HomeMy WebLinkAboutX2016-0316 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2016-0316
04 p 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 6 0 3 1 6 Project No : 2670-2013
Permit Counter Phone (949)644-3288
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`j Inspection Requests Phone (949)644-3255 Issued Date : 01/2912016
Combination Type - SFP ELEC MECH PLUM
Inspection Area : 4
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
INSTALL OR VERIFY SMOKE/CARBON MONOXIDE DETECTORS /PLUMBING FIXTURES TO BE UPGRADED , k"P
Job Address: 2000 PORT CARDIFF PL NB Y"'„'
Description: SFR -CHANGE OF CONTRACTOR (X2014.0436) /INCREASE SCOPE OF WORKIREPAIR HANDRAILS, REMODEL (3) RESTROOMS ,
Legal Desc.: N TR 6623 LOT 13 dv61 . 110%
Owner: CHANG DERRICK & ANNE Contractor: OWNERIBLDR Architect:
Address: 2000 PORT CARDIFF PL Address: CHANG DERRICK Address:
NEWPORT BEACH, CA 92660
State Lic:
Phone: 310-806-5898 Phone: 310-806.5898 Phone: ,
Applicant: HAMPTON CRAIG Con State Lic: OIB Engineer: FORBES DALE L
Address: 46 MALLARD CT Lic Expire: Address: 1800 E 16TH ST
MAGALIA CA 95954 Bus Lic: SANTA ANA CA 92701 - • , , , , ,
Phone: 949-209-8883 Lic Exp Date: Phone: 714-835-2800 State Lic:C-030407 . .
Code Edit : 2010 Worker's Compensation Insurance Designer: HAMPTON CRAIG -
Type of Construction: V-B Carrier: Address: 46 MALLARD CT
Occupancy Group: R3/U Policy No: MAGALIA CA 95954
Added /New sq.ft. Bldg: 0 Expire: Phone: 949.209-8883
Added /New sq. ft. Garage: 0 '
No of Stories: 2 Building Setbacks Rear: / Special Conditions:
No of Units : 1 Front: I
Bldg Height: 0 Left: I
Bldg Sprinklers: N Right: /
Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N
Construction Valuation: $0.00
Building Permit Fee: $0.00 Excise Tax: $0.00 Planning Department - Fire Department
Plan Check Fee: $0.00 Additional Fee : $8.00 Plan check Fee : $0.00 Fire Inspection: $0.00
Overtime Plan Ck: $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: $27.98 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 P/W Plan Check : $0.00 Grading Bond: $0.00
Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00
Building Green Fee : $0.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00
Plumbing %: $0.00 $0.00
TOTAL FEE : $35.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $35.00
PROCESSED BY: PUBLIC WORKS APPROVAL:
ZONING 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) 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 licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora 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
. pilarovements 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
51.d forthe purpose of sale).
ownerof 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
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).
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature belww 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 le call)
:.ell a structure tb3' I have built as an owner -builder if it has n been c ns cted in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Protessions Code, is available upon request when t is appli is b i d o t the following Web site:hftp://www.leginfo.ca.gov/calaw.html.
Sig,natule of Property owner or Authorized Agent Date Z5 6
LICENSED CONTRACTOR'S DECLARAT ON
I I,e,',Ly affirm under penalty of perjury that I am licensed under provisions of Ch pter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
=rd cf`ect. License Class License No Date Contractor Signature
.VORKERS' COMPENSATION DECLARATION
V{ RNING; FAILURL TO CECJRE 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
'OST,OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND. ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
I ha:e and 'Ail' :T.a.ntain 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 thI
•erformince of the worK for which this permit is issued. Policy No.
have and will mainiain 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'
rance carrier and policy number are:
Policy Number
of Agent
Date
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 provisions.
signature of Applicant Date_
)ECLARATION REGARDING CONSTRUCTION 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 issued (Section 3097, Civil Code).
ender's Name Lender's Address
ly 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 orclinances and state laws relating to building construction.
I authorize representatives of this city or county, to me e-identified property for inspection purposes.
signature of Property Owner or Authorized Agent Yc � r / Print Property Owner's or Authorized Agent's NameX J�ftr�C lLla"
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