HomeMy WebLinkAboutX2019-0744 - PermitsCity of Newport Beach - Building Division
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COMB Permit: X2019-0744
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
X 2 0 1 9 0 7 4 4
Project No: 1113-2014
a
Inspection Requests Phone(949)644-3255Combination
Type- SFP ELEC. MECH PLUM
Issued Date : 09/2312019
Inspection Area : 2
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 8:00 a.m, to 6:00 p.m. No work on Sundays or Holidays
Job Address: 810 KINGS RD NB
Description: SFR -(REPLACE EXPIRED PERMIT X2014-1350) ADD 75 SF/REMOVE (E) STAIRSIBATH
AND PANTRY ADDN
Legal Desc.: N TR 1218 BLK G LOT 12
Owner: ELMORE TRUST
Contractor: OWNER/BLDR Architect:
Address: 810 KINGS RD
Address: GALLAGHER SHAUN Address:
NEWPORT BEACH CA 92660
Phone:
Phone:
Phone:
State Lic:
Applicant: RICHART JASON
Con State Lic: O/B
Engineer:
HADIDI-TAMJED HASSAN
Address: 1041 W 18TH ST, STE A106
Lic Expire:
Address:
35 GOLF RIDGE DR
COSTA MESA CA 92627
Bus Lic:
DOVE CANYON CA 92679
Phone: 949422-9191
Lic Exp Date:
Phone:
949-632.6047 State Li¢C-049136
Code Edit : - 2013
Worker's Compensation Insurance.
Designer:
RICHART JASON
Type of Construction: V -B
Carrier:
Address:
1041 W 18TH ST, STE Al 06
Occupancy Group: R3/U
Policy No:
COSTA MESA CA 92627
Added /New sq.ft. Bldg: 75
Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 3
Building Setbacks Rear: I
Special Conditions: O/B FORM ATT
No of Units : 1
Front: /
INSPECTOR
Bldg Height: 0
Left: I
Bldg Sprinklers:
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 : $168.00
Plan check Fee :
$0.00 Fire Inspection:. $0.00
Overtime Plan Ck: $0.00
Grading Bonds Fee: $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: $0.00
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
WO Insp. Fee: $0.00
Park Dedication : $0.00
Refund Deposit $0.00
Disabled Access : $0.00
PAN 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 : $168.00
Plan Check Fee:
$0.00 Fee
Due at Permit Issuance : $168.00
Op >SC O flP 60
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PROCESSED BY: 'Cf-
` ,`, ` `
PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
ne occ s o �.. cc o00
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 ite{n(s)
lection 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
1e 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
of more than five hundred dollars ($500). le
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,
',usiness 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
nprovements 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
n 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
5ply 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:
,y 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 legalli
ell a structure that I have built as an owner -builder if it h A been s r in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Tofessions Code, is available upon request when is I tion i submy or at the following Web site:http://www.laginfo.ca.gov/calaw.html.
ignature of Property Owner or Authorized Agent A "ter!
.ICENSED CONTRACTOR'S DECLARATIO�P�~
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
nd effect. License Class License No Date - Contractor Signature
COMPENSATION DECLARATION
'ARNING: 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 ($100,000), IN ADDITION TO THE
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
1 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
erformance of the work for which this permit is issued. Policy No.
]I 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' compensatioi
Isurance carrier and policy number are:
arrier Policy Number Expiration Date
,, e of Agent Phone #
I ertify that, in the performance o he w0r F is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compe sation laws of California, and agre
,at if I should become subje w rke ' coion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
ature of Applicant Da
�ECL.ARATION REGARDING CONSTRUCTION DING A ENCY
hereby affirm under penalty of perjury that there 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
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 or, inan es law relating to building construction. �I.aw C,q talk
ai e��
I authorize representatives of this city or county came e t ove-Iden ' ied property for inspection purposes. J7.//� VV1l 1. Dale VL
ionature of PrODertv Owner or Authorized ADent J Print Property Owners or Authorized Agent's Name/ `� _
ACTION
PERMIT EXPIRED
PERMITCANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
DATE BY •� �' DECLARATION OP"CpMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONSP 61 OF TITLE 40ANDAQMD RULE
1403
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