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Home My WebLink AboutX2019-3640 - PermitsY,N!IYx�, City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 rA rE �ti* Combination Type - BLDG COMB Permit: X2019-3640 IIIIIIIIII�lilllll�lllllll�llllllllllllll II Project No : 2687-2018 Issued Date : 1111312019 Inspection Area : 5 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: 4500 ROXBURY RD NB Description: RETAINING WALL 303 LF Legal Desc.: N TR 3357 LOT 11 Owner: ROWSHAN KASRA Contractor: GABAY DAVID JOHN JR Architect: TEALE MARK Address: 4500 ROXBURY RD Address: 31726 RANCHO VIEJO RD Address: 2900 BRISTOL ST BLDG A203 CORONA DEL MAR, CA 92625 SAN JUAN CAP CA 92675 COSTA MESA CA 92626 Phone: Phone: 949370-0478 Phone: 949-975-0123 State Lic:CO22162 Applicant: GABAY DAVID JOHN JR Con State Lic: 529750 Engineer: PATEL SHARAD Address: 31726 RANCHO VIEJO RD Lie Expire: 06130/2020 Address: 9283 RESEARCH DR SAN JUAN CAP CA 92675 Bus Lie: BT30033857 IRVINE CA 92618 Phone: 949-370-0478 Lie Exp Date: 12131/2019 Phone: 949-943.8080 State Lic:S-004488 Code Edit: 2016 Worker's Compensation Insurance Designer: Type of Construction: Carrier: CALIFORNIA INSURANCE Address: Occupancy Group: U Policy No: 468264410 Added /New sq.ft. Bldg: 0 Expire: 04/01/2020 Phone: Added /New sq. ft. Garage: 0 -I No of Stories: 0 Building Setbacks Rear: Special Conditions: No of Units : 0 Front: 1 tC Bldg Height: 0 Left: I Bldg Sprinklers: Right: I Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone: N Construction Valuation: $90,000.00 Building Permit Fee: $412.00 Excise Tax: $0.00 - Planning Department - i y Fire Department Plan Check Fee: $365.00 Additional Fee : $0.00 Plan check Fee : $40.00 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: $0.00 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: $4.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $821.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $821.00 PROCESSED BY: ZONING APPROVAL: '"1-111 GRADING APPROVAL: si a" a Pl3BQiDWORKS APPROVAL: _ 0 0 � o00 ,PLAN CHECK.BY: o .+ � • � Quo c. a APPROVAL TO ISSUE: a 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 1e 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 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 U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, ',usiness 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 nprovements 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 nproved 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 pply 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). 7 1 am exempt from licensure under the Contractors' State License Law for the following reason: ly my signature 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 legal ell a structure that I have 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 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/mlaw.html. signature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 0) of ivis' n 3 of the Business and Pr as ions ode, and my li ense is in full force nd effect. License Class License No Dat ( Contractor Signature IIORKERS' COMPENSATION DECLARATION LIT DARNING: 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), DDITION TO THI DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty 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 rmance of the work for which this permit is issued. Policy No. Eve 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' compensatioi ance carrier and policy number are: Tier Policy Number Expiration Date ne of Agent Phone # certify that, in the performance of the work for which is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compen tion laws of California, and agre t, if I should bec ) t to the rkers' compens ion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. T nature of Applican Da �J [ CLARATION REGAR IN CONSTRUCTION LENDI GENCY weby affirm under penalty o perjury that there is a constru lending agency for the performance of the work for which this permit is issued (Section 3097, Ivil C de). Ider'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 the property owners behalf. I have read this application and the information I have 'ded is correct. I agree to comply with all applicable city and c my grdinance d stat aws re ting to building construction. I authorize representatives of this city or count t enter t above-ide $rep auns>_ion purposes. nature of Property Owner or Authorized Agent/ Print Property Owner's or Authorized Agent's Name) Date 1 f [ TION DATE BY ft4LARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART61OFTITLE 40ANDAQI RULE PERMITEXPIRED I I I U I SUBMITTED ASBESTOS PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCYISSUED TO V e 0 ° ee 0 o