HomeMy WebLinkAboutX2021-0894 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2021-0894
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 0 8 9 4 Project No: 0533-2021
F � Peanit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - MFP Issued Date :
Inspection Arearea :2021
4
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, PROJECTS MUST BE COMPLETED BY 04/15/2024 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: 32 OCEAN VISTA NB
Description: MFR *STOP WORK* DRYWALL REPAIR @ THE COMMON WALL �'1
Legal Desc.: TR 9676 LOT 4 UNIT 31 OF PROJECT LOCATED ON AP 442-361-31 TOGETHER C T
Owner: ORD MARIE TR CABASSA TRUST Contractor: OWNERIBLDR Architect: KEMMERER MARCUS
Address: 1835 NEWPORT BLVD #109-15 Address: JOHANSSON KIMBERLY MARIE Address: 228 CREST AVE-
COSTA MESA, CA 92627 HUNTINGTON BEACH CA 92648
Phone: Phone: 949-300-3984 Phone: 714-752-0052 State Lic:CI0t299552 -
Applicant: KEMMERER MARCUS Con State Lic: O/B Engineer: A`p� BUILT PER' V'�j -
Address: 228 CREST AVE Lie Expire: Address: S�
Phone: 714N752 0052 TINGTON BEACH CA 92648 Bus
ExpDate: Phone: ELECTRICAL,
ALL
StAtp.CTURA
Code Edit : 2019 Worker's Compensation Insurance Design //�RLUMBING` /t '
Type of Construction: V-B Carrier: Address!' 4 C A L COMP
r-1 ` D
Occupancy Group: R2 Policy No: AOA /E�l��
Added /New sq.ft. Bldg: 0 - Expire: Phone: � V
Added /New sq. ft. Garage: 0 -
No of Stories: 2 Building Setbacks Rear: I Special Conditions: 119-0949
No of Units : 4 Front: I VERIFIED OWNER
Bldg Height: 0 Left: I O/B AUTH ATTACHED
Bldg Sprinklers: Right: I
Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N
Construction Valuation: $1,000.00
Building Permit Fee: $110.00 Excise Tax: $0.00 Planning Department - Fire Department
Plan Check Fee: $0.00 Additional Fee: $0.00 Plan check Fee: $0.00 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: $110.00 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee
Record Management: $2.00 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 P/W Plan Check: $0.00 Grading Bond: $0.00
Hazardous Mat $0.00 Electrical %: $0.00 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: $223.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Plan Check Fee
$0.00 Fee Due at Permit Issuance : $223.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
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 anplicable items)
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
lot 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,
3usiness 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 will have the burden of proving that it was not built or
or the purpose of sale).
ner 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
IppI 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:
3y my signature below I acknowledge that, except form ersonal reside in which I must have resided for at least one year prior to completion of the improvements co 'red by this permit, I cannot legall3
Ell a structure 'hat I hove built as an owner -builder if as not be c str din its entirety by licensed contractors. I understand that a copy of the applicable law, Se on 7044 of the Business and
rrofessbns Code, is available upon requ whe - is n i bm' or at the (lowing Web site:http://www.leginfo.ca.gov/calaw.html. � �\
3,godid.e of Prupeny Owner or Authorized A h to `
-ICENSED CON7. RACTOR'S DEC L 4 N
hcreb� affirm unc er penalty of perjurythat I am lice sad eEpiovisions of Chapter 9 (commencing with Sec' ) of Division 3 of the Business an fessions Code, and my license is in full force
Ind effect. License Class `. License No D Contractor ore
VORKERS' COMPENSATION DECLARATION, XA
IARNING: FAILUR=TO SLCURE WORKERS' COMPENSATION,COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE NDRED THOUSAND DOLLARS I$100,00D3, IN ADDITION TO THE
:UST OF COMPENSAI ION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABORCODE, INTEREST, AND ATTORNEY'S FEES.
I,efuLy affirm under penalty of perjury one of the following declarations:
11 ha.'e and v:ill 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
erformance of the wort for which this permit is issued. Policy No.
havd and wit; 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'
rance carrier and pnlicy number are:
Policy Number
Date
ertify that, in the perfo anceof the w9FKfcoorr which this permit is issued, I shall not employ any person in any manner so as to become subject to the
if I shout becom Iect a rs mpensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of A, ar1�
DECLARATIO R GAAR'DII CO R N LENDING AGENCY
hereby affirm under penalt of perjury that here is a construction lending agency for the performance of the work for which this permit is issued
-ender's Name Lender's Address
3y 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 1 have provided is correct.
I agree to comply with all applicable city and cou dinances and a laws relating to building construction.
I authorize representatives of this ci cou ter t ab v ified pro a F4nspection purposes.
Signature of Property Owner or Authorized Print Property Owner's or Authorize en ' arfl
ACTION DATE Bf ATION F COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ON
EGULATIONS PART 61 OF TITLE 40 AND AQI RULE
PERMITEXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED UEPA
PERMIT EXTENDED MD
PERMIT FINAL BEST N (CAT SNOTAPPLICABLE TO
CERTIFICATE OF PRO LIT
OCCUPANCY ISSUED SIGNAT
compensation laws of California, and
Civil Code).
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