HomeMy WebLinkAboutX2019-0799 - Permitsrf' City of Newpprt,t3egph-.Bllildbgg Division
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COMB Permit :X2019-0799
`Newpoft
4 100 Civic Center Diive Bench, 6P.920'60m
X 2 0 1 9 0 7 9 9
Project NO :
F + Permit Counter Phone W49)684%3288 : : m m
Inspection RequmfsrPhdhe (949)644132556 O 00
'r'wryu:a Combination Type -BLDG -
Issued Date :.03115/2019
' e o
Inspection Area : 8
. PEI@MITS gXP1RE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.:
Construction'Fhurs: IY%nr�ag =Friday 7f00 a.m, to 6:30 p.m. and
Saturday from 8.00 a.m, to 8:00 p.m. No work on Sundays or Holidays
Job. Address:- 44 PELICAN CT NB
Description:: SFR. WROUGHT -IRON ATOP (E) BLOCK WALL 67" MAX(AS-BUILT) '119 -0040 -
Legal Desc : N TR 12212 LOT 38
Owner GERY PHYLLIS GAVAZZA Contractor: '. OWNER/BLDR
Architect:
:Address: 44 PELICAN CT ,.Address :GERY PHILLIS G Address:
NEWPORT BEACH, CA 92660
Phone: .Phone:
Phone:
State Lie:
_
Applicant: GERY PHYLLIS GAVAZZACon State Lie:. O/B
Engineer.
.Address: 44 PELICAN CT tic Expire:
Address:
NEWPORT BEACH, CA 92660 Bus Lie'
Phone: Lie Exp Date -
Phone:. `
State Lie:
Code Edit 2016 Worker's Compensation Insurance
Designer:
Type. of Construction V -B Carrier:
Address:
,
Occupancy Group: U Policy No:
Added /New sq.ft::Bldg: 0 Expire:
Phone:
Added /New sq-. ft. Garage 0
`�,,., V�
No of Stories: 0. " Building: Setbacks Rear: /'
Special Conditions: 119-0040'
No of Units : 0 Front: I
.\..... '-
Bldg Height. 0 -. Left:
- Bldg. Sprinklers: Right
Flood Zone: Use Zone: Parking Spaces:
0 ..Fire Hazard Zone : N
Construction Valuation: $500.00.
,.
Building Permit Fee: $104.00 Excise Tax $0.00
Planning Department -
Fire Department
Plan Check Fee: $0.00 Additional Fees;- $0.00
` Plan check Feer $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 ` WQ Insp. Fee: '. $0.00
:. Park Dedication : $0.00
Refund Deposit -
$0.00
'. Disabled Access . $0.00
P/W Plan Check: $0.00.
Grading Bond:
$0.00
Hazardous Mat , $0.00 -Electrical %: -: $0.00
San Dist: .$0.00
Building. Green Fee: $1.00 Mechanical °/ a: -:$0.00
NMUSD: Fee: $0.00:
$0.00
Plumbing %: $0.00
-
.$0.00
TOTAL FEE : $105.00 Plan Check Fee :
$0.00 Fee Due at Permit Issuance : $105.00
PROCESSED BY: QA
PUBLIC WORKS. APPROVAL: -
-
ZONING APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
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 6y Die dhDclontk47I ha.ve placgd next to the applicable item(s)
ction 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or reftr�anyisiruatum, 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 wish Sec'tion*MO) of Division 3 of the Business and
fessions 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).***
$500).. . * * * . 0 * 0
I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, andfhe ft?ucjure V not DAer(Iiea pr olerld for sale (Section 7044,
liness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employeeC Lr pertlonal effort buds or improves the property, provided that the
rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the OwnerBuilder wilt have the burden %droving that it was not built or
roved for the purpose of sale).
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
I o an owner of property who builds it improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the-Contractors'-State License Law).` -- - --- -
�I a 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 legally
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
fessions Code, is available upon request when this application is submitted or at the following Web site:http://v w .leginfo.ca.gov/calaw.htmi. , J, /
nature of Property Owner or Authorized Agent D,
:ENSED CONTRACTOR'S DECLARAT114
�reby affirm under penalty of perjury that I am licensed under provisions of Cii 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
effect. License Class License No Date Contractor Signature
)RKERS' COMPENSATION DECLARATION
:NTNG: 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
T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
reby 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
'ormance of the work for which this permit is issued. Policy No.
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'
Nance carrier and policy number are:
Policy Number
of Agent
Date
Eertify that, in the performance 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 agm
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
ature of Applicant j�
;LARATION REGAY��ING CONSTRUCTION LENDING AGENC
eby 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 Coda).
ier's Name Lender's Address
iy 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 r the Spove-identified property for inspection purposes.
sture of Prooertv Owner or Authorized ADentV _ S"%-'� Print Property Owner's or Authorized Agent's Name
G� �% Date
DATE
BYV N
DECLARATION OF COMP}IjANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
EXPIRED
U I SUBMITTED ASBESTOS NOTIFICATION TO
CANCELLED
DEPA
EXTENDED
0AQMD
FINALyqq
ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO
ATEOF
j�-{'I'�`
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PROPOSED DEMOLITION
NCY ISSUED
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