HomeMy WebLinkAboutF2022-0008 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
\, Permit Counter Phone (949)644-3288
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Job Address: 4515 ORRINGTON RD NB
Inspector Area: 5
Owner:
ZIEMBA FAMILY TRUST
Address:
4515 ORRINGTON RD
CORONA DEL MAR, CA 92625
Phone:
Applicant:
VU ANTHONY
Address:
9559 NIGHTINGALE AVE
FOUNTIN VALLEY CA 92708
Phone:
714-234-9633
Code Edit : 2019
Type of Construction:
V-B-SPR
Occupancy Group:
R3/U
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
1
No of Units:
0
Flood Zone:
X
Bldg Sprinklers:
Y
`F2022-0008"
FIRE Permit: F2022-0008
Project No : 0035-2022
Inspection Requests Phone (949)644-3255
FIRE SPRINKLERS (59) HEADS (X20194056)
Legal Description:
N TR 3357 LOT 76
Contractor:
(FIRE PROTECTION
Address:
9559 NIGHTINGALE AVE
FOUNTAIN VALLEY CA 92708
Phone:
714-234-9633
Con State Lic:
1038755
Lic Expire:
0413012022
Bus Lic:
BT30067240
Lic Exp Date:
06/31/2022
Worker's Compensation
Insurance
Carrier:
EXEMPT
Policy No:
no employees
Expire:
Issued Date: 01/12/2022
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
o'
Phone:
State Lic:
Engineer:
Address:
Phone:
State Lic:
Designer:
VU ANTHONY
Address:
9559 NIGHTINGALE AVE
FOUNTAIN VALLEY CA 92708
'
Phone:
714-234-9633
-
Special Conditions:
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FEES
Construction Valuation:
$9,500.00
Building PC Fee :
$222.00
Fire Residential Alarm PC Fee :
$0.00 Records Management:
$6.00
Building Overtime PC Fee:
$0.00
Planning Counter Review:
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee :
$0.00
Building Investigation Fee :
$0.00
$0.00
Fire Plan Check Fee:
$0.00
Public Works PC Fee :
$0.00
$0.00
Fire Permit Fee :
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$269.00
TOTAL FEE :
$497.00
Plan Check Fee :
$222.00 Fee Due at Permit Issuance :
$275.00
PROCESSED BY: OTHER DEPARTMENT:
ZONING APPROVAL: PLAN CHECKED BY::
FIRE APPROVAL: APPROVAL TO ISSUE: G
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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 Iicensum 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
improved for the purpose of sale).
111, 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
Law)-'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
0 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 sfte:http://www. leginfo.ca.gov/calaw.html.
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 Sectio I)� Qf Division 3 of the Business and Pro Ions Code, and my license is in full farce
and effect. License Class License No Data 1 /12/22 Contractor Signature Anthony Vu _-M-_-
WORKERS' COMPENSATION DECLARATION An
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 $708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 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 the
���p-errformance of the work for which this permit is issued. Policy No.
1Khave 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' compensation
ns rance carder and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
❑I Certify that in the performance 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 agree
that, if I should becomVjblect to the workers' Compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions.
Signature of Applicant i�AnthonyVu Date 1/12/22
DECLARATION REGA D G CONSTRUCTION LENDING AGENCY
I hereby 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 Code).
Lenders 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 owners 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.
I authorize representatives of this city or courpp enter the above-identthed property for inspection purposes -
Signature
of PropertyCwner orAuthorized Agent Anthony Vu _
9 -°••• Print ProcertvOwner's orAuthorized ADent'sName ANTHONY VLJ Da 1/12/22
DATE BY Y ECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
Rr§ULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMITFINAL ,��. SBE5rOS T ICATION IS NOT APPLICABLE TO
OCCUPANCYLSF a C.//// sH PU pSED DEM =
OCgJPANCY/SSUED w SIGNATURE: