HomeMy WebLinkAboutXR2023-0744 - Permits,rr�WPogT
City of Newport Beach
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Community Development Department- Building Division
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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 - SFP
Work Class - Other
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COMB Permit : XR2023-0744
Plan Check No : PC2022-2168
Issued Date : 03/21/2023
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
Job Address : 2417 BAMBOO ST Legal Desc : N TR 4893 BLK LOT 49
Description: SFR REMODEL TO KITCHEN, GREAT ROOM, MST BR; DEMO COVERED PATIO (CHANGE OF CONTRACTOR)
Owner: MICHAEL MUELLERLEILE
Address : 32 Sunset Cv
Newport Beach, CA 92657
Phone : (949) 633-8865
Applicant : PHIL NIELSEN
Address : 6131 ANACAPA DRIVE
HUNTINGTON BEACH, CA 92647
Phone : (714) 717-1418
Owner/Builder : MICHAEL MUELLERLEILE
Address : 32 Sunset Cv
Newport Beach, CA 92657
Phone : (949) 633-8865
Contractor
Address :
Phone :
Con State Lic
Lic Expire
Bus Lic :
Bus Lic Expire
Workers' Compensation Insurance
Carrier:
Policy No:
W. C. Expire:
Architect
Address
Phone:
State Lic:
Engineer: ABARQUEZ JOSE M
Address : 18 EL CORZO
RANCHO SANTA MARGARITA, CA
Phone : (714) 277-9895
Designer
Address
Phone :
Code Edition :
2019
Fire Sprinklers :
NO
Construction Valuation :
Type of Construction :
V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg : 0
Occupancy Groups :
R-3
No of Units :
1
Alteration sq. ft. Bldg :
Bldg Height:
No of Stories :
1
Added/New sq. ft. Garage : 0
TOTAL sq. ft.: 0
Building Setbacks :
Front: 10, Side: 6, Side: 6, Rear: 6
Flood Zone :
X
Use Zone :
R-1-6000 - Single -Unit Residential (6000
indicates minimum
lot area)
PROCESSED BY
SPECIAL CONDITIONS: O/B FORM ATTACHED
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)
clion 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 ',or
permit to file a signed statement that he or she is I!Gonsed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
fessaons 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
more than five hundred dollars ($500).
1, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
;mess 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
rovements 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
roved 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
ily to an owner of property who builds or Improvesthereon, and who cgbtracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law),
LJ I am exempt from Iicensure under the Contractors' State Licens L
By my signature below t acknowiedgo that, except for my persona e
sell a structure that I have built as an owner-buildor if I has no[ a
Professions Code, is available upon request when applica." i
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATIO
I hereby affirm under penalty of perjury that I am licensed un(Wr provisk
and effect. License Class License No
COMPENSATION DECLARATION
ng reason:
must have resided for at least one year prior to completion of the improvements coven
�ty ny bconsad contractors. I understand that a copy of the applicable law, Section
ng Web site:http:liwww.leginfo.ca.govlcalaw.html.
of Chapter 9
with Section 7000) of Division 3of the Business and Professions
Date Contractor Signature
and
my license is In full force
ING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARS (St00.000), IN ADDITION
OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3704 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
I have and wilt 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
'ormance 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 Ibis permit is issued. My workers' compensa
Trance carrier and policy number are:
Policy Number
of Agent
Date
certify that, in the peKING
of the r r i h it is issued, I Sri not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
t, III should becomesthew c r lions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant __DatZ�
CLARATION REGAR NG AGENCY'
areby affirm under penalty of perjury h t there is a construction lending agency for the performance of the Work for which this permit Is issued (Section 3097, Chit Code).
ider's Name Lender's Address
my signature below, I certify to each of the following:
1 am the property owner or authorized to act on the propI
er's behalf.
I have read this application and the information I have oa Is co Tact.
I agree to comply with all applicable city and county�IQrdisands a laws relating to building construction. �/
I authorize representatives of this city or county (iL$nter qfor inspection purposes./A�` �//V't )� ,�/2�nature of Prooenv Owner or Authonzed Anent �I J��AA Print Pronertv Owner's or Authorized Anwnt's NAnd4 A e
ACTION I DATE BY REGIJ IONSIOP V(IOMRT 61 LIAM1 E VI ANDODE OF AQMD FEDERAL E I FOR OFFICE USE ONLY
PERMIT EXPIRED
i LJ I SUBMITTED A58FSTO NOTIFICATION TO
PERMITCANCELLED
LJEPA —
CERMIFfXTENOfD
PERiW FINAL
CERTIFICATE OF
OCCUPANCYISSUED
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