' main 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' compensatiol In lance carger an() policy number are: fa•nicr •••••• Pnliry Numher EXDitatlOn Date - of Agent I certify that, in the performance of th ork f 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 d, if I should become s be rk compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Inature of Applicant Date) CLARATION REG CI ONSTRUT6N-L-ENDING AGENCY Breby affirm under 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 ode). 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. I have read this application and the information I have provided is corre I agree to comply with all applicable city and c�nty ordina d s to laws rel Ing to building construction. I authorize representatives of this city or court t -id ntified pro rty for inspection purposes. mature of Prooeriv Owner or Authorized Aoent% Print Property Owner's or Authorized Agent's Name Date h R ACTION DATE BY " DECLAI 1PLIA CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED EPA PERMIT EXTENDED AQMD PERMIT FINAL y fry ASBESTOS OTIF LICA E TO CERTIFICATE OF f O SE D MO OCCUPANCYISSUED /TM_ SIGNA R