HomeMy WebLinkAboutX2021-0560 - PermitsCity of Newport Beach - Building Division *X2021-0560* COMB Permit: X2021-0560
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` 100 Civic Center Drive, Newport Beach, CA 92660
'- Permit Counter Phone (949)644-3288 X 2- _ 11 /_ C) Project No
Inspection Requests Phone (949)644-3255 '� Combination T e GRAD Issued Date : 03/0912021
YP -
1% c.armovgvit G'e r Inspection Area : 3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 03/09/2024 OR PERMIT WILL BE INVALID
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: 18 CORMORANT CIR NB
Description: SFR YARD DRAINAGE "CITY STANDARD" pp
Legal Desc.: N TR 12529 LOT 8 i N Eu
T
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Owner:
VOSS MELANIE& MICHAEL
Contractor:
OWNER/BLDR
Architect:
Address:
18 CORMORANT CIR
Address:
SIMONIAN PAT
Address:
NEWPORT BEACH, CA 92660
Building Permit Fee:
$0.00
Excise Tax:
Phone:
Planning Department -
Phone:
Plan Check Fee: $0.00
Phone: State Lic:
Applicant:
SIMONIAN PAT
Con State Lic:
O/B
Engineer:
Address:
18 CORMORANT
Lic Expire:
Fair Share:
Address:
Investigation Fee:
NEWPORT BEACH CA 92660
Bus Lic:
$0.00
SJH Trans :
Phone:
949-721-8585
Lic Exp Date:
Grading Permit Fee:
Phone: State Lic:
Code Edit : 2019
Type of Construction:
Occupancy Group: U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 0
No of Units: 0
Bldg Height: 0
Bldg Sprinklers:
Worker's Compensation Insurance
Carrier:
Policy No:
Expire:
Building Setbacks Rear: /
Front: /
Left: I
Right: I
Designer:
Address:
Phone:
Special Conditions: CIS FORM ATTACHED TO
X2020-2179
ood Zone:
Fire Department
Use Zone:
Parking Spaces:
0
Fire H,
Construction Valuation:
$0.00
$0.00
Building Dept Adm
General Service
Building Permit Fee:
$0.00
Excise Tax:
$0.00
Planning Department -
Plan Check Fee: $0.00
Additional Fee :
$0.00
Plan check Fee
Overtime Plan Ck:
$0.00
Grading Bonds Fee:
$0.00
Fair Share:
Investigation Fee:
$0.00
Grading PC Consultant:
$0.00
SJH Trans :
Record Management:
$2.00
Grading Permit Fee:
$232.00
In -lieu Housing Fee:
Energy Compliance:
$0.00
Grading PC Fee: ',
$195.00
Public Works Department -
CA Seismic Safety:
$0.00
WQ Insp. Fee:
$0.00
Park Dedication :
$0.00
Disabled Access :
$0.00
PAN Plan Check:
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
San Dist:
$0.00
Building Green Fee :
$0.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
Plumbing %:
$0.00
TOTAL FEE: $429.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Plan Check Fee:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 Fee Due at Permit Issuance : $429.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 Fee Due at Permit Issuance : $429.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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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) 1 have placed next to the applicable items)
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 applicant for
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
fessions 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
gasan five hundred dollars ($500).
as owthner 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,
.mess 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
Irovements 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).
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
fly 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).
I am exempt from licensure under the Contractors' State License Law for the following reason:
my signature below I acknowledge that, except far m e one[ residence in which must have resided for at least one year p for to completion of the improvements co ered by this permit, I cannot legal)
a structuretYat I have built as an owner -build I it as t been constructed in it ntirety by licensed contractors. I unders nd that a copy of the applicable law, Se tion 7044 of the Business and
ifessions•Cr gpis available upon requ at e t 1 a I al
is submitte r at a following Web site:http://www.leginfo. .gov/calaw.htmi.
nature of Property Owner or Authorize gent
penalty of perjury
Class
am licensed under provisions of Chapter 9 (commencing with
License No
CoIje, andlq.I'y license is in full force
)j1KERS16U MPENSATION DECLARATION _./
2NIRG: 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 (E100,000), IN ADDITION TO THE
YOF COMP ENGATIOFT DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
R#qy affirm BridCf penalty of perjury one of the following declarations:
1 hive 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
fo�mance otfheaA& for which this permit is issued. Policy No.
pave and willl�maigtain 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
Jranee cain ii and-imilicy number are:
Tier Policy Number Expiration Date
TIE of nt Phone #
certify that, int perfor anc of the work for which tfs permit is issued, I shall not ploy any person in any manner so as to become subject to the work 'compensation laws of California, and agre
t, if I should be o su act the workers' com ens on provisions of Section 3700 o the Labor Code, I shall forthwith comply with those provisions.
natureof Ap 'ca ny�i /.f �� ��T /Q/2./ D e c j
CLARATIO EGARDING CONSTRUCTION LENDING AGENCY -
Ireby 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, Civil Code).
Idler'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 th M
roperty owners behalf.
I have read this application and the information av provided is corre t
I agree to comply with all applicable ci d /,6�6 ordinances and stat laws relating to building constru tion.
I authorize representatives of this city o outer ting at idle I fled property for inspection purp as. -
nature of ProDertv Owner or Authorized Aa tOwnersor Authorized A en _ at
ACTION DATE Y\ DECLARATION OF I( REGULATIONS PARTO61 OFTNCE WITH CODE OF TLE 40AN AQMD RULE AL I FOR OFFICE USE ONLY
1403
PERMIT EXPIRED
U I SUBMITTED ASBESTOS. NOTIFICATION TO
PERMITCANCELLED
LIEPA
PERMIT EXTENDED
LIAQMD
PERMITF/NAL
ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATEOFI
PROPOSED DEMOLITION
OCCUPANCYISSUED
,/✓'/'A_/U
SIGNATURE: -