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Home My WebLink AboutXR2023-1717 - PermitsaE� o?ram City of Newport Beach IIIIIIIIIIIIIIIIIIIIIIiIIIIIIIIIIIIIIII II COMB Permit : i�R2023-1717 ° We Community Development Department - Building Division O4, 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: 1U i Permit Counter Phone: (949) 718-1888 Issued Date : 06/22/2023 newportbeachca.gov/civic Inspection Area : 2 cg4rFn`r Combination Type - Work Class - Alteration PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS Job Address : 209 AMETHYST AVE Legal Desc : A TR BALBOA ISLAND SEC 3 BILK 19 LOT 24 Description: DUPLEX INFILL 80 SF AT EQUIPMENT WELL ON ROOF, 1/2" SHEATHING W/ 8D AT 6" ON CENTER NAILING - Owner: HAN CAD Contractor: DUSTIN DUNNING GRIMME Architect Address : 3667 ARLINGTON AVE Address : 20771 CASHEW ST Address RIVERSIDE, CA 92506 WILDOMAR, CA 92595 Phone: (951)205-8623 Phone: (619)733-7267 Phone: Con State Lie : 1099604 State Lie Lie Expire : 12/31/2024 Applicant : DUSTIN DUNNING GRIMME Bus Lie : BT30081501 Engineer Address : 20771 CASHEW ST Bus Lie Expire : 05/31/2024 Address WILDOMAR, CA 92595 Phone: (619) 733-7267 Workers' Compensation Insurance Phone: Carrier: STATE COMPENSATION INSURANCE FUND Owner/Builder: Policy No: 9325411 Designer: Address : W. C. Expire : 10/1/2023 Address Phone: Phone: Code Edition : 2022 Fire Sprinklers : NO Construction Valuation : $2,800.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/Ti sq. ft. Bldg : 0 Occupancy Groups : U,R-3 No of Units : 2 Alteration sq. ft. Bldg : Bldg Height : No of Stories : 2 Added/New sq. ft. Garage: 0 TOTAL sq. ft. 0 Building Setbacks : Front: 10, Side: 3, Side: 3, Rear: 5 Flood Zone : X Use Zone: R-BI - Two -Unit Residential, Balboa Island PROCESSED BY: SPECIAL CONDITIONS: 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) §ecflon 7031.5, Business and Professions Code: Any city or county that requires a permit to constrict, alter, improve, derricks or repair any structure, prior touts Issuance; also requires the applicant for is permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Lawt6hapter 9 (commencing with Section 7000) of Division 3 of the Business and rofessions Code) or that he or she is exempt from licensors and the basis for the allegad exemption. Any. violation of Section 1031:6 by any applicant for a permit subjects the applicant to a civil penalty of of more than five hundred dollars (S500). 1 I, as owner of the property, or my employees with wages as their sole compensation, will do (._) all of or (_) portions of the work, and the structure is not Intended oroffered for sale (Section 7044, usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through am yees' or personal effort, builds or improves the property, provided that the nprovements are not intended or offered for sale. If, however, the building or Improvement is sold within orre year of completilic n, the Owner -Builder will have the burden of proving that it was not built or n roved for the purpose of sale). i, as Owner of the property, am exclusively contracting with licensed Contractors to Constructthe project (Section 7044, Bus mess and Professions Coder The Contractors' State License Law does not Iy to an owner of property who builds or Improvesthereon, and who contracts for the projects with a licensed Contractor pu uant to the Contractors' State License Law). I am exempt from ficensure under the Contractors' State License Law for the following reason: _ y my signature below f acknowledge that, except for my personal residence in which I must have resided for at least one year nor to completion of the improvements covered by this parmh, I cannot legally all a structure that I have built as an owner -builder if It has not been constructed in its entirety by licensed contractors. I under- rand that a copy of the applicable law, Section 7044 of the Business and rofessions Code, is avalleble upon request when this application is submitted or at the following Web sff$;http:/twww'.ieginfo:C .gov/Calaw,himl. ignature of Property Owner or Authorized Agent Date ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sectio 000 D' ' f 3 of the Business and Profs " &nd my license is In full force nd effect. License Class License No Dat — Contractor Signature _ :RS' COMPENSATION DECLARATION Y FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES :OMPENSATxNr. DAMAGES As PROVIDER FOR {N SECTION 9700 OF THE LABOR CORE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to SOINneure for workers' compensation. Issued by the Director of ormance of the work for which this permit is issued. policy No, have villl maintain Workers' componsatien iersumnes, as required by Section 3700 W the Labor Codo, for the pe Rar'sce ter and policy numost are: tier policy Number ne o Agent certify that, in the pedc an the work for which this permit is Issued. I shall not. employ any person to any mannor s If I should become u act I a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith mature of Applicanf hereby affirm under pengityof'perjury that there is a construction lending agency for the performance of the work for which Order's Name Lender's Address y 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 t have provided incorrect. I agree to comply with all applicable city and countyprj►tf)ances and state laws relating to building construction. I authorize representatives of this city or county�tn r he above -identified property for inspection purposes. ACTION PERMIT E)rPARED DATE I BY R£GULATION5 PART 61: OF TITLE 40 AND AQMD RULE CERTIFICATE OCCUPANCY SSUED`EiO.'t,'� yl J ( IG POTURE:AM1 i TION S NOT APPLICABLE 70 I UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,000j., IN ADDITION TO THE Relations as provided for by Section 3700 of the Labor Code, for of the work for which this permit is Issued. My workers' Date to became subject to the works ' mpensation laws of California, and aly with those provisions. Da — Z� Hermit is issued (Section 3097. Ivil Cade). FOR OFFICE USE ONLY