HomeMy WebLinkAboutX2014-2006 - Permit Application (2)Ay,n rO4T City of Newport Beach - Building Division �IIIIIIIIIIIIIIIIII IIIIIII II
Lt 4A 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 t 4 2 0 0 6
Per
Permit Counter Phone (949)644-3288
n
Combination Type - SFP ELEC MECH PLUM
Job Address: 375 NEWPORT GLEN CT NB
Description:SFR CONVERT (E) SPACE TO LIVABLE 703 SF & DECK EXTENSION 270 SF, RELQ9i ilIEWATERHEATER 'C%6
Inspector Area: 3
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
WOOD,RANDY D TRUST
291 ESTHERST
COSTA MESA CA 92627
Legal Desc.: N TR 9776 LOT 1
BERNADETTEIRICHARD DESIGN
1041 W 18TH ST
COSTA MESA CA 92627
949-422-9191
Code Edit
Type of Construction:
Occupancy Group:
Added /New sq.ft. BI
Added /New sq. <
No of Stories:
No of Units:
Bldg Height
Bldg Sprinklers:
Flood Zone:
2013
/ 703
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management
Energy Compliance:
CA Seismic Safety: $8.24 1
Disabled Access:
$0.00
Fee Increase: Fee:
$0.00
Additional Fee:
$0.00
Hazardous Mat:
$0.00
Building Green Fee:
$3.00
TOTALFEE:
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Contractor:
Con
Lic E
COMB Permit: X2014-2006
Project No 1625-2014
Inspection Requests Phone (949)644-3255
HE EL K;IAN/CO�1�Cy O Arc ct:
30031L4r\LEQ ddress:
NUEVO CA 92
/951-326-4 6 Phone:
54X30 r100 Engineer: HADIDI-TA `ED"I
10131.12014 r�Q
ST306465443
'`'fit\/ �icVExp=Bate:
03/31/2015'
Worker's Compensation
Insurance
Carrier
PRESERVER
Policy No
WCCO0478800
-i rL xpire
0110412015
ding Setbacks
.Rear. /.:"?
Front;-
Left /
kiY
Right: /�
Issued Date :
State Lic:
Address:
35 GOLF RI E D,R,
DOVE CANYO CA192679
Phone:
949-632-6047-State
Designer:
!F�IR JAI ON
Address:
°Ilfj�W 18TH STRE
"q�wse'�`oSTA MESA CA 92 7
PTt 7e
'A 949-022-9191
don,
,,G�5`ye�c�lal ;Bitions:-
Q�,�
Lic:C-049136
i
\' F $a�e,>� Planning Depa t ;� ` y,W Fire Department
E�ie(se Tax: g�} ® Plan chec e : $32.00 Fire Inspection: $0.00
�� Fair S e : �, $0.00 Fire Plan Rev $0.00
Grading PC Cop Its $0.00 S Trans: - $0.00 Demolition Fee
Grading P f- e'fi. 0.00 n-lieu Ho ngEe�' $0.00 Building Dept Adm $0.00
GCadln re. ;§`v .00 Public ri Department- General Service $0.00
VV��1Q In F6e �J $0.00 fk Dedication : $0.00 Refund Deposit $0.00
P/W Plan Check: $37.75
ectric t..°�o�f-`� �8 San Dist : $716.00
echani l °/a: (") $41.20 NMUSD Fee: $1,293.52 $0.00
Plumbing %: C $82. " $0.00
f..s
26n Check Fee : $680.28 Fee Due at Permit Ise once : $3,227.42
PUBLIC WORKS APPROVAL: �-
�� PLAN CHECK BY:
APPROVAL TO ISSUE:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
INSTALL OR VERIFY SMOKE/CARBON MONOXIDE DETECTORS /PLUMBING FIXTURES TO BE UPGRADED
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 items)
(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 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 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).
111, 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).
❑ 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 least one year.prior to completion of the improvements covered by this permit, I cannot legalll
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.htmI.
Signature of Property Owner or Authorized Agent -. Date
LICENSED CONTRACTOR'S DECLARATION +' n` `e
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se 'on7000) f DKisipp 3'o#4fiBus es and Prof ions Code a of my lie nse is in full force
and effect. License Class License No D e -i Contra S nature
ORKERS' COMPENSATION DECLARATION
ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL ES UP TO ONE H RE THOUSAND DOLLARS ($100,000(, 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:
I have and will maintain a certificate of consent to self -insure for workers' -Compensation, issued by the Director of Industrial Relations as provided by Section 3700 of the Labor Code, for IN
p rmance of the work for which this permit is issued. Policy No.. .,
have and will maintain workers' compensation insurance, equued by Section 3700 of the Labor Code, for the performance of the work for which this ermit is issued. My workers' compensatio
nsurance carrier and policy number are: �O'1 -
Carrier Number. Expiration Date
Ie of Agent
certify that, in the performa c of. the wodffowhic�spermit Is Issued { shall not employ any person in any manner so as to
if should become subjec the workepens flan proyisions of Section 3700 of the Labor Code I shall forthwith comply
r .
lature of A014icant1 11-
!reby affirm under penalty/ of perjury thattt0ere is a c
Ider's Name
my signature below, I certify to each:of}ffiefollowing
I am the property owner or authorized to act on, the
I have read this application and the informs on 1 hE
I agree to comply with all applicable city cou
I authorize representatives of this city or co
nature of Property Owner or Authorized °
the
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for they performance of the
Lender's Address _.ol
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building construction.
Tspection purposes.
Print Property Owned
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