HomeMy WebLinkAboutX2021-2967 - Permits�EHhr,�T City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2021-2967
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 2 9 6 7 Project NO : 2573-2021
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
�.., Issued Date : 11I01/2021
Combination Type - SFP
Inspection Area : Tc 3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, PROJECTS MUST BE COMPLETED BY 1110112024 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: 430 TUSTIN AVE NB
Description: DEMO DETACHED GARAGE
Legal Desc.: FIRST ADD TO NEWPORT HEIGHTS BILK 26 LOT 8
Owner:
430 TUSTIN LLC
Address:
790 NEWTON WY
COSTA MESA CA 92627
Phone:
Applicant:
DEUSTERMAN JAMI
Address:
790 NEWTON WY
COSTA MESA CA 92627
Phone:
714-288-0732
Code Edit :
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 0
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Flood Zone:
11 Construction Valuation:
Contractor:
SEPULVEDA BUILDERS INC
Address:
790 NEWTON WY
COSTA MESA CA 92627
Phone:
714-222-1150
Con State Lic:
695401
Lic Expire:
10/3112022
Bus Lic:
ST30058100
Lic Exp Date:
02/28/2022
2019 Worker's Compensation Insurance
Carrier: NO EMPLOYEES
U Policy No:
p Expire:
0
Building Setbacks Rear: I
Front: /
Left: /
Right: /
Building Permit Fee: $110.00
Plan Check Fee: $0.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $111.00
PROCESSED BY:
ZONING APPROVAL:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
State Lic:
State Lic:
Phone:
Special Conditions: X2021-2969 a
Fire
Excise Tax:
$0.00
Planning Department -
Fire Department
Additional Fee :
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
Grading Bonds Fee:
$0.00
Fair Share :
$0.00
Fire Plan Rev
$0.00
Grading PC Consultant :
$0.00
SJH Trans :
$0.00
Demolition Fee
Grading Permit Fee:
$0.00
In -lieu Housing Fee :
$0.00
Building Dept Adm
$0.00
Grading PC Fee:
$0.00
Public Works Department-
General Service
$0.00
WQ Insp. Fee :
$0.00
Park Dedication :
$0.00
Refund Deposit
$0.00
PAN Plan Check:
$0.00
Grading Bond:
$0.00
Electrical %:
$0.00
San Dist:
$0.00
Mechanical W
$0.00
NMUSD Fee:
$0.00
$0.00
Plumbing %:
$0.00
$0.00
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$111.00
PUBLIC WCFKS APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL: APPRO ✓AL 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)
(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 Iicensure 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 U all of or (_) 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 j
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).
❑ 1 am exempt from Iicensure under the Contractors' State License Law for the following reason:
By 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
sell 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://wvvw.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I 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 Professions Code, and my license is in full force
and effect. License Class License No Dfy Contractor Signatur
NORKERS' COMPENSATION DECLARATION
NARNING: 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), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
1 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 Cade, for the
Derformance 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'
rance carrier and policy number are:
Policy Number
of Agent
Date
Iffy 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 California, and
I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
SiTTISture of ADD licantY_ Da e
DECLARATION REG.giiI4tNG CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjurythat there is a construction lending agency far the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By 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 ordinances and state laws relating to building construction.
I authorize representatives of this city or county to enter the above -identified property for inspection purposes.
Signature of Property Owner or Authorized AgeTtV Print Property Owner's or Authorized Agent's Nameiz Date
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED I SUBMITTED ASBESTOS NOFIFICACION,TO
PERMITCANCELLED EJEEPA -`
PERMIT EMENDED LJAQMD
PERMIT FINAL (-Iro'2( ,S►I-VI 'tVS ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATEOF . fix ROPOSED DEMOLITION
OCCUPANCYISSUED IGNATURE: