HomeMy WebLinkAboutX2019-3516 - PermitsV1ro, City of Newport Beach- Building Division
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COMB Permit: X2019-3516
��
� - 100 Civic. Center Drive, Newport Beach, CA 92660
X
2 0 1 9 3 5 1 6
: Project No.:
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Issued Date : 71104/2019
r Combination Type - SFP
goa`'
Inspection Area : 8
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LASTVALID 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: 20301 RIVERSIDE DR N13
Description:. SFR REMOVE/REPLACEWINDOW *LIKE FOR LIKE* AS BUILT 119-3050Leg-
-
Desc.:
1�^a,
I
Lyr.1r 1g�[^_Tg
Owner MARS MARGARET
Owner:
Contractor
` OWNER/BLDR
Architect
YV.Y.
1..,C U"R
.Address:: 20301 RIVERSIDE DR
Address:
AUTH AGENT:
Address:
NEWPORT BEACH, CA 92660
ROBERT CLARK
-
:' , AS BUILPERMIT.1.
O
Phone
Phone
Phone:
9fd .
Applicant: CLARK ROBERT
Con State Lic 0/8
Engineer:
EXPOSE ALL STRUCTURAL
Address 20992 SEQUOIA LN
Lic Expire
Address:
c f
MISSION VIEJO, CA 92551
Bus Lic:
I C
6 f_LECTRICAI.rsPt�IQMBIN."�ry
°�•��°
Phone: 949.678-0301.
Lic Exp Date:
Phone:
t °A®
r� T
CI
•e®•0°
Code Edit 2016
Worker's Compensation Insurance
Designer:
'? iANI.CAL COMPON
Type of Construction: V-B
Carrier:
Address:.
o
O ° ° •
` `'
Occupancy Group: R3/IJ
Policy No:
° °
Added /New sq.fL .Bldg:. 0
Expire'
Phone:
....
Added /New sq. k. Garage: 0
-
....
r
No of Stories: 1
Building Setbacks
Rear I
Special Conditions: OWNER/BLDR ATTACHED m
No of Units: 1
Front: I
_ o .
.: • I ° . .
Bldg Height: 0
Left I
�
Bldg Sprinklers:
Right I
�. ° :
m ° • A U
Flood Zone:
Use Zone:
Parking Spaces:
0 Fire Hazard Zone : N m ° °
• • •'T
.Construction Valuation: $400.00.
- -" -
-
Building Permit Fee: $104.00
Excise Tax:
$0.00
Planning Department-
Fire Department ...
Plan Check Fee:.. $0.00
Additional Fee:
$0.00
Plan check Fee i
$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: $104.00
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
PNV 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 %:
$0.00
NMUSD Fee: -..$0.00
$0.00-
.
Plumbing %:
$0.00
_
$0.00
TOTAL FEE: $209.00
Plan Check Fee:
$0.00 Fee Due at Permit Issuance : $209.00
PROCESSED. BY:
PUBLIC WORKS APPROVAL: -
-ZONING APPROVAL: ,
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
l
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 item(s)f'
ction 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 aWica... ,r
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
Pssions 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).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
II ss 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
�rovements 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
roved for the purpose of sale). -
1, 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 pr j cts with a licensed Contractor pursuant to the Contractors' State License Law).
I am exempt from licensure. under the Contractors' State License Law for the followi § 1e"on:
my signature below I acknowledge that, except for personal residence in which mu have resided for at least one year prior to completion of the improvements covered y this permit, I cannot legall,
a structure that I have built as an owner -builder If i as nppt been onstru din i ery`tetty by licensed contractors. I understand that a copy of the applicable law; Section 44 of the Business and
fessions Code, is available upon request when th'. 'epplic5tion is ubm' ed� r a h following Web site:http://www.leginfo.ca.gov/calaw.htmi. /�
nature of Property Owner or Authorized Agent Da
TENSED CQJJVffTOR'S DECLARATI '"'
,reby effivn under penalty of perjury that am cans# nder p ovisi ns of hapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Zode, and my license is in full force
,e,Licence Class-
ifeot License No Date Contractor Signature
IRITERS' COMPENSATION DECLARATION
THING: -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 DPCOMPENSAJIQa, JDAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
Wbgaffirm utift pe salty 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
o01
rmance of theyftk for which this permit is issued. Policy No.
se•
jipyq 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' compensatiol
Nance carrier and pGlicy number are:
vier . Policy NumbeK—Z Expiration Date
rQa.inje• oPAgent • • • ' Phone #
1 certify that, in toe �ierfor an2e� th for which th'sk per itis 1 ued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree
that, if I should become see 'e to a ers' compo atio'h p�visi s of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant �,
DECLARATION REGAR{^S1 G NS RUCTION V ND NG A ENCY
1 hereby affirm under pe al y of perjury that there is construction lending agency for the performance of the work. for which this permit is issued (Section 3 7, Civil Code).
Lender's Name' Lender's Address
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 beh If.
I have read this application and the information I ha/(e provide cor
I agree to comply with all applicable city and coun ordina"y,^� nd te, ws r Sting to 4ig construction.
I authorize representatives of this city, or county t enteF I -ided p party f it ction purposes.'. //!, /Z, /'. /_
Signature of Property Owner or Authorized Agent (((fff Print Property Owner's or Authorized Agent's Nam ('�'VrJL-/f� L. Dahl 1 l
ACTION DATE BY % DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL. FOR OFFICE USE ONLY
I R TIONS PART 61 OF TITLE 40 AND AQMD RULE
.1403
PERMITEXPIRED LJ ISUBMITTED ASBESTOS NOTIFICATION TO
EXTENDED
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