HomeMy WebLinkAboutX2010-1461 - PermitsCity of Newport Beach Building Department COMB Permit No: X2010-1461
L°. PROJECT NUMBER: 1141.2010
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
K":I CJI..Y4.4k4.
Combination Type - SFP/ ELEC/ MECH/ PLUM/
Job Address: 1551 ORCHARD DR NB
Description:RES/REMODEL BATHROOM, CLOSET, GARAGE DOOR, FIREPLACE FACADES
Inspector Area: 3
Legal Desc.: -
Owner: BERTHIAUME DOREEN
(,ijjoP-
Contractor: OWNER/BLDR Architect: 0
Address: 1551 ORCHARD DR
Address:
Address:
NEWPORT BEACH CA 92660
Phone: 949.633-4585
Phone:
Phone: State Lic:
Applicant: BERTHIAUME DEE
Con State Lic: O/B
Engineer:
Address: PO BOX 7442
Lic Expire:
Address:
NEWPORT BEACH CA 92658
Bus Lic:
Phone: 310-782.4788
Lic Exp Date:
Phone: State Lic:
Code Edit : 2007
Worker's Compensation Insurance
Designer: BERTHIAUME DEE
Type of Construction: V - B
Carrier:
Address: PO BOX 7442
Occupancy Group: R3/ U
Policy No:
NEWPORT BEACH CA 92658
Added /New sq.ft. Bldg: 0
Expire:
Phone: 310-782-4788
Added /New sq. ft. Garage: 0
No of Stories: 1
Building Setbacks Rear: /
Special Conditions: O/B AUTH ATTACHED
No of Units : 1
Front: I
Bldg Height: 0
I Left: I
Bldg Sprinklers: N
Right: /
Flood Zone:
Use Zone:
Issued Date: 06/25/2010
Parking Spaces: 0
Fire Hazard Zone : N
Construction Valuation: $9.000.00
Building Permit Fee: $193.10
Solar System PC : $0.00
Planning Department - Fire Department
Plan Check Fee: $139.03
Excise Tax: $0.00
Plan check Fee: $60.00 Fire Inspection:
$0.00
Overtime Plan Ck: $0.00
Fair Share : $0.00 Fire Plan Rev
$0.00
Investigation Fee: $0.00
SJH Trans : $0.00 Demolition Fee
Record Management : $29.20
Grading Permit Fee: $0.00
In -lieu Housing Fee : $0.00 Building Dept Adm
$0.00
Energy Compliance: $52.00
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
P/W Plan Check : $0.00
Fee Increase: Fee: $0.00
Electrical %: $13.52
San Dist : $0.00
Additional Fee : $0.00
Mechanical %: $9.66
NMUSD Fee: $0.00
$0.00
Hazardous Mat: $0.00
Plumbing %: $19.31
$0.00
Building Green Fee: $
TOTA EE : $ 6.8
Plan Check Fee
: $199.03 Fee Due at Permit Issuance :
$317.79
PROCESSED BY: -�'�
PUBLIC WORKS APPROV
� c
ZONING APPROVAL v
`tr�
PLAN CHECK BY: 41)
GRADING APPROVAL:
'- °
APPROVAL TO ISSUE:
4
PERIS":TS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTIO .
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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
W1.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
as owner of the property, or my employRes with wages as their sole compensation, will do (--) all of or ( 1 portions of the
ork, 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).
❑ 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 apply to an owner ofproperty 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:
myy signature below I E
Ir to completion of the
of Property Owner or
must have resided for at least one year
structure that I have built as an owner -
and that a copy of the applicable law,
,irthis pplication Is submitted or at the
ate b — 1 f b
LICENSED CONTRACTOR'S DECLARATION r U `
I hereby affirm under penalty ofperjury 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 and effect.
License Class License No.
Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: 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 COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I 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 the performance of the work for which this permit is
issued.
Policy No.
❑ 1 have and will maintain workers' compensation insurance, as requiredby, Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
❑ 1 certify 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 agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm, under enalty of perjury that there is a construction lending agency for the performance of the work for
which this permit is Issued (Section 3097, 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 propert owner's behalf.
I have read this application and the infb' ati n I have pro vi is correct.
I agree to comply with all applicable city an unty ordinance a d state s relating to building construction.
I authorize representatives of this city or cou t nt /{'�,/(hr v 'f perty for insyeotion urpo es',_r4fgnature of Property Owner or Authorized Agent t�`tin , 1 % I1Ont Property Owner's or Authorized Agent's Name: O Ir-- ISL �� �
/01/2009
DATE
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL G r �f�_ (Zf L✓"`C1 h
CERTIFICATE OF
OCCUPANCY ISSUED
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
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