HomeMy WebLinkAboutX2019-1486 - Permits�1�,� City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2019-1486
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 1 4 8 6 Project No:
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' Permit Counter Phone (949)644-3288
x` +qi Inspection Requests Phone (949)644-3255
„,°t �.�,� Combination Type - MFP Issued Date: 05/08/2019
6
Inspection Area : 3
I
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
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 Hors
s
Investigation Fee:
Job Address:
240 NICE LN NB St: 1 FI: 1 Unit: 117.
$0.00
Description:
MFR - REPLACE (2) RETROFIT WINDOWS & (2) RETROFIT PATIO DOORS "LIKE FOR LIKE"
CA Seismic Safety:
Legal Desc::
TR 8336 LOT 14 UNIT 117 OF PROJECT LOCATED ON AP 423-011-22 TOGETHER
$0.00
Designer.
e • •
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Owner.
ENGELKE PAM Contractor: PACIFIC SHORES DISTRIBUTING Architect: ;
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Address:
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240 NICE LN #117 Address: 10573 ELLIS AVE Address: . •e.r�a
000000
In -lieu Housing Fee:
° ° °
NEWPORT BEACH, CA 92663 FOUNTAIN VALLEY CA 92700
Phone: '562-420-2465
Phone: 714.841-2228 Phone: State Lic:
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App!icant:
o• e
PACIFIC SHORES DISTRIBUTING Con State Lic: 887442 Engineer. •
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Address:
10573ELLIS AVE Lic Expire: 1113012020 Address:
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FOUNTAIN VALLEY CA 92708 B LBT30034488 e •
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Phone: 714.841-2228
Code Edit :. 2016
Type of Construction: I -A -SPR
Occupancy Group: R21U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 3
No of Units : 1
Bldg Height: 0
Bldg Sprinklers:
Flood Zone:
Building Permit Fee: $104.00
Plan Check Feer $0.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access:
$0.00
Hazardous Mat $0.00
Building Green Fee : $1.00
TOTAL FEE: $105.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
us c.'
Lic Exp Date: 02/28/2020
Worker's Compensation Insurance
Carrier: COMPWWEST INS CO
Policy No: WCV65028620
Expire: 1012512019
Building Setbacks
Excise Tax:
Additional Fee
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical W
Mechanical %:
Plumbing %:
Rear: I
Front: I
Left: I
Right: /
$0.00
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Phone:
State Lic:
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Plan check Fee :
00
Fire Inspection:
$0.00
0 0 0
omsoo
Designer.
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Address:
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00000
Demolition Fee
000000
In -lieu Housing Fee:
0 0
o e 0
Phone:
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Public Works Department -
0
$0.00
$0.00
Park Dedication : $0.00
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Refund Deposit
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0e•oo
Special Conditions:
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Grading Bond:
$0.00
ommo
San Dist: $0.00
$0.00
Planning Department -
Fire Department
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
$0.00
Fair Share :.
$0.00
Fire Plan Rev
$0.00
$0.00
SJH Trans :
$0.00.
Demolition Fee
$0.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
$0.00
$0.00
Public Works Department -
General Service
$0.00
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
PAN Plan Check: $0.00
Grading Bond:
$0.00
$0.00
San Dist: $0.00
$0.00
NMUSD Fee: $0.00
$0.00
$0.00
$0.00
Plan Check Fee:
$0.00 Fee
Due at Permit Issuance :
$105.00
/
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
I hereby affirm under penalty of perjury that 1 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)
Iction 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
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
Ifessions 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
more than five hundred dollars ($500).
1, 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,
31ness 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
irovements 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
xoved 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
)ly 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 licensure under the Contractors' Slate License Law for the following reason:
my signature bet"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
I a structure tiiat.11wve 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
decsibns Cor%zs available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
naturb of ProbeKX Swner or Authorized Agent Date
.ENygED CONTRACTOR'S DECLARATION
ireby affirm Under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 of ivision 3 of the Business and Professions Code, and my license is in full force
I effect. Licaris4'Class License No Date / Contractor Signature
5191I4ERS' CCSAMNSATION DECLARATION
MING: FAILURIbTWECYRE 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
it QE eOMPENSIPrION!DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
?*y affirm under penalty of perjury one of the following declarations:
I have and 416ein iitain 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 the
fp"%nce of the worn for which this permit is issued. Policy No.
-have and will meinlain 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
uance carrier an8 policy number are:
Ie of Agent
certify that, in the pi
if I should become
of
Policy Number
Date
m,once 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 agree
j€ct to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
%x,�,� Date5%£z F
DECLARATION 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
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 rdinances and state laws relating to building construction.
I th' t t' f th' 't t t ter the above -identified ro art for ins action ur oses
Civil Code).
au orize represen a Ives o Is cI y or coun y en p p y p p p 7
innature of Prnnnriv Owner or Authorized Anent Ill 11`4,44, Print Prooertv Owner's or Authorized Aaent's Name /�dia- l '"—d/c
ACTION DATE BY l DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED I U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATEOF
OCCUPANCY ISSUED
SBESTOS NOTIFICATION 15 NOT APPLICABLE TO
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