HomeMy WebLinkAboutXR2022-2866 - Permits�EWF_oRT
City of Newport Beach
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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
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newportbeachca.gov/inspections
Combination Type - MFP ELEC MECH PLUM
Work Class - Alteration
111111111111111111111111111111111111111111111111111111111jj COMB Permit : XR2O22-2866
Plan Check No : 1100-2022
Issued Date : 10/27/2022
ps r 0 T ^ 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 : 1055 GRANVILLE DR Legal Desc : N TR 14839 BLK LOT 2 UN HOLD
Description: DELTA 1 REVISION & ADD'L SCOPE: REMODEL GUEST BATHROOM; REPLACE WALLS @ FIREPLACE; REMODEL KITCHEN; REVISE MASTER BATH
ELECTRICAL.(X2022-1193)
Owner: NIELS AND JENNIFER LARSEN TRUST
Contractor :
Architect : LA ROCHE DENIS A
Address : 105 TRAVIS CORNERS RD
Address :
Address: PO BOX 3708 TUSTIN, CA 92781
GARRISON, NY 10524
Phone: (949)500-6713
Phone:
Phone: (949)939-3047
Con State Lic :
State Lic
Lic Expire
Applicant: DAVIDFEUERBORN
Bus Lic:
Engineer:
Address :
Bus Lic Expire :
Address
Phone : (949) 500-6713
Workers' Compensation
Insurance
Phone
Carrier :
Owner/Builder : NIELS AND JENNIFER LARSEN TRUST
Policy No:
Designer
Address: 105 TRAVIS CORNERS RD
W. C. Expire:
Address
GARRISON, NY 10524
Phone: (949)500-6713
Phone:
Code Edition : 2019
Fire Sprinklers :
NO
Construction Valuation : $20,000,00
Type of Construction : V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg
Occupancy Groups : R-2
No of Units :
6
Alteration sq. ft. Bldg : 120
Bldg Height :
No of Stories :
2
Added/New sq. ft. Garage: 0 .. ,
TOTAL sq. ft. Bldg : 0 _
Building Setbacks : Front: 15, Front: 3
Flood Zone: X
Use Zone: RM - Multiple Residential
PROCESSED BY:
-
SPECIAL CONDITIONS: REV2022-1978
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable items)
(Section 7031.5, Business and Professions Code: Any city or county that requires a. parrnit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for
the permit to flle 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 ferthe 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 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. IL 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).
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
ra-�rply 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).
't,...l I am exempt from licensors under the Contractors' Slate 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 legall}
self a structure that I have built as an owner -builder it it has not been constructed in its entirety by licensed contractors. 1 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:htip:llw .leginfo.ca.gov/cataw.html.
'..Signature of Property Owner or Authorized Agent Date 0 A7 A Z
'.. LICENSED CONTRACTOR'S DECLARATI --
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 Date Contractor Signature
COMPENSATION DECLARATION
YARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLNNFUL, AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS BI00,000f. IN 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:
-1 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 Code, for the
)erformaoce 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 Cade, for the performance of the work for which.. this permit is issued My workers'
rance carrier and policy number are:
Policy Number Expirall
Phone #
Date
certify 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 agree
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
iature of Applicant _ Dale
hereby affirm under penalty of perjury thatthere is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
.ender's Name Lender's Address
3y my signature below, I certify to each of the following:
I' an the prcpci.) owner or authorized to act on the property owner's behalf.
I have read'h'.s rpplication and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and slate laws relating to building construction.
I authorize representatives of this city or county_to enterthe above -identified property for inspection purposes. _
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
REGULATIONS PART 67 OF TITLE 40 AND AGMD RULE
FLdivti7 FINAL IPIVZ3 /S L�ASB€STOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATE OF . - `� PROPOSED DEMOLITION _
OCCUPANCY ISSUED SIGNATURE: �-