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City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit
Counter Phone (949)644-3288
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Inspection Requests Phone (949)644-3255
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Combination Type - SFP
*X2017-0727*
COMB Permit: X2017-0727
Project No :
Issued Date : 03/06/2017
Inspection Area : 3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Job Address: 369 SANTA ISABEL AVE NB
Description: SFR -CHANGE OUT (1) WINDOW AND (2) DOORS "INTO EXTG" 1,
ega Desc.: TR 300 LOT 105 POR OF LOT
�...-_ 4
Owner: WORLEY ADRIENNE Contractor: K & L CONCRETE 2 rchitect . " '
Address: 369 SANTA ISABEL AVE - - EA
rm 24 ELROSE DRIVE E®NEWPORT BEACH, CA 92660 s OR NA CA 92880 9f a "` , b1e•Phone: 949-5003103 e - 41'0'---- Phone. Or { iv-Sfate�lic:
le"
Applicant: K & L CONCRETE PUMPING AND PUMP RE IR Con State Lic 013�„ ^s�-s.;•, El ngmeer: ,' ° ° •,
Address: 1724 MELROSE DRIVE Lic a > 30f,$$1 Z Address' ,; • ° • °
CORONA CA 92880 - c us� iQ068294 f `�
Phone: 909-261-0410 r w� Lic xp-E3'�te 4 dtt3j01; 0 ,� to r orn ` -----P---� • ......
e^�"�.> "" one:. State ic: •.
Code Edit 2016 °° •••
r er' ompensation Insurance Designer. ®.
Type of cy Group:
V-B Career STATE COMP
Occupancy Grou R3/U -• Address:
P Y P: aal��rry 0 0 "y,q lr o o a• o
Added /Newlrl s ft. Bldg: p `ezz�.
q 9 "_'r+,.'a-s' `u Exp+re,F' 4/ 't:7�� I*'. k� 'Phone:
Added /New sq. ft. Garage: 0 ,T- ° `�'+� [ ,^ • • o e» e e
1 h oe e o
No of Stones: 2 �bcs No of Units Rea / Special Conditions: { L l
1 Front. / �•.•••
s e
Bldg Height: 0 Left; / •,°...
Bldg Sprinklers: Right: / ., s .°.°s.
Flood Zone: %Use Zone: Pnrki n s, 0 _ _
Construction Valuation: $5 000.00 - - r~ - i, `
Building Permit Fee: $142.00 - Excise /� vvoriv started) '
cam., �, > $0.00 Planning Depattm"ent - Fire Department
Plan Check Fee: $0.00 Addi�t ;��.Orieq� $0.00 Plan check Fee : $0.00 Fire Inspection $0.00
Overtime Plan Ck: $0.00 Gradi g Bonds Fee: $0.00 Fair Share : $0.00 u $0.00 Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Tr .00 De L
Record Management: $0.00,�. Grading Permit Fee: In -lieu Housing Fee : 0 a•
Energy Compliance: $0.00 '_"° g Fee: $0.00 Public Works De artm -� t�et.6�' d d $0.00
A G at Service ' $0.00
CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 a ication : 0-- epos $0.00
Disabled Access : $0.00 _-,.��^plµ-F;}•T--- 0.00 Grading Bond: $0.00
Hazardous Mat $0.00 - .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 : $143.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $143.00
PROCESSED BY: PUBLIC WORKS APPROVAL:
ZONING APPROVAL: PLAN CHECK BY:
GRADING APPROVAL: APPROVAL TO ISSUE:
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)
action 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
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 U portions of the work, and the structure is not intended or offered for sale (Section 7044,
;iness 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
movements 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
moved 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
)ly 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 for my personal residence in which I must have resided for at least one ear W6mdgaIV s covered by this permit, I cannot legal
a structure that I have built as an owner -_builder if it has not bee - un erstand that a copy of the applicable applicable 7044 of the Business and
dessions Code, is available upon " p 1 a Ion Is submitte or at the following Web site:http://w .leginfo.ca.gov/celaw.html.
nature of Property Owner or,thorized Agent IF ., v,iar n9�° Q Date
_. a
I hereby affirm u&W pelllalty of
ald, Vlec:. License Class
ceby.affirm uN T6r p&Ratty of
....
I.Alva and WUlrajntain a
rUce of tAe e+ed�Nor whi
ave and will maintain wor
16fi8dcarrier Wd poicy nur
certify that, iA fie pt
, if I should become
iature of Applicant/
to
hereby affirm under penalty of ped
-ender's Name
3y my signature below, I certify to a
I am the property owner or auth
I have read this application and
I agree to comply with all applic
I authorize representatives of tf
Signature of Property Owner or Aut
ACrION I DATE
PERMITEXPIRED /
PERMITCANCELLED
PERMITEXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYISSUED
> License No
ENSATINVE E19 uNA G,NO
ORN Ow OFCTIO
lwans.l
FSdt
of cogent to self -insure for workers'
with Section Ol wnelr XAor#I�a'dtb/�iTn°dt�7att° io: CG Ylice full force
PFi,NvALTIE,$_Aj 6ri- FINES UP TO
of Industrial Relations as provided for by
performance of the work for which
Date
.which this permit is issued, I shall not employ any a rmer so as to bec u ' ens col
m ation provisions of eta of the Labor ode, sh II fJom e o s�
�
Date_
LE DING NCY a - (pc) AA/®r k :tame
is a c`b ' rgka4IF rcy for[ the performance of the wor& or whit this permit is issued (Section 3097, Civil C
Lender's Address
on the
city and county
correct.
DE OF FEDEF
PART 61 OF TITLE 40 AND AQMD RULE
I SUBMITTED ASBESTOS NOTIFICATION TO
NOTIFICATION IS NOTAPPLICABLE TO
Insp. i
FOR OFFICE USE ONLY
bOLLARS ($'100,000), IN A-DMr0N-TQA
io,'n 3700 of the Labor Code, for
s'issued. My workers' compensa
arisation laws of California, and ac
All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall
be in place prior to approval to fill pool/spa & shall remain in place & be maintained for the
life of the pool.
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