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Home My WebLink AboutX2019-4056 - Permits�awro City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2019-4056 04 100 Civi; Center Drive, Newport Beach, CA 92660 X 2 0 1 9 4 0 5 6 Project No : 2796-2019 Permit C ounter Phone (949)644.3288 i 0 Inspection Requests Phone (949)644-3255 Combir ation Type - SFP ELEC GRAD MECH PLUM Issued Date : 0912912020 Inspection Area : 5 PERMIT E KPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0913012023 OR PERMIT WILL BE INVALID Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 6:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 4515 ORRING FON RD NB Description: NEW SFR W/ 3ASEMENT & GARAGE 7286/1860 SF Legal Desc.: N TR 3357 LO F 76 Owner: ZIEMBA FAMILY TRUST Contractor: S C HOMES INC Architect: TEALE MARK Address: 4515 ORRINGI ON RD Address: 3050 PULLMAN ST Address: 2900 BRISTOL ST BLDG A203 CORONA DEL MAR, CA 92625 COSTA MESA CA 92626 COSTA MESA CA 92626 Phone: Phone: 949.723-4243 Phone: 949-975-0123 State Lic:CO22162 Applicant: TEALE MARK Con State Lic: 828216 Engineer: HAKIM FADY Address: 2900 BRISTOL ST BLDG A 203 Lic Expire: 12/3112021 Address: 124 PEONY COSTA MESA CA 92626 Bus Lic: BT30002421 IRVINE CA 92618 Phone: 949-975-0123 Lic Exp Date: 0212812021 Phone: 310-422-1536 State Lic:C-075736 Code Edit: 21.16 Type of Construction: V-B-SPR Occupancy Group: R f/U Added /New sq.ft. Bldg: 7288 Added /New sq. ft. Garage: 1860 No of Stories: 1 No of Units : 1 Bldg Height: 0 Bldg Sprinklers: Y Flood Zone: X $1,460,640.00 Building Permit Fee: $9,E05.00 Plan Check Fee: $6,652.50 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : 598.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access: $0.00 Hazardous Mat $0.00 Building Green Fee : 459.00 TOTAL FEE: $36,176.43 PROCESSED BY: ZONING APPROVAL: NO GRADING APPROVAL: 15� \`�1 Worker's Compensation Insurance Carrier: STATE FUND Policy No: 1763760 Expire: 0110712021 Building Setbacks Rear: 30 Front: 6 Left: 6 Right: 6 Use Zone: Parking Spaci Designer: Address: Phone: spr e% I Special Conditions: '� Excise Tax: $1,921.08 Planning Department - Additional Fee : ($329.11) Plan check Fee Grading Bonds Fee: $0.00 Fair Share Grading PC Consultant : $1,741.68 SJH Trans Grading Permit Fee: $3,018.00 In -lieu Housing Fee: Grading PC Fee: $382.32 Public Works Department - WQ Insp. Fee: $120.00 Park Dedication : $0.00 PAN Plan Check: $344.00 Electrical %: $1,283.47 San Dist; $994.00 Mechanical %: $733.41 NMUSD Fee: $7,240.40 Plumbing %: $1,660.18 Plan Check Fee : $8,697.14 Fire Department $462.50 Fire Inspection: $0.00 $0.00 Fire Plan Rev $0.00 $0.00 Demolition Fee $0.00 Building Dept Adm $0.00 General Service $0.00 Refund Deposit $0.00 Grading Bond: $0.00 $0.00 $0.00 Fee Due at Permit Issuance : $27,479.29 PU9UC `VCRKS APPROVAL: �,AtY-A—� PLAN CHECK BY: Nl" ' APPHOVAL TO ISSUE: DocuSign Envelope ID: 146OCC23-5942-4B4A-80OF-1)8EB7AC6FB2E I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reas (Section 7031.5, Business and Professions Code: Any city, or county that requires a permit to constmet, alter, iml the permit to file a signed statement that he or she is licensed pursuant to the provisions or me Contractors' StatE Professions Code) Gr that he or she is exempt from licensure and the basis for the alleged exemption. Any v€alati not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, win do (_) all of or Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who Improvements are not intended or offered for sale. If, however, the building or improvement is sold Within one ye, ri-m-roved for the purpose of sale). LJ I, as Owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed ❑ 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 I sell a structure that I have built as an owner-buGlder if it has not been constructed in its entirety by licensed contre Professions Code, Is available upon request when this application is submitted or at the following Web site:httpy/ Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Sectic and effect. License Class License No Dt WORKERS' COMPENSATION DECLARATION ARNNG: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO GRIM COST OF COMPENSATID MAGES AS PROVIDED FORNSECTION 3706 OFTHE LABOR CODE, INTEREST, AND ATiORNEY'SFEES I hereby amrm fly of perjury one of the following declarations: I n t1yR main a certificate of consent to self -insure for workers' compensation, issued by the I S pedor a work torwhich this permit is issued. Policy No. ave antl Will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, insurance Oarrrerand policy number are: CarderSTATE COMPENSATION INSURANCE FUNAlicy Number 1763760 Name of Agent I certify that,. In the performance of me work for which this permit Is Issued, I shah not employ any person in an that, if I Should become sub -Act to the workers' compensation provisions of Section 3700 Ot the Labor Code, I shl Slanature of ADDlicaZ ireby affirm under penalty of perjury that there is a construction Gentling agency forthe performance of the work Ider's Name Lenders Address my signature below, I certify to each of the following: I am the property owner or authorized to act on the properly owner's behalf. I 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 Goun above -identified property for inspection purposes. foe er me nature of Property Owner or Authorized Agent Print Property Owne DECLARATION OF COMPLIANCE WITH CODE OF FEDEF REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403 CER TWI FINAL V /*f4t! I TOS NfFIF:LATIY7 t5 NOT a^FCCA CEflT7F/CATEOF Ifs PROPOSED DEMRLP'POp� ' OCCUFANCYISSUED arunmoc�//� �. ;s) indicated below by the checkmark(s) i have placed n A to the applicable Item(s) is, demolish, or repair any structure, prior to its issuanc:. also requiresthe applicant toy cone Law (Chapter 9 (commencing With Section 700D) :f Division 3of the Business and of Section 7031.5 by any applicant for a permit subjects he applicant to a civil penalty of Dns of the work, and the structure Is not intended or otfe ad for sale (Section 7044, trough employees' or personal effort, builds or improves Is property, provided that the A completion, the Owner -Builder will have the burden of ?roving that H was not built or 17044, Business and Professions Code: The Contractor State License Law does not Ttractor pursuant to the Contractors' State License Law) gone year prior to completion of the improvements cove red try this permit I cannot legall its. I understand that a copy of the applicable law, Seclik 17044 of the Business and Dat P c2"TLVWJI`pd Profes s CDc and my license is in full force Contractor algnatur PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND fLLARS ($100,000), IN ADDITION TC of Industrial Relations as provided for by Sectiol 37GO of the Labor Code, for the performance of the work for which this permit is i sued. My workers' Son Date 01/07/2021 #877-405-4545 so as to become subject to the workers' compen ation laws of California, and agre t comply with those provisions. Daft „Q9/28/,'_0 1 2:03 PM PDT �� which this permit is Issued (Section 3097, Civil Code). or Authodzed Aaeni's NameSCott Cross �,•r,r City of Newport Beach - Buiiding Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2019-4056 100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 1 9 4 0 5 6 Project No : 2795-2019 Permit Counter Phone (949)644-3288 si 4 Inspection Requests Phone (949)644-3255 c „= Combination Type - SFP ELEC GRAD MECH PLUM Issued Date : Area : 2020 Inspection Area 5 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1010212023 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: NEW4515 BASTON M NB i-� � DI ��A7 Description: NEW SFRW/ BASEMENT 8 GARAGE 728811860 SF L j�,j� Legal Desc.: N TR 3357 LOT 76 Owner: ZIEMBA FAMILY TRUST Contractor: S C HOMES INC Architect: TEALE MARK - Address: 4515 ORRINGTON RD Address: 3050 PULLMAN ST Address: 2900 BRISTOL ST BLDG A203 CORONA DEL MAR, CA 92626 COSTA MESA CA 92626 COSTA MESA CA 92626 ran"P Phone: Phone: 949-723-4243 Phone: 949-975-0123 State LicCO21162 i J Applicant: TEALE MARK Con State Lic: 828216 Engineer: HAKIM FADY Address: 2900 BRISTOL ST BLDG A 203 Lic Expire: 12/3112021 Address: 124 PEONY COSTA MESA CA 92626 Bus Lic: BT30002421 IRVINE CA 92618 Phone: 949-975-0123 Lic Exp Date: 02/2812021 Phone: 310-422-1536 State Lic:C-075736 Code Edit: 2016 Worker's Compensation Insurance Designer: Type of Construction: V-B-SPR Carrier: STATE FUND Address: Occupancy Group: R31U Policy No: 1763760 Added /New sq.ft. Bldg: 7288 Expire: 01/0712021 Phone: Added /New sq. ft. Garage: 1860 No of Stories: 1 Building Setbacks Rear: 30 Special Conditions: No of Units : 1 Front: 6 Bldg Height: 0 Left: 6 Bldq Sprinklers: Y Right: 6 1:1 Construction Building Permit Fee: $9,805.00 Excise Tax: $1,921.08 Planning Department - Fire Department Plan Check Fee: $6,652.60 Additional Fee : ($329.11) Plan check Fee : $462.50 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: $1,741.68 SJH Trans : $0.00 Demolition Fee Record Management: $98.00 Grading Permit Fee: $3,018.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $303.00 Grading PC Fee: $382.32 Public Works Department - General Service $0.00 CA Seismic Safety: $189.88 WQ Insp. Fee : $120.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 PAN Plan Check : $344.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $1,283.47 San Dist: $994.00 Building Green Fee : $59.00 Mechanical %: $733.41 NMUSD Fee: $7,240.40 $0.00 Plumbing %: $1,650.18 $0.00 TOTAL FEE: $36,669.31 PROCESSED BY: ZONING APPROVAL: Plan Check Fee : $36,669.31 Fee Due at Permit Issuance : $0.00 PUBLIC WORKS APPROVAL: 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) indica ad 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, demo ish, 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 L (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 Sectio 17031.5 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 L) portions of th 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 a ployees' 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 comple tion, 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, B usiness 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 r ursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: 3r prior to completion of the improvements covered by this permit, I cannot legal) By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one ye 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://w .leginfc.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 Section 7000) of I ivision 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No Date Contractor Signature WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI SAND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1E100,0001, 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: El I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of I idustrial Relations as provided for by Section 3700 of the Labor Code, for th performance of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the per rmance of the work for which this permit is issued. My workers' compensatio insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # as to become subject to the workers' compensation laws of California, and agre I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner si that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cade, I shall forthwith omply with those provisions. Signature of Applicant Date_ DECLARATION REGARDING 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 its permit is issued (Section 3097, Civil Code). Lender's 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 owner's behalf. I 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 county to enter the above -identified property for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Auth rized Agent's Name Date ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE I, SE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQM D RULE 1403 PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED LJEPA PERMIT EXTENDED 7 QAOMD PERMITFINAL ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATEOF PROPOSED DEMOLITION OCCUPANCY ISSUED SIGNATURE: