HomeMy WebLinkAboutX2020-1890 - Permits`aN+6�n City of-NewportBeech - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
v _ h Inspection Requests Phone (949)644-3255
Combination Type - MFP
*X2020-1890* COMB Permit: X2020-1890
Project No :
Issued Date: 0812412020
Inspection Area : 6
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 08/25/2023 OR PERMIT WILL B,: 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 Ho yyy days
Job Address: 607 JASMINE AVE NB St: 1 Ft: 1 Unit:.5 g
Description: MFR - DRYWALL REPAIR IN GARAGE (120-2590)
Lagal Desc.: CORONA DEL MAR ELK 636 LOT 7,t- pp�
Owner: LAKSHMI SHANKER SHUKLA Contractor: OWNER/BLDR Architect:,
Address: 3 WEYMOCT Address: LAKSHMI SHANKER Address:
NEWPORT EWPORT BE BEACH CA 92660 O/B FORM ATTACHED
Phone: 9491584-9739 Phone: Phone: State Lie:
Applicant: LAKSHMI SHANKER SHUKLA Con State Lie: O/B Engineer:
Address: 3 WEYMOUTH CT Lie Expire: Address:
NEWPORT BEACH CA 92660 Bus Lie:
Phone: 9491684-9739 Lie Exp Date: Phone: State Lic:
Code Edit: 2019 Worker's Compensation Insurance Designer:
Type of Construction: VB Carrier: Address:
Occupancy Group: R3/U Policy No:
Added /New sq.ft. Bldg: 0 Expire: Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2 Building Setbacks Rear: / Special Conditions:
No of Units : 2 Front: /
Bldg Height: 0 Left: /
Bldg Sprinklers: Right: /
Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N -
Construction Valuation: $20000
Building Permit Fee: $110.00 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 PNV 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 W $0.00 NMUSD Fee: $0.00 $0.00
Plumbing %: $0.00 $0.00
TOTAL FEE : $111.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : :;111.00
PROCESSED BY: PUBLIC WORKS APPROVAL:
ZONING APPROVAL: PLAN CHECK BY:
GRADING APPROVAL: APPROVAL TO ISSUE:
OWNER -BUILDER -DECLARATION
I hereby affirm under It snally 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 Cade: Any cityor 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 latement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) or Division 3 of the Business and
Professions Code) or that Ie 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 hundre. dollars ($500).
0 I, as owner of the prof i ty, 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: 'f he 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 WE Ided 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 : I sale).
❑ I, as owner of the prof =tty, 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 prep: -y 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 lic_- sure under the Contractors' State License Law for the following reason:
By my signature below I-mowledge 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 hava ,01L 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 avzi: ble upon request when. this a �licalion its subr�ritted or at the following Web site:http:ww.leginfo.ca.govlcalaw.html. 1
Signature Of Property OWa —r or Authorized Agent ' % -✓�� site:http:,'I�%ww.leginfo.ca.gov/calaw.html.
LICENSED CONTRAC -OR'S DECLARATION
I hereby affirm under pen: -_y of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect. License Class License No Date Contractor Signature _
COMPEW ATION DECLARATION
!ARMING. FAILURE TO FECUR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE. HUNDRED THOUSAND DOLLARS IS100,0001. IN ADDITION TO THE
'uST OF COMPENS—TC 6: DAP. 1GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES.
hereby affirm ur.de- pert . tv of perjury one of the following declarations:
7 1 have and wia main[: r: 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 the
erformance of the wj:k f: -which this permit is issued. Policy No.
'T^ve and wul rtlainfan 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
,once carrre, arkd polic : number are:
Policy Number
Date
m= mf Agent Phone #
cel;ify that in the nerr rmance or 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
t_ 'r 1 should become sr .eject to the workers' compensation provisions of Section 3700 Of the Labor Code, I shall forthwith comply with those provisions.
I ature of Applicant _ Date
CLARATIDN REGARD ING CONSTRUCTION LENDING AGENCY
;reby affirm under pentty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097
Ider's Name _ Lender's Address
my signature below, I c artify to each of the following:
I am the property own :r or authorized to act on the property owner's behalf.
I have read this app!ic lion and the information I have'provided is correct.
1 agree to comply wit! all applicable city and county ordinances and state laws relating to building constnlction.
I authorize represents ,as of this city or county to -enter the above -identified property for inspection purposes. r�
'nature or Prooerty Chu; zr or Authorized Acentl l n L, z74.� Print ProDertv Owner's or Authorized Anent's Name: �'7T� N✓
ACTION DATE BY j DECLARATION OF COMPLIANCE WITH COOEOFFEDEI
i REGULATIONS PART 61 OF TITLE 40 AND ACLMD RULE
1403
PERR4rT EXPIRED I Ll SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT FINAL v 17 et.P LJAS ESTOSN IFIC TION IS NOTAPPLICABLE TO
CERTIFICATE OF 0^ZTw P&OL CISEO DEMDIT N /I
OCCOPANCYISSUEO ? SIGNATURE: A,, 41n...11
FOR OFFICE USE ONLY
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