HomeMy WebLinkAboutF2022-0341 - Permits�ygH'1'C3.y
City of
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Permit Coi
wport Beach - Building Division II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
.r Drive, Newport Beach, CA 92660
Phone(949)644-3288
Job Address: 20475 UPPER BA* DR NB
Inspector Area: 3
Owner: JORDAN/GALLOG Y
Address: 20475 UPPER BA DR
NEWPORT BEAC , CA 92660
Phone:
Applicant: CASEY MONTY
Address: 1101 KINGSTON r
LA HABRA CA 906
Phone: 714476-5370
Code Edit: 2019
Type of Construction:
V-E
Occupancy Group:
R3/
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
1
No of Units :
a
Flood Zone:
X
Bldg Sprinklers:
Y
Construction Valuation
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee:
Fire Plan Check Fee:
Fire Permit Fee :
Building Permit Fee
TOTAL FEI
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
FIRE Permit: F2022-0341
Project No : 1670-2022
Inspection Requests Phone (949)644-3255
Description: SFR FIRE SPRINKLERS (X2021-1085) 26 HEADS
Legal Description: N TR 6407 LOT 2
Contractor:
FIREPROOF FIRE PROTECTION
Architect:
Address:
1101 KINGSTON DR
Address:
LA HABRA CA 90631
Phone:
714-476-5370
Phone:
State Lic
Con State Lic:
876004
Engineer:
Lic Expire:
04130/2024
Address:
Bus Lic:
BT30040107
Lic Exp Date:
07/31/2022
Phone:
State Lic:
Worker's Compensation Insurance
Designer:
CASEY MONTY
Carrier:
SECURITY NATIONAL INS
Address:
1101 KINGSTON OR
Policy No:
SWC1373758
LA HABRA CA 90631
0 Expire: 02/15/2023 Phone:
0
Issued Date: 0613012022 Special Conditions:
Setback- Front:
Rear:
Left: Right: 1 w �\V{ r^V\ P E
$2,600.00
FEES
$222.00
Fire Residential Alarm PC Fee :
$0.00 Records Management :
$4.00
$0.00
Planning Counter Review:
$0.00
$0.00
Planning Zoning PC Fee :
$0.00
$0.00
$0.00
$0.00
Public Works PC Fee :
$0.00
$0.00
$0.00
Public Works Traffic Plan Check Fee;
$0.00
$269.00
$495.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance :
$495.00
OTHER DEPARTMENT:
- PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 EAYS A,=TER ISSUANCE'OR LAST VALID INSPECTION
DINNER -BUILDER DECLARATION
1 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
.he 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
tot 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
i�m roved 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 Iicensure 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 legall)
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://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 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 is r1J LL Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN ED THOUSAND DOLLARS I$100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37DG OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
k
Ihereby affirm under penalty of perjury one of the following declarations:
ave 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 ofthe Labor Code, for th
mance of the work for which this permit is issued. Policy No.
eve 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' compensatio
nce carrier and policy number are:
Policy Number
Date
le Of Agent 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
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pTvisions. A
ignature of Applicant '
iECLARATION REGARPNNONSTRUCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is iss d (;
Ender'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 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.
'ignature of Property Owner or Authorized Age
Gt w- Print Property Owner's or Authorized Agent's Name
ACTION I DATE ✓ I \ 8Y
I PERMIT EXPIRED I I I
PERMIT CA 'CELLED
rPERMIT EXTENDED _
I PERMIT FINAL 1 "7 "L, L- /. l,'l -�
F1 OF TITLE40 AND
f1Q^4D RULE 1403.
7 i SUdMITTEDASBESTOS NOT7VICATION TO:
23 EPA
❑ AQMD
❑ ASBESTOS NORFlCATIONIS NOT APPLICABLE TO
PR.:POSED DCMOLITIOl".
SIGNATttkE:
OCCUPANCYISSUED I I
lei
3097, Civil Code).
413 `/1-