HomeMy WebLinkAboutX2021-3334 - Permit Application�ywrtjr
City of Newport Beach - Building Division
*X2021-3334'
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
w $
Inspection Requests Phone (949)644-3255
Combination Type - MFP
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VAL
/N P C N. PROJ
3 MUS
Construction Hours: Monday- Friday 7:00 a.m. to 6:30 p.m d Satur
rom 8�0
COMB Permit: X2021-3334
Project No : 1212-2020
Issued Date :
0��� Inspection Area : 6
:'OMPLETED OR PERMIT WILL BE INVALID
to 6:00 . No wo on Sundays or Holidays
Job Address: 21 CHERBOURG NB 4 n
Description: **CHANGE OF CONTRACTOR** MFR INTERIOR REMODEL 2605 SF" ADDITIONX%4 SF *$,Ti� WORK* 120-2
Legal Desc.: TR 9858 LOT 6 UNIT 56 OF PROJECT LOCATED ON AP 461-13. TOGETHER $U ,�(�
Owner: O'BRIEN MARK Contr for CO AL CONST UUCTION�>�5-INC/BILL Architect:
HEFNER CHARLES �
Address: 12 GENEVE ddress 3050 Pt1 10% ST '0 Address: 6320 VAN NUYS BLVD
NEWPORT BEACH, CA 92679 COSTA MESA CA 92626 VAN NUYS CA 91401
Phone: 818-769-0444 Ph� 949-637-3674, Phone: 818.997-10 Ra� State
Applicant: ZONOUZ ALI on State Lc: 958542 '
Address: 13300 SPECTRUM 'Y Lic5-xpire: 03/31/2023"T
IRVINE, CA 92618 ry Bus Li BT30037317
Phone: 747-265.0079 \�V 'Lic Exp Date: 10I3112022 "Q`�
Code Edit : OT
oi-Ipmpensaticn InsuranceType of Construction: <V-BV�" arrier - EXEMPT
Occupancy Group: '" R3/U�°' �olicy No: no emptgyeeAdded /New sq.ft. Bldg: 634Expire,
Added /New sq. ft. Garage: 0 r
No of Stories: 1 Building Setbacks Rear: 5
No of Units : 2 : .
Front: 5
Bldg Height: 0 '�' vLeft: 5 y
Bldg Sprinklers: Righ r-4
❑in,.,, z.,,o `"e Use one Parktxlh.. 0
Engineer:
Address:
Phone± 1\ Stat
5-
LL'N.CQ3963
4: re Os„ �j
Special Co ions_a A CONTRACTOR
Fire Ha£ard.?Fne : N
Construction Valuation: V290
Building Permit Fee: $0.00 "" cise Tax: Ian g Oepa nt Fire Department
Plan Check Fee: $0.00 Additional Ian chec ee " $0.00 Fire Inspection: $0.00
Overtime Plan Ck: $0.00 Gradin and .�� `30.00 Fair S re: $0.00 Fire Plan Rev $0.00
Investigation Fee: $0.00 Gr Consultgr�tR,O $0.00 S r $0.00 Demolition Fee
Record Management: $0.00 Gra it Fee. �$0.00 n-I' ousing Fee : $0.00 Building Dept Adm $0.00
Energy Compliance: $0.00 radi C Fee: �.• $ . 0 P is Works Department- General Service $0.00
CA Seismic Safety: $0.00 O Insp. Fee : �� 0.00 Park Dedication : $0.00 Refund Deposit $0.00
Disabled Access : $0.00 PNV Plan Check : $0.00 Grading Bond: $0.00
Hazardous Mat $0.00 Elec 'cal °/n: t,�Q� • .00 San Dist : $0.00
Building Green Fee : $0.00 Mach ical $ NMUSD Fee: $0.00 $0.00
Plumbi 9/°:" 0.00 $0.00
TOTAL FEE : $38.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $38.00
PROCESSED BY: `375 PUBLIC WORKS APPROVAL:
ZONING APPROVAL: PLAN CHECK BY:
GRADING APPROVAL: 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) indic below by the ch kmark(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 Dish, or repair any str Lure, 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 Anse Law (Chapter 9 (cc a ing 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 vi n of Section 7031.5 byline 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 ( of or Lj.pp-rs of thand the structu is t intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of properthrou FIRyees' or perso effort, iIds or improves the property, provided that the
improvements are not intended or offered for sale. If, however, the building or improve`m.tis sold wit¢�irl4st? year ofretion, the Ow - wilder will he the burden of proving that it was not built or
improved for the purpose of sale). .mom' \ ,p, (��olp
❑ I, as owner of the property, am exclusively contracting with licensed Cont rs to construct the prof i& Kn 7044, Bus' ss and Professions Code: T Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who c acts for the pr is with a linsed ContraRkm rsuant to the Contractors' State L nse.Law).
❑ I am exempt from licensure under the Contractors' State Licen aw for the Poll ng reason
By my signature below I acknowledge that, except for my Be residence in ch I must have resided fok,01east one year priorto completion of the improvem is covered by this permit, I cannot legal)
sell a structure that I have built as an owner -builder if it h of been constr ad in its entirety by licensed"contractors. (understand that a copy of the applicable Is action 7044 of the Business and
Professions Cuue, Is available upon request when t ' pplicatipp is s itted or.atrthe following Web sitb:http:f/www.leginfo.ca.gov/calaw.html. ' -
Signa!ure of Property Owner or Authorized Age 9 ate
L.iGENSED CONTRACTOR'S DECL ION ��
I hereby affirm under penalty of .0 at am likens nder provlslonao a commencng with Sectlo��II 7000) of Division 3 of the BuSurr g, rofessions Co axid my license is in full force
a,,d ef`ect. Licelise Class License No �L( �.�'r Dafe"X ��` /O -a� C tra 'Signature �C
NORKERS',COMPEN ON DECLA ION --� ~T�
NARNING: FAILURE TO SEC E WORFj S COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES no ESup &NE HUNDRED THOU 0,000), IN ADDITION TO THE
COSTOF COMPEN X.T J DA DES AtFROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 4® f e _
hereby affirm L-Id I pena . of perjury one olFthe following declarations
J I have and wtll maintain a certfdoate of consent to self -insure for workers compensation, issued b00011,
f`InduJo Relations as Ided for b ec' 700 of the Labor Code, for thI
De-form.ance of the work for which this perniit B`Ksued. Policy No. q uo V
�I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor the rformance of work lch permit is issued. My workers' compensatior
nsura%e carrier Prdpolicy number are. - . - �,AS�•
Carrier Policy N4 ber ExpnlaCion
Vame gent ,�. 'c£` on
certify that, in the performance of th work er r, irh this permit is issue he t employ any person in an anner so o b e subject to the workers' compensation laws of California, and agree
:hat, if I should become subject to the wo ers' 6 ensation provision C n 06T the Labor Code, all forthwi o ith those provisions. ��jj
Signature of Applicant Date< /P= L
DECLARATION REGARDING UC N LE GAY
hereby affirm under penalty of perjury that th'X is ction le q genc I he p rmance o e W or which this permit is issued (Section 3097, Civil Code).
-ender's Name ,,�- \ L er's Addre
3y my signature below, I certify to each of the fol wing:
I am the property owner or authorized to act od he propert is be .
I have read this application and the information ave p ed is act.
I agree to comply with all applicable city and coun ordigatas'and state I re g to building construction.
I authorize representatives of this city or county to,)?i;. {fie ---Fly for inspection purposes.
ACTION
DATE
BY
DECLA„RATIOfy QF_COMPUANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED
/���-.,
I SUBMITTED ASBESTOS NOTIFICATION TO
EPA
PERMITCANCELLED
2 2q
PERMIT EXTENDED
0AQMD
PERMIT FINAL
ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATE OF
PROPOSED DEMOLITION
OCCUPANCY ISSUED
SIGNATURE: 7C i-��
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