HomeMy WebLinkAboutXR2023-0356 - Permits��WPoAr
City of Newport Beach
0 9 '
Community Development Department - Building Division
>
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone: (949) 644-3288
Inspection Requests Phone: (949) 644-3255
C9C/pOpN�P
newportbeachca.gov/inspections
Combination Type - SFP ELEC PLUM
Work Class - Other
11�1 111111111111111111111111111111111111111111111111111 11111COMB Permit : XR2023-0356
Plan Check No : 1591-2020
Issued Date : 02/07/2023
Inspection Area : 4
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 1814 PORT CHARLES PL Legal Desc : N TR 6622 BLK LOT 8
Description: SF FREE-STANDING FIREPLACE (WITH PLMB/ELEC)
Owner: BLACKBURN TIMOTHY M TR
Address : 1814 PORT CHARLES PL
NEWPORT BEACH, CA 92660
Phone
Applicant: JEREMYGRISSINGER
Address: 11912 ARROYO AV
SANTA ANA, CA 92705
Phone : (949) 922-5755
Owner/Builder:
Address :
Phone
Contractor:
JEREMYGRISSINGER
Address :
11912 ARROYO AV
SANTA ANA, CA 92705
Phone:
(949)922-5755
Con State Lie : 807874
Lie Expire :
05/31/2024
Bus Lie:
BT30043274
Bus Lie Expire
: 05/31/2023
Workers' Compensation Insurance
Carrier :
Policy No: NONE
W. C. Expire:
Architect
Address
Phone:
State Lie
Engineer: FORBES DALE L
Address : 1800 E 16TH ST #B
SANTA ANA, CA 92701
Phone: (714)835-2800
Address r: I a NSPEC-For"
Phone :
Code Edition :
2022
Fire Sprinklers :
NO
Construction Valuation :
Type of Construction :
V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg
Occupancy Groups :
U
No of Units :
1
Alteration sq. ft. Bldg :
Bldg Height:
No of Stories :
0
Added/New sq. ft. Garage:
TOTAL sq. ft.
Building Setbacks :
Front: 20, Side: 5, Side: 5, Rear: 10
Flood Zone :
X
Use Zone:
PC - Harbor V w Hi
PROCESSED BY:
SPECIAL CONDITIONS
$7,500.00
0
0
0
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' Slate License Law for the reasons) indicated below by the checkrnark(s) I have placed next to the applicable 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
io permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Stale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
'rofesslons Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.E by any applicant for a permit subjects the applicant to a civil penalty of
of more than five hundred dollars ($500).
3 I, as owner of the property, or my employees with wages as their sole compensation, will do(_) all of or (_) portions of the work, and the structure is not Intended or offered for sale (Section 7044,
lustiness and Professions Coda: 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 builtor
nproved for the purpose of sale).
3 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).
5 1 am exempt from licensure under the Contractors' Stale, License Law for the following reason
iy 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 legally
ell astructure 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
'rofesslons Code, isavailable upon request when this application is submitted or at the following Web site:http:liw v.leginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent _ Date _
ACENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Of Division 3-of the Business and Profes 'bns Cod / n nse is In full force
nd effect. License Class License No Date `/�� Contractor Signature
VORKERS' COMPENSATION DECLARATION
'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNG HOU NO LABS (Sie6;0001, {N ADDITION TO THE
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 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 the
erformance of the work for which this permit is issued. Policy No.
have 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'
Fence carrier and policy number are:
Policy Number Expiration Date
of Agent Phone #_
Filly that. in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califemia, and agrai
at, f I should become subject io the work ' c pensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
11
nalureof.Applicant __ to 2—% 2'
3ECLARATIGN REGA IN CONS U ING AGENCY
hereby affirm under penalty of per} t t re is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
_enders Name Lender's Address
3y my signature below, I certify t the following:
I am the property owner creel rized to act on the property owner's behalf.
I have read this applicationand the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county to ent r the above-i antlfied property for inspection purposes.
Si nature of Property Owner or Authorized Agent_ / Print Property Owner's or Authorized Agent's Name
ACTION DATE BY DECLARATION OF COMPLIANCE WITH 000E OF FEDERAL FOR OFFICE USE ONLY
} REGULATIONS PART 61 OF TITLE40 AND AQMD RULE
1403
PERMIT EXPIRED 0 1 SUBMITTED ASM STUS NOTI FI,:AI ION TO
PERMIT CANCELLED EPA -I
PERMiTF1NA1 jjqASBESTOS NOTIFICATION 15 NOT APPLICABLE TO
CERTIFICATEOF l•�,Z3 OPOSEDOEMOLITION
OCCUPANCVISSUED l SIGPRNATURE