HomeMy WebLinkAboutX2021-3066 -x «r City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2021-3066
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 3 0 6 6
P Project No : 0703-2021
Permit Counter Phone (949)644-3288
h Inspection Requests Phone (949)644-3255
Issued Date : 1111012021
Combination Type - BLDG PLUM
Inspection Area :3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1111012024 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: 411 EL MODENA AVE NB
Description: DEMO SFR - 2453 SFA BEDROOMS. SEWER CAP INCLUDED
Legal Desc.: FIRST ADD TO NEWPORT HEIGHTS BLK 26 LOT 22
Owner: GONZALEZ JOSE
Contractor:
OWNER/BLDR
Address: 411 EL MODENA AVE
Address:
GONZALEZ JOE
NEWPORT BEACH, CA 92663
Phone: 949-975-0123
Phone:
Applicant: TEALE MARK
Con State Lic:
O/B
Address: 2900 BRISTOL ST BLDG A203
Lic Expire:
COSTA MESA CA 92626
Bus Lic:
Phone: 949-975-0123
Lic Exp Date:
Code Edit: 2019
Worker's Compensation Insurance
Type of Construction:
Carrier:
Occupancy Group:
Policy No:
Added /New sq.ft. Bldg: 0
Expire:
Added New sq. ft. Garage: 0
No of Stories: 0
Building Setbacks
Rear: /
No of Units : 1
Front: /
Bldg Height: 0
Left: /
Bldg Sprinklers:
Right: /
Flood Zone:
Use Zone: Parking Spaces: 0
11 Construction Valuation: $15,000.00
Building Permit Fee:
$122.00
Excise Tax:
Plan Check Fee: $0.00
Additional Fee
Overtime Plan Ck:
$0.00
Grading Bonds Fee:
Investigation Fee:
$0.00
Grading PC Consultant
Record Management:
$0.00
Grading Permit Fee:
Energy Compliance:
$0.00
Grading PC Fee:
CA Seismic Safety:
$0.00
WQ Insp. Fee:
Disabled Access :
$0.00
Hazardous Mat
$0.00
Electrical %:
Building Green Fee :
$1.00
Mechanical %:
Plumbing %:
TOTAL
FEE : $2,117.98
PROCESSED BY: l
ZONING APPROVAL:
GRADING APPROVAL:
Architect:
TEALE MARK
Address:
2900 BRISTOL ST BLDG A203
COSTA MESA CA 92626
Phone:
949-975-0123 State Lic:CO22162
Engineer:
HAKIM FADY
Address:
124 PEONY
IRVINE CA 92618
Phone:
310-422.1536 State Lic:C-075736
Designer:
Address:
Phone
Special Conditions: TIGHT QUARTERS
TO HAUL
I Ni �� �.
%_4i"9._ k- a i
Fire Hazard Zone : N
$0.00
Planning Department-
Fire Department
$0.00
Plan check Fee:
$0.00
Fire Inspection:
$0.00
$0.00
Fair Share :
$0.00
Fire Plan Rev
$0.00
$0.00
SJH Trans :
$0.00
Demolition Fee
$0.00
In -lieu Housing Fee :
$0.00
Building Dept Adm
$27.00
$0.00
Public Works Department-
General Service
$265.00
$0.00
Park Dedication :
$0.00
Refund Deposit
$1,692.00
PM Plan Check :
$0.00
Grading Bond:
$0.00
$0.00
San Dist :
$0.00
$0.00
NMUSD Fee:
$0.00
$0.00
$10.98
$0.00
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$2,117.98
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 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 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://www.leginfo.ca.gov/calaw.htm1.
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) Div' ion 3 of the Business and ProVs ions ri y I" nse 's In full force
and effect. License Class License No Dat (/6 Z/ Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL RS J$100,0001, IN ADDITION TO THE
COST OF COMPENSATION, 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 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
performance 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
c rtify that, in the performance rmit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre,
I, f I should become subje D wor np sa provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant Date
CLARATION REGA CONS ENDING AGENCY
:reby affirm under penalty of perju that here is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Ci 'I Code).
Ider'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 I have provided is correct.
I agree to comply with all applicable city and county ordinances -a I relating to building construction.
I authorize representatives of this city or county to Vitef the above-' r rty for inspection purposes.
signature of Property Owner or Authorized Agent V - Print Property Owner's or Authorized Agent's Name
ACTION DATE BY V CLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED I LJ I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED Fyq
PERMITEXTENDED I VkoMD
OCCUIPANCYISSUED `'rr / /I v I crNATIERD