HomeMy WebLinkAboutX2020-0122 - Permits4ry Io�z City of Newport Beach - Building Division IIIIIIIIIIIIIIIII'llllllllllllllllllllll II COMB Permit: X2020-0122
t4 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 0 0 1 2 2 Project No: 0098-2020
Permit Counter Phone (949)644-3288
s :fir Inspection Requests Phone (949)644-3255
v'rtr>:tia�"' Combination Type - BLDG Issued Date :
Inspection Arearea :2020
8
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: 4 MAIDSTONE DR NB
Description: SFR POOLISPA DEMO 475 SF "METHOD
A"
Legal Desc.: N TR 15390 LOT 16
Owner: GUPTA PRACHI
Contractor:
BURNS COMPANY THE Architect:
Address: 4 MAIDSTONE DR
Address:
630 S EL CAMINO REAL STE B6 Address:
NEWPORT BEACH, CA 92660
SAN CLEMENTE CA 92673
• ° °
Phone:
Phone:
949.388.5928
Phone:
State Lic:
°
Applicant: ELLISON PAUL
Con State Lic:
605145
Engineer:°pOO•
�o��,,.;
Address: 74642 VIA RAZA
Lic Expire:
01131/2021
Address:
66Q���... g� •
s
,,
LAKE FOREST, CA 92630
Bus Lic:
BT30047416
°
Phone: 949.663.9861
Lic Exp Date:
0513112020
Phone:
State Lic:
•
Code Edit: 2019
Worker's Compensation Insurance
Designer:
Type of Construction:
Carrier:
NAT'L LIABILITY & FIRE INS CO Address:
Occupancy Group: U
Policy No:
V9WC089367
Added /New sq.ft. Bldg: 0
Expire:
05107/2020
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 0
Building Setbacks
Rear: /
Special Conditions:
°
No of Units: 0
Front: /
°
•Op
Bldg Height: 0
Left: /
° °
• ° ° °
Bldg Sprinklers:
Right: /
Flood Zone:
Use Zone: Parking Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $6.000.00
Building Permit Fee: $168.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $146.16
Additional Fee :
$0.00
Plan check Fee : $40.00
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: $4.00
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
PNJ 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 : $359.16
Plan Check Fee :
$0.00 Fee Due at Permit Issuance :
$359.16
PROCESSED BY:
Z)
PUBLIC WORKS APPROVAL:
(
PGA
PLAN CHECK BY:
lyv"
ZONING APPROVAL:
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 by the checkmark(s) I have placed next to the applicable item(s)
(Section 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
the 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
not more than five hundred dollars ($500).
❑ 1, 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, and the structure is not intended or offered for sale (Section 7044,
Business 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
improvements 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
improved 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
apply 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:
By 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
sell a st LOLte 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
ProfesSiggss Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm].
Signaturg of Property Owner or Authorized Agent Date
LICEN6eDCbNTRACTOR'S DECLARATION %
thereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 O) of IVIS' j� 3 of the Business and Prof si n , an y ' Bfise is in full force
and effect. Licepse Class License No Date 1W Contractor Signature
WORKEI&VCOMPENSATION DECLARATION
%DARNING: FAILUff� TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN L PENALTIES AND CIVIL FINES UP TO ONE HUNG EO THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
ODST OF COMPErZSAT10N, DAMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
'Phejeby affiraltinder penalty of perjury one of the following declarations:
Ihav and wigmaintam 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
Far c4ofthe fork for which this permit is issued. Policy No.
and yvjll•mainta" 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
kr c carIner yropolIcy
number are:
Irler Policy Number Expiration Date
ne of Agent Phone #
certify that, in the pe r eV
ich 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 agre,
I, if I should become bj ct ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.nature of Applicant Dat/ivil
CLARATION REGAR NDING AGENCY
:reby affirm under pe alt of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097,de).
Ider's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the V If.
I have read this application and the information I h ve r `
I agree to comply with all applicable city and coun y rdiI lating to building construction. I authorize representatives of this city or count property for inspection purposes.
nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name (.� , D e
TION DATE BY DECLARATION OF COMPTANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGUL. LIONS PART 61 OF TITLE 40 AND AOMD RULE
PERMITEXPIRED I I I'L_I I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYISSUED
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