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Home My WebLink AboutX2022-1280 - Permits (3)y"�'Nt3r;4'r City of Newport Beach - Building Division IIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2022-1280 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 2 1 2 8 0 Project No: 1184-2022 4,. Permit Counter Phone (949)644-3288 Inspection Requests Phone(949)644-3255 `ar,,.�w."•' Combination Type - SFP MECH ELEC PLUM Issued Date : 06/20/2022 Inspection Area: 5 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 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: 4530 ROXBURY RD INS Description: SFR CONVERT (E) GARAGE INTO ACCESSORY DWELLING UNIT 646 SF Legal Desc.: N TR 3357 LOT 15 s,,> 4 Owner: TANZER TED L Contractor: T A EDISON CORP Architect:.;-ge Address: 4530 ROXBURY RD Address: 2526 SEAVIEW AV Address: CORONA DEL MAR, CA 92625 CORONA DEL MAR CA 92625'' Phone: Phone: 949-391-8886 _ Phone: State Lie: Applicant: TANZER TED L Address: 4530 ROXBURY RD Can State Lie Lie Expire: : 548043 10/3112023 Engineer: Address: CORONA DEL MAR, CA 92625 Bus Lie: BT30068216 Phone: 949-903-1825 Lie Exp Date: 02/2812023 Phone: State Lie: Code Edit : 2019 Worker's Compensation Insurance Designer: GAO LJ Type of Construction: VB Carrier: STATE FUND Address: 1161 MISSION ST a - Occupancy Group: R3/U Policy No: 9081192 SAN FRANCISCO CA 94103 Added /New sq.ft. Bldg: 0 Expire: 12/1012022 Phone: 213-787-7578 - Added /New sq. ft. Garage: 0 , No of Stories: 1 Building Setbacks Rear: / Special Conditions: No of Units : 1 Front: / Bldg Height: 0 Left: / Bldg Sprinklers: N Right: / Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone: N Construction Valuation: $44,720.00 Building Permit Fee: $739.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $642.93 Additional Fee : ($1,727.48) Plan check Fee : $52.00 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 : $34.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $61.00 Grading PC Fee: $0.00 Public Works Department - General Service $0.00 CA Seismic Safety: $0.00 WO Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 PAN Plan Check : $50.75 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $51.73 San Dist : $0.00 Building Green Fee : $2.00 Mechanical %: $29.56 NMUSD Fee: $0.00 $0.00 Plumbing %: $66.51 $0.00 TOTAL FEE: $2.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $2.00 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 (a) 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 the 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 not more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U 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 improvements 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 improved 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 apply 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: By my signaturL �)Jjw 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 legall, sell a structure �I,V 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 Professions Code, Is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.govicalaw.html. Signature of P, opartv Owner or Authorized Agent Date I ICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 7 00) f .ivisio 3 of the Business and Pr si s ode, and my lice se' in 4F force and effect. Livens= Class License No Date Contractor Signature NORNERS' COMPENSATION DECLARATION NARNING: FAILURli TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDHOUSAND DOLLARS ($100,000(, IN ADDITION TO THE COST OF COMPENS... ILN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. i hereby affirm under penalty of perjury one of the following declarations: I have and will ma'ntain 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 IT performance of the worK for which this permit is issued. Policy No. and w`II main in 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' carrier and policy number are: Policy Number Date me of Agent Phone 8 I certify that, in the performance of the work far which this ermit is issued, I shall not employ any person in any manner so as to became subject to the workers' compensation laws of California, and agre It, if I should becoqsubegtheworkrs' compen I provisions action 3700 of the Labor Code, I shall forthwith comply with those provisions.Inature of Applica D e:CLARATION RERUCTION LENDING AGENCY ereby affirm undejury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). rider'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 owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ord' ances and state I relatin o building construction. I authorize representatives of this city or county toe the above-identif' rope for inspection purposes. � / /, ,y mature of Pronertv Owner or Authorized ADelll� /�161� Print PrODertv Owner's or Authorized ADent's NarnP I�z�`I//� ACTION DATE BYY 'DECLARATION OF COMPLIANCE' WITH CODE OF FEDERAL FOR OFFICE USE ONLY Y REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED EPA PERMIT EXTENDED D PERMITFINAL ASBESTOS NOTIFICA 1 IS NOT APPLICABLE T ✓)'/� PROPOSED DEjuj(\LIT /I OCCUPANCYISF OCCUPANCY ISSUED I '� ( SIGNATURE: /%_ //