HomeMy WebLinkAboutPV2021-024 - Permit Applicationprint Form Worksheet for Combo Building & sour rermrL r+NNrr
City of Newport Beach - Building Division
(— Comm'I r. Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading [Drainage rElec [Mech FPlum CuvdCut I CuYdFill I
N/A Floor Suite No
Project Address (Not mailing address) F F_
Flood Fire Liq Landslide
210 La Jolla Dr
Drrta.1
ion of Work Use r� Const Type
# Stories #Units (if Res)
o u es, OUN e
Valuation $ F25'OOO
New/Add SF 708
RemodelSF— Garage/New/Add — Material/Labor
OWNER'S NAME Last IBahadorani First lJonn
Owner's Address Owner's E-mail Address
210 La Jolla Dr john.bahadorani@gmail.com
State CA Zip 92663 Telephone 713-806-2784
city Newport Beach
APPLICANT'S NAME Last IStablein
First lbam
Applicant's E-mail Address
Applicant's Address
2102 Alton Pkwy Suite B
State CA
sstableln@tesla.com
Zip 92606 Telephone 714-496-0688
City Irvine
-----'
ARCHITECT/DESIGNER'S NAME
Last
First
Lic. No.—Y--
Architect/Designer's E-mail Address
Architect/Designer's Address
_...
_.
State
Zip
r---.-_.--.__ Telephoner--.._..---.---
City
_.. _
ENGINEER'S NAME Last
First
r-._._-_-_._-_- Lic.No.r_--..__._.
I
Engineer's E-mail Address
Engineer's Address
State F_
Zip
r..-_.._..__._— Telephoner--.—._--.—_.-_-
city
Lic. No. 888104 Class C46
CONTRACTOR'S NAME/COMPANY
Sam StableinlTesla
Contractor's E-mail Address
Contractor's Address
2102 Alton Pkwy
State CA
Zip
sstablein@tesla.com
92606 Telephone 714-496-0688
city Irvine
ACKS REAR
SETBACKS FRONT
PERMIT NO.
`KS LEFT
SETBACKS RIGHT
PLAN CHECK NO. /
FEES $
-
DEVELOPMENT NO
PLAN CHECK