HomeMy WebLinkAboutX2020-1904 - Permitsw1'a City of Newport Beach - Building Division
�^ °k 100 Civic Center Drive, Newport Beach, CA 92§60 '
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
`fir nix`b Combination Type - SFP
IIIIIIIIIIIII�II�IIIIIIIIIIIIIIIIIIIIIIIIIuJl
II COMB Permit: X2020-1904
Project No : 0604-2020
Issued Date: 0910112020
Inspection Area : 3
+
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST IBE COMPLETED BY 09/02/2023 OR PERMIT WILL BE INVALID
Rear: I
Front: /
Left: /
Right: I
Parking Spaces:
Address:
Phone:
Special Conditions: OWNERIBLDR ATTACHED
0 Fire Hazard Zone: N
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
Construction Valuation: $15.000.00
Job Address:
2529 VISTA BAYA NB
......
°°°°e �..
Description:'
SFR DELTA 1, CHANGE OUT (7) (E) WINDOWS, INFILL 4 WINDOWS, AND INSTALL 3 NEW WINDOWS IN NEW LOCATIONS °• ° ° m
Legal Desc.:
TR1159LOT3NWLY66FT
$0.00
�°
Fire Department
moom
Additional Fee :
Owner:
SMITH ALEXANDER 8 KATHRYN
Contractor: OWNER/BLDR Architect: OLDHAM RYAN ®•®
°o °
° ° °
Address:
2529 VISTA BAYA
Address: SMITH KATHRYN Address: 2651 E. CHAPMAN AVE #110 • ° e e
Fair Share : $0.00
Fire Plan Rev
NEWPORT BEACH, CA 92660
FULLERTON, CA 92831 ......
• • o °
Phone:
SJH Trans: $0.00
eee•°
Phone: Phone: 714-482-8296 State Lic:CO29715
°
//////•+�••+����� ° ° °
Record Management: $2.00
Grading Permit Fee:
°
eaoeoe
os000
Applicant:
PACIFIC WEST CO
Con State Lic: O/B Engineer:
Grading PC Fee:
Address:
3672 PROVINCETOWN AVE
Lic Expire: Address: •
$0.00
CA Seismic Safety: $0.00
IRVINE CA 92606
Bus Lic:
�e ®, o
Phone:
714-396-0088
Lic Exp Date: Phone: State Lic: m • ° ® °
PAN Plan Check: $0.00
Grading Bond:
mmoco
Code Edit
2019
Worker's Compensation Insurance Designer: pp°°e
meo o°
Type of Construction: V -B
Occupancy Group: R311)
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 1
No of Units : 1
Bldg Height: 0
Bldg Sprinklers:
Flood Zone: X
Carrier:
Policy No:
Expire:
Building Setbacks
Use Zone:
Rear: I
Front: /
Left: /
Right: I
Parking Spaces:
Address:
Phone:
Special Conditions: OWNERIBLDR ATTACHED
0 Fire Hazard Zone: N
Construction Valuation: $15.000.00
"
Building Permit Fee: $331.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $287.97
Additional Fee :
$0.00
Plan check Fee : $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: $2.00
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
PAN 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 : $621.97
Plan Check Fee
: $0.00 Fee Due at Permit Issuance :
$621.97
PROCESSED BY:
PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
���
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
15rdO%
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
ie 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 ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided t$at the
nprovements area o untended 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 B Jilt or
roved for the purposQof sale).
a5 Owner of s.hle opp
roperty, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
pply to an owner of pro$erty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
..
I,arf exempt fro.; licensure under the Contractors' State License Law for the following reason:
y myaignature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legalh
eY a structure tD&9919ve built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
aof�ggiEns Code! i' Enable upon request whe apgli ti 'a submitted oyyt the follow n b site:http://www.leginfo.ca.gov/calaw.html.01
Cj
94 �Iu of Property Oyvner or Authorized Agent 4 7/A/t,/� L Lr",� Date [ — !
'CSED COi1T1Yl(CTOR'S DECLARATI v
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
n- !t
LicerJse Gess License No Date Contractor Signature
VORKtRS' CQpIPP�NSATION DECLARATION
'ARNING. FAILURE J(]$ CURE WORKERS' COMPENSATION COVERAGE le UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
MaPOF COMPENBAl16t DAMAGES AS PROVIDED FOR IN SECTION X706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm unde9 tenalty 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
erformance of the work for which this permit is issued. Policy No.
❑I 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' compensatiol
Insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
❑I 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 agre
that, if I should becom��sl//�lact t rkers' compen ion visions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. J /
Signature of Applicant A (. � Date
DECLARATION REGA DI CONSTR CTIO ENDING AGENCY
I hereby 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, ivil 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 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 count enter the above -identified property for inspection purposes. / /! G
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name KA7TA n /111 T>< Date ` �!
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY _
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
PERMIT EMENDED
ITFINAL
CERUEICATE OF `�I -' 1 AQR ON O IIR DEN 0 %O NOT YAnETO
AC
OCCUPANCY ISSUED ',"a1Af�'
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