HomeMy WebLinkAboutF2019-0492 - Permitsaw» City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
k =:, Permit Counter Phone (949)644-3288
Job Address: 2322 ORCHID HILL PL NB
Inspector Area. 8
Owner: PINTER INVS CO RESIDL LP
Address:. 27452 CALLE ARROYO
SAN JUAN CAPISTRANO CA 92675
Phone:
Applicant: PIVNIH JORDAN
..Address: 15469 DORIAN ST
SYLMAR CA 91342
Phone: 818.970-1526
Code Edit: 2016
Type of Construction:. V-A
Occupancy Group: R311.1
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 2
No of Units : 0
Flood Zone: X
Bldg Sprinklers: Y
Construction Valuation- $3,500.00
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FIRE Permit: F2019-0492
Project No : 1896-2019
Inspection Requests Phone (949)844-3255
State Lie:
State Lic:
Workers Compensation Insurance
Description: SFR FIRE SPRINKLERS (25) HEADS (X2019-1850)
PIVNIN JORDAN
1896-2019
OAK RIVER INS
Legal Description:
N TR 6407 LOT 17
.Policy No:
Contractor:.
SO CAL FIRE PROTECTION
Architect:
Address:
15469 DORIAN STREET
Address:
818-970-1526
SYLMAR CA 91342
09/18/2019
Phone:
818-322-4387
Phone:
Con State Lid:
893040 -
Engineer:
Lie Expire:
11/30/2019
Address:
Bus Lia
BT30068960
Lie Exp Date:
09/30/2020
Phone:
State Lie:
State Lic:
Workers Compensation Insurance
Designer:
PIVNIN JORDAN
Carrier:
OAK RIVER INS
. Address:
15469 DORIAN ST
.Policy No:
RVWC916414
$0.00
SYLMAR CA 91342
Expire:
10/21/2019
Phone:.
818-970-1526
Issued Date:
09/18/2019
Special Conditions:
Setback- Front:
Rear
Left:
Right
Building PC Fee:
$202.00
Building Overtime PC Fee:
$0.00
Building Extention Fee :
$0.00
Building Investigation Fee :
$0.00
Fire Plan Check Fee:
$0.00
Fire Permit Fee: -
$0.00
Building Permit Fee:
$240.00
TOTAL FEE:/ / $446.00
.PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
FEES
Fire Residential Alarm PC Fee:
$0.00 Records Management:
Planning Counter Review:
$0.00
Planning Zoning PC Fee:
$0.00
Public Works PC Fee:
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Plan Check Fee :
$202.00 Fee Due at Permit Issuance
OTHER DEPARTM NT
PLAN CHECKED
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID
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$244.00
IWNER-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 itertl(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
le 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
'rofessions 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).
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
Iusiness 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
p 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).
J I am exempt from licensure under the Contractors' State License Law for the following reason:
ly 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
ell a 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
Irofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
-ICENSED CONTRACTOR'S DECLARATION
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 Professio C e, and my license is in full force
end effect.
.!cense Class License No Date 9 —1 — t Contractor Signature
VORKERS' COMPENSATION DECLARATION
FARMING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN ED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 9708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm Unelenpenalty of perjury one of the following declarations:
I have and w1l i'Mintain 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
n
f"Jnce of Jh%%orQ for which this permit is issued. Policy No.
....
se 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' compensa lo'.
arecarrier and policy number are:
. . �...: Policy Number Expiration Date
ne of Agent
cefkity that. Tntfig 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 agre
t` 91 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those p ions/.�'�/� Q S{
I ... D'�jt l
nature of Apeeltcan /@
CLAFfATIOId1��G�*af
STRUCTION LENDING AGENCYIT&J affirm uryfpr rjury that there is a construction landing agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Itl@I•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 property owner's behalf.
1 have read this application and the information I have provided is correct.
I agree to comply with all applicable city and count rdinances and state laws relating to building construction.
I authorize representatives of this city or county a art b -identified property for inspection purposes.
nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam �o Rn a�'Da
AC770N DATE BY UECLARATIONOFCOMPLtAIVCEMTHCODEOF FOR OFFICE USEONtYI
FEDERAL REGULATIONS PART 61 OF TfTLE40AND
PERMITEXPfRED AQMDRULE14Q3.
1 SUBMfTFED ASBESTOS NOTIFICATION TO:
PERMITCANCELtED 0 EPA
PERMITEXTENOEO AQMD
❑ ASBESTOS NOTTiiCATiONtS NOT APPLICABLE TO
PERMIT FINAL PROPOSEODEMOLITION.
CERTIFICATEOF SfGNATURE.
OCCUPANCYISSUED
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