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Home My WebLink AboutX2021-0823 - PermitsCity of Newport Beach - Building Division �IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII� COMB Permit: X2021-0823 4 yS Ts 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 0 8 2 3 Project No: 0439-2019 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 .. Combination Type -SFP Issued Date: 0912012021 Inspection Area : 5 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0912012024 OR PERMIT WILL BE INVALID nstru ion 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 36 ENDOZA T NB Job Address: 4360 Description: R DELTA 3, ANGE OF ENGINEER & ARCHITECT OF RECORD & CHANGE 1ST & 2ND FL LAYOUT, RAISE (E) FLAT ROOF 1'-9", INCREASE ROOF DECK 138 SF Legal Desc.: TR 1237 135 Owner: 436 MENDOZA INVESTMENT LLC Contractor. KEYSTONE D C S INC Architect: Address: 436 MENDOZA TER Address: 9140 TRASK AVE Address: CORONA DEL MAR CA 92625 GARDEN GROVE CA 92844 Phone: 949-274-3761 Phone: 714-791.3771 Phone: State Lic: Applicant: NGUYEN TIMOTHY Con State Lic: 1013293 Engineer: CHRISTIAN DALE Address: 2961 W MAC ARTHUR BLVD Lic Expire: 0413012022 Address: 1744 W KATELLA AVE #107 SANTA ANA CA 92704 Bus Lic: BT30076080 ORANGE CA 92667 Phone: 714-791-3771 Lic Exp Date: 07/31/2022 Phone: 714-997-1145 State Lic:S-002705 Code Edit: 2019 Worker's Compensation Insurance Designer: NGUYEN TIMOTHY Type of Construction: V-B-SPR Carrier: STATE FUND Address: 2961 W MAC ARTHUR BLVD ' Occupancy Group: R3/U Policy No: 9157538 SANTA ANA CA 92704 _ Added /New sq.ft. Bldg: 0 Expire: 04/21/2022 Phone: ®' Added /New sq. ft. Garage: 0 No of Stories: 2 Building Setbacks Rear: 15' Special Conditions: RRV21-0507 No of Units: 1 Front: 5' - Bldg Height: 0 Left: 6' „ Bldg Sprinklers: Y Right: 6' Flood Zone: Y Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $240,000.00 Building Permit Fee: $2,077.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $1,806.99 Additional Fee : $455.75 Plan check Fee : $52.00 Fire Inspection: $13a^ Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee Record Management : $24.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $27.00 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department- General Service $265.00 CA Seismic Safely: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0,00 Refund Deposit $564,00 Disabled Access : $0.00 P/W Plan Check: $50.75 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $10.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $5,332.49 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: LI\V V Plan Check Fee: $0.00 Fee Due at Permit Issuance PUBLIC WORKS APPROVAL: I PLAN CHECK BY: APPROVAL TO ISSUE: G $5,332.49 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 L) 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). ❑ 1 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 Jaw, 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) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No Date /61. 90-A.1 Contractor Signature -e...�t.c� . WORKERS' COMPENSATION DECLARATION 7�� 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 DOLLARS ($100,000), IN ADDITION TO THE COST OF CON PEN SALJd, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. f he, eby affirm urJr penalty of perjury one of the following declarations: 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 IN Ipprtgtmance of the work for which this permit is issued. Policy No. and will mairlI 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' carrier and policy number are: if Agent Policy Number Expiration Date Phone # JI cart^y that, in the,pgrformance 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 tat, if I should i eco,n/e subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ignatula of Appl;car�c_ N�gC.c.c.,P DateI 20. 21 IECLARATION REGARDING NST UCTION 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). ender's Name Lender's Address y 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 e aws reto building construction. 1 authorize representatives of this city or courlty to enter the ove-identified property for inspectiogpurposes. Signature of Property Owner or Authorized Agen Print Prop y Owner's or Authorized Ag ACTION DATE BY RATION OF COMPLIANCE WITH CODE OF DERAL FOR OFFICE USE ONLY D GULATIONS PART 61 OF TITLE 40 AND AQMD WILE IN PERMIT EXPIRED L_I1 SUBMITTED ASBESTOS NOTIFICATION TOX PERMIT C4NCELLED LIEPA PERMIT EXTENDED QMD PERMITFINAL i —ZL— J t2 SBESTOS NOTIFICATION IS NOT APPLICABLE CERTIFICATE OF p POSED DEMOLITION OCCUPANCYISSUEO SIGN URE: '�� 1