HomeMy WebLinkAboutM2019-0055 - PermitsnLo City of Newport Beach - Building Division IIIIIII�IIIIIIIIIIIIIIIIIINIIIIIIIIIIII II HARBOR Permit: M2019-0055
100 Civic Center Drive, Newport Beach, CA 92660 - M 2 0 1: 9 0 0 5 5 Project No : 1472-2019
E Permit Counter Phone (949)644-3288
-�w4rrn¢b' Inspection Requests Phone (949)644-3255
Job Address: 634 LIDO PARK DR Floor:
Suite: Bldg: 0
Description of Work: COMM REPLACE (1) GUIDE PILE AT FLOATING DOCK
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InspectorArea: 1
...
Legal Description: TR 815 LOT 11 ALL -EX WATERWAY -(AND ALL -EX WATERWAY- LOTS 12 & 14 TO
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Owner: URSINI FRANCIS A
Contractor: SHELLMAKER INC
Engineer: PETROVPLAMEN
Address: 25 CAMBRIA DR
Address: 837 W 17TH STREET
Address: 28161 CASITAS CT
NEWPORT BEACH, CA 92625
COSTA MESA CA 92627
LAGUNA NIGUEL CA 92677
Phone:
Phone`. 949-548-5359
Phone: 714-717-7542 m�°.e•
° a
State Lic:
C-066942
Applicant LINDA/SHELLMAKER
Con State Lic:561434
Designer. °
e
momoe
Address: 837 W 17TH ST
Lic Expire: 03/31/2021
Address:
COSTA MESA, CA 92627
Bus Lic: BT00009706
Phone: 949-548-5359
Lic Exp Date: 0113112020
Phone:
Special Cond:
Longshoremen's and Harbor Workers' Compensation Declaration -
Carrier : LONGSHORE
Issued Date 06/27/2019
Policy No: L&H-90494517
Expire : 07/11/2019
FEES
Valuation: $10,000.00
Fire Inspection Fee: $0.00
$0.00
Inspection Fee: $287.00
Fire Plan Check Fee: $0.00
Plan Dep - Counter Review: $0.00
Plan Check Fee $302.00
Records Mangement: $4.00
Plan Dep - Zoning Plan Check: $0.00
OT Plan Check Fee: $0.00
Harbor Plan Check Fee: $131.00
Plan Dep - OverTime Plan Check: $0.00
Investigation Fee: $0.00
Building Green Fee: $1.00
TOTAL FEE : $725.00
Plan Check Fee: $0.00
Fee Due at permit Issuance : $725.00
PROCESSED BY:
PUBLIC WORKS:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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OTHER DEPARTMENTS:
FINAL INSPECTION
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
VNER-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 applicableitem(s)
action 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 to
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 an
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 penally o
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 (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
;mess 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 thatch
movements 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 o
(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
)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' State License Law for the following reason:
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
a structure.tkist•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 anC
fessions CgpIZ•ifi available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
nahrre of Pr9gefty Owner or Authorized Agent Date
••• • • �.
:qNSED CONTRACTOR'S DECLARATION
welly affirm uilder penalty of perjury that I am licensed under provisions of Chapter 9 (comm ncing with Section 7000) of Division 3 of the Busine s nd Professio Code, and y license is in full forcE
reflect. Licens e@!1'ss License No. Date — • ( Contractor Signature
NGSHORISMEN+S & HARBOR WORKERS' COMPENSATION DECLA TION
MNG: FAILURE Tq CCURE LONGSHOREMEN'S & HARBOR WORKERS' COMPENSATION COVERAGE IS UMLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
GINO), IN ADSITILN TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S. FEES. I hereby affirm under penally of perjury one of the following
y0ions:
.
•• •. I have and will maintain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
led ; My6 *workers' compensation insurance carrier and policy number are:
hem 0 Policy Number Expiration Date
Ke of AGent • • _ _ Phone #
I certify that, in the erformance 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'
that, if I should beco subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Iture of Applicant
.ARATION REGARDING CONSTRUCTION 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
Lender's Name Lender'sAddress
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 c ply with all applicable city and county ordinances and state laws relating to building construction.
I authorize epreessentatives of this city orrccounty
l)to enter the above -identified property for inspect! n purposes.
iianature:/rte('. 50 . ��dGh6' Print NamYILtnd.-_ SAr_4cXo /
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