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Home My WebLink AboutXR2023-2957 - Permits",EWpoR, City of Newport Beach 111IIIIIIII1111111111111111111111111111111111111111111l jj COMB Permit : XR2O23-2957 "ICommunity Development Department- Building Division X R 2 0 2 3 2 9 5 7 F 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: r Permit Counter Phone: (949) 718-1888 Issued Date : 10/18/2023 o.� newportbeachca.gov/civic Final Date: C9G/F00.N�P Combination Type - SFP Permit Status: Issued Work Class - Other Inspection Area : 2 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 : 217 VIA RAVENNA Legal Dose: N TR 907 BLK LOT 164 Description: SFR - BLOCK WALL 30 LF X 5' HIGH. INSIDE P/L Owner: MOHN LARS TR MOHN LIVING TR Address : 217 VIA RAVENNA NEWPORT BEACH, CA92663 Phone Applicant: MIKE HOLLAND CONST INC Address: 28081 MORRO COURT LAGUNA NIGUEL, CA 92677 Phone: (949)235-9477 Owner/Builder : Address : Phone Contractor: MIKE HOLLAND CONST INC Architect Address : 28081 MORRO COURT Address LAGUNA NIGUEL, CA 92677 Phone: (949)235-9477 Phone: Con State Lie : 898714 State Lie Lie Expire: 06/30/2025 Bus Lie: BT30058852 Engineer: Bus Lie Expire : 04/30/2024 Address Workers' Compensation Insurance Phone: Carrier: STATE COMPENSATION INSURANCE FUND Policy No: 9140185 Designer W. C. Expire: 7/29/2024 Address Phone: Code Edition : 2022 Fire Sprinklers : NO Type of Construction : V-B Fire Hazard Zone : NO Occupancy Groups: U,R-3 No of Units : 1 Bldg Height: No of Stories: 1 Building Setbacks : Front: 4, Front: 10, Side: 3, Side: 3 Flood Zone : X Use Zone: R-1 - Single -Unit Residential PROCESSED BY: Q' SPECIAL CONDITIONS: Construction Valuation : Added/New/Ti sq. ft. Bldg Alteration sq. ft. Bldg : Added/New sq. ft. Garage: TOTAL sq. ft. : $6,300.00 0 OWNER -BUILDER DECLARATION I hereby affirm under penalty Of perjurythat I am exempt from the Contractors' State License Law for the reason($) indicated below by the cfeeckmark(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 for a permit subjects the applicant to a civil ponalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do L) 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). Ell, 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). D I am exempt from ficensure 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 ownarbuiider 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:htlpalwwwJoginfc.ca.govlcalaw.html. Signature of Properly Owner or Authorized Agent _ ____� Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of penury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and Professions Code, my license is II farce and effect. License Class License No afa ?.1��« Contractor Signature o h 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 HUNDRED THOUSAND DOLLARS t6Ie0JW0),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION ]TDB OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: I 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 th perrommance of the work for which this permit is issued. Policy No. sw PN have 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' compensatior insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone If Ell certify that, in the performance of the work for itijfich 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 agre that, If I should become subjectZ_TRLUc-n_0N orkers' pensallon previsions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions Signature of Applicant provisions - Date �G�j DECLARATION REGARDING 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), 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 an�the abo%v ,ifle_nlified property for inspection purposes. rfl/� Signature of RrODeTV Owner or Authorized Agent /// ,� /T _. Print Property Owner's orAuthorizee Agent's Name f�L- --t"I I . l/ r, ` Dale 'r ACTION 1 DATE PERMIT EXPOIL PERMIT CAN CrLLEL PERM'1T EXTENDED PERNNT FLNAi CERTIFICATE OF OCCUPANCY ISS, TECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AONID RULE NOTIFICATION TO !T� I L_j ASBESTOS NOTIFICATION IS NOT APPLICABLE TO I PROPOSED DEMOLITION