HomeMy WebLinkAboutX2019-3389 - Permitsr ; City of Newport Beach - Building Division 100 Civic Center Drive Newport Beach, CA 92660 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIII COMB Permit: X2019-3389
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Permit Counter Phone (949)644-3288 Project No :.
Inspection Requests Phone'(949)644-3255 -
' Combination Type- SFP Issued Date: 10124/2019
Inspection Area : 1
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION:.
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: 3609 W BALBOA BLV Y
D NB
Description: SFR WINDOW CHANGE OUT (8) *LIKE FOR LIKE -
Legal Desc.: 'N TR 15935 LOT 69 i�' NOISE
Owner: OSADCHE SAMUEL Contractor: OWNER/BLDR Architect:. NO CONSTRUCTION NOISE
Address: 3609 W BALBOA BLVD .- SAMUEL:OSADCHE . NEWPORT BEACH, CA 92660[ddress:Phone. 949-630-6290 : l�one: 4,State LieApplicant' OSADCHE SAMUEL -- En� 'F?iCu�bleon State Li O/B _ giPeer. YtL,�J �p 1 r�
Address 3609WBALBOA BLVD .Lie Expire: d ON Y17E I=EKEND I
NEWPORT BEACH, CA 92660 Bus Lie'r ,�i �;;v"�^a a4y, gbs6lo or 100% "vfund
Phone: 948-630-6290 Lie Exp Date"'". °`" S ;�. Phone:
y�� a , `mra State Lie:
Code Edit : 2016 Worker's=Compensation Ins�u{a.'c�^we - " b. ?r F,.• .. ��($�>���`j:
OccTypupancy
Construction: R3/V-B Carrier Address: ���®`
Occupancy Group: R3/U Policy No:YA,��
Added /New sq ft.Bldg. 0 Expire ,t'-�° �- r* D
No of SoAdded nSsq. ft. Garage20� Y � PhoneNo of Umts 1 413, ildmg Setbacks i�tF>'a'r -) , , ; S ecial Conditions LIQUEFACTION
It ;.. �' .&" NAY2Front p OIB ATTACHED
Bldg Height: 0 Left: / ACKNOWLEDGMENT RECIEVED
Bldg Sprinklers �� Right I
.Flood Zone: Use Zone: Parking Space 0 Fire Hazard Zone : N'
Construction Valuation. $2,400.00
Building Permit Fee: $120 00 "� 'll'� an pi& - & y °
Plan Check Fee: $0.00 s Exc se x'r 0 Plan a paYtrr nt �,..n' `c"ti�'o,sl M9 � .�,� , "Meb, ment
(� Additl 1 .� $0.00 Plan check Fe $0.00 Fire Inspection:
Overtime Plan Ck: $0.00 Grad}ri F'E ) 'd% � $0.00 Fair Share . �i'•io work ,ssitil)r"d''bed) Fire Plan Rev �.. $000
0.00 Investigation Fee: $0.00 ,t Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee
Record Management $0.00 € g• Grading Permit Fee: $0.00 In lieu HousingFee : 0
Energy Compliance: '$0.00 ' � `�--erading4l...__.$0.an p nr $0.00 Building Dept $0.00
17L4Lka-Department - General Service $0.00 CA Seismic Safety. $0.00 2 WQ Insp Fee >$0.00 Park Dedication : $0.00 Ref eposit $0.00 Disabled Access : $0.00 PNV Plan Check : ` G ond: $0.00
Hazardous Mat $0.00 ctr cal% $09 c'c0 e3h8'i
L.,..,,-�:,,._.,E,��, $0.00 San Dist - -$0 00 ---
8 .- i
Building Green Fee : $1.00 Mechanical.. "''"' ' $g' }' ° "�'°°'^^N= Fff.-I �d8z,g„ u ,� _.,� $0.00
Plumbing %: $0.09 $O.AO
TOTAL FEE : $121.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $121.00
PROCESSED BY: PUBLIC WORKS APPROVAL:
ZONING APPROVAL: PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE: 1.
OWNER BUILDER DECLARATION
,1 hereby affirm under penalty of perjury that I am exempt from the Contractors'. State License Law for the , improve, demobs below repair
the checcture, prior
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
he 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
3rofessions 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
iot 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 (_) portions of the work, 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
mprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion,, the Owner -Builder esEh an ofproving that it was not built or
mm ved for the purpose of sale). i
It)/j I, as owner of the property, am exclusively contracting with licensed Contractors action ra?t Business and Professions Code: The Co ractots' State License Law does not
'appiq to an owner of property who builds or Improves ther he-a9Rf or the projects with a licensed Contr` tour pnurn)yffpJdt�,F�g Contractors' State.Licens Law)',
❑ 1 am exempt from Iicensure d - - rectors' Stat a se—L, o to wing reason: 1ltt�,ct' an covered b this permit, I cannot legall
By. my signature below I acknow dge that, except for my pers n I r de in Ic I e-resid�dTo"r at least one year prior to cpwplatjo�-p��l�ierpa�able law, action 70 4 of the Business and
e In its entiret b licensed contractors. n r nnII d({��t o-bbFF{{ ppiT'
sell a structure that I have built a an o�a er,.btfijder if it Y Y l �-.g
Professions Code, is available un rega�'§��ulfeo lic ub ed or at the foil _,' h a/www.l n o.ca.gov/calaw htmL Date io2(2L"t9
Signature of Property Owner or A thorized Agent
LICENSED CONTRACTOR'S DEC
I hereby affirm under penalty of p 'ury at I am nsed der pro p� f ty ( ci it LF'000)'6f Division 3 of the Business and Professions ! ode; sand my license is in full force
and effect. License Class is a i"
Date Contractor Signature.
WORKERS'COMPENSATIO DE .f#.
WARNING: FAILURE TO SECURE WORKE 'COMP SATION COVERAGE IS UNLAWFUL, ANPcornlp
A R E 5 ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA D DOLLARS ($100,000I,IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS OVIOED FOR IN SECTION 0 BO �+
I hereby affirm under penalty of pert ry o wing c aratio ❑. I have and will maintain a cert 'cote f o to s Insure f s - n, uhe Director of Industrial Relations as providedfor by Sec on 37p0 of the Labor Code, for th
performance of the work for which t s pe it i !as Po
I have and will maintain workers' omp 'goon insurance as required by Section 3700 of the Labof Code for the �ertor cue of h or rang h permit i issu�Lt. My workers compensatio insurance carrier and policy number re:
Carrier Policy Number pRa Ion ate ,
Name of Agent
'
I certify that, in the perf mance of e w hiclhf is miltis issue _III {hall not employ any person in any m hn�r so as to become subject to the workers' c mpe ioll ews of California, and agre
that, if I should become s rkers compenset'VVvv r Is q' �,wAgn 3700 of the Labor Code, I shall forthwith comply with those provisions. its a
l Da
Signature of Applican
DECLARATION REG ING CONS UCTION LENDING AGENCY '�- t`l
I hereby affirm under enalty of perjury hit t�g[a.ls a construction I encyf6r"t a performance of the work for which this _pI►"0�+pis�lc� (adflon 30 CI i ode
Lender's Name IVY & Lender's Address
Bylmy signature below, I certify to each f the following: ----` -
I am the property owner or authoriz do a tc s-pre wner's behalf.
! I have read this application and the Iformat' • romil re I.
I agree to comply with all applicable y and co ty ' a es a d state laws relating to building construction.:.
I authorize representatives of this city or coun r abov -i ntified property for inspection purposes.:
Signature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Name
ACTION DATE DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE. USE ONLY
r REGULATIONS. PART 61 OFTITLE 40 ANDAQMD RULE
14 14
PERMIT EXPIRES I SUBMITTED ASBESTOS NOTIFICATION TO
PEHMITC4NCELLED EPA
PERMITEXTENDED QMD
PERMITFINAL SRESTOS NO ION APPLICABLE TO
CERTIFICATE OF 0 ED DE
OCCUPANCY ISSUED SIGNATURE:
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