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HomeMy WebLinkAboutXR2023-1025 - Permits�gWPpRT City of Newport Beach p� @ Community Development Department- Building Division �" 100 Civic Center Drive, Newport Beach, CA 92660 .".� n Permit Counter Phone: (949) 644-3288 u�, Inspection Requests Phone: (949) 644-3255 °sc�Foae`F newportbeachca.gov/inspections Combination Type - MIFF ELEC MECH PLUM Work Class - Alteration 1111111111111111111111111111111111111111111111111 JillCOMB Permit : XR2023-1025 Plan Check NO: PC2023-0915 Issued Date : 04/20/2023 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 Legal Desc : N TR5740 BLK LOT 8 TR 5740 (L.L.84-214028) PAR 8 Job Address : 423 VISTA FLORA Description: MFR - BATH REMODEL 200 SF Owner: Dennis Lee Sundstrom Contractor : Architect Address Address : 423 VISTA FLORA Address : NEWPORT BEACH, CA 92660 phone Phone : (714) 612-8299 Phone Con State Lie : State Lie Lie Expire: Applicant: Dennis Lee Sundstrom Bus Lie: Engineer Address Address : 423 VISTA FLORA Bus Lie Expire NEWPORT BEACH, CA 92660 Workers' Compensation Insurance phone Phone : (714) 612-8299 Owner/Builder : Dennis Lee Sundstrom Carrier Policy No : y Designer Address Address : 423 VISTA FLORA W. C. Expire NEWPORT BEACH, CA 92660 Phone Phone : (714) 612-8299 Fire Sprinklers : NO Construction Valuation : $20,000.00 Code Edition : 2019 Fire Hazard Zone : NO Added/New/TI sq. ft. Bldg : 0 Type of Construction : V-B No of Units : 1 Alteration sq. ft. Bldg : 200 Occupancy Groups : U,R-3 2 Added/New sq. ft. Garage : 0 Bldg Height: No of Stories : TOTAL sq. ft. : 0 Building Setbacks Flood Zone : X Use Zone : R-1 - Single -Unit Residential PROCESSED BY: 5 I i' (Z SPECIAL CONDITIONS: REPLACES EXPIRED PERMIT X2020-0319 PER MK I hereby affim under penalty of perjury that I ant exempt from the Contractors' Stale License Law for the reasons) indicated below by the checkrnark(s) I have placed next to the applicable item(s) (Section 7031.5, Business end 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 Profs ons Code) or that he or she is exempt from licensors 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 y of 'not ore than five hundred dollars ($500). penalt El 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions af 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 rile Contractors' State License L or a following reason: By my signature below I acknowledge that, except for rat rest ante i which I must have resided for at least one year prior to Can plation of the improvements covered by this permit, I cannot Iegall sell a structure that I have built as an owmsr-but r if It has not b n c nstru t in its entirety by licensed contractors. I understand that a copy of the applicable law, Suction 7044 of the Business and Professions Code, is available upon request wh p' ation 1 so itt or at the following Web site:hitp:/lwww.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Darr=,2iO��, LICENSED CONTRACTOR'S DECLA..Rgoo W I hereby affirm under penally of perjury that I am li en ad under Or isions 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 Chcs Lic se No Date Contractor Signature WORKERS' COMPENSATION DECLARATION NAI,N,NG . 44URE TL, jLCJRE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS t$100,0001, IN ADDITION TO THE COST OF COMPENSATION IIAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'$ FEES, hereby affirm under penalty of perjury one of the following declarations: - 1 have and will hralrtcin a cerlifeate 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 tedormanre of the +vnrK for which this permit is issued. Policy No. 5 have and will n r t..in 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' compensatior nsurance arrier and pa'cy number are: of Agent Policy Number Expiration Date J reWif l trial, 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 agre ta,, if I should be,.ome subject to the workers' compensation provisions of Section 3700 of the Labor Code, Ishall forthwith comply with those provisions. ignalure of Applicant Dste IECLARATION REGARDING CONSTRUCTION LENDING AGENCY — hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). order's Name Lender's Address y my signature below, I certify to each of file following: I am the property owner or authorized to act on the property owner's If. I have read this application and the information I h. video is orre I agree to comply with all applicable ciIty and c tty ordina as a. s to s relating to building construction. L I authorize representatives of this city or Go ty to nt r the a. ove-i ra for Inspection purposes. wL'S LF�q n jai ature of Pro eny Owner or Authorized A ant Print Pro art Owner's or Authorized A eot's Nam Cat ,CTION DATE BY DECLARAT N.OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY .GJ NS PART 61 OF TITLE 40 AND AQNID RULE ASBESTOS NOTIFICATION TO PERAfITEXTENDED MD __ PER,LiIT FINAL (� /f. 23, i $BEST FICAl10! 15 ppLICABLE TO CPR RFlCATE OF PROPOS EEfpAtCLITION OCCUPANCYIS5UE0 T.—X m 0