HomeMy WebLinkAboutX2015-0032 - Permits (3)rP k, City of Newport Beach - Building Divisiun
o G� Civic Center Drive, Newport Beach, CA 92660
100
Permit Counter Phone (949)644-3288
Per
c' Inspection Requests Phone (949)644-3255
Combination Type - BLDG
IIIIIII I II
X 2 0 1 5 8
0 1
0 3 2
COMB Permit: X2015-0(
Project No
Issued Date :
Inspection Arearea :2015
'st3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Job Address: 3430 IRVINE AVE NB
Description: BLOCK WALL 6'- 0" HI X 130 LF (ON P/L) (STD PLAN)
Legal Desc.: TR 706 LOT 77 POR OF LOT
Owner: JOHNSON GREGORY Contractor:
BROWN DAVE MASONRY
Architect:
Address: 1127 SOMERSET LANE Address:
720 NORTH 1ST AVENUE
Address:
NEWPORT BEACH, CA 92660
UPLAND CA 91786
- -
Phone: 949-413-1343 Phone:
909-981-6290
Phone:
State Lic:
Applicant: BROWN DAVE MASONRY Con State Lic: 708860
Engineer:
Address: 720 NORTH 1ST AVENUE Lic Expire:
06/30/2015
Address:
UPLAND CA 91786 Bus Lic:
BT30046697
Phone: 3a9-981-6290 Lic Exp Date:
03/31/2016
Phone:
State Lic:
"
Code Edit : 2013 Worker's Compensation
Insurance
Designer:
'
Type of Construction: Carrier:
WIC EXEMPT
Address:
Occupancy Group: U Policy No:
NO EMPLOYEES
Added /New sq.ft. Bldg: 0 Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 0 Building Setbacks
Rear: 0
Special Conditions:
No of Units : 0
Front: 15
,
Bldg Height: 0
Left: 0
Bldg Sprinklers:
Right: 0
,
Flood Zone: X Use Zone: OG
Parking Spaces*
0
Fire Hazard Zone : N
Construction Valuation: $6,000.00
Building Permit Fee: $159.00 Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $114.48 Additional Fee :
$0.00
Plan check Fee :
$32.00
Fire Inspection:
$0.00
Overtime Plan Ck: $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: $2.00 Grading Permit Fee:
$34.80
In -lieu Housing Fee :
$0.00
Building Dept Adm
$0.00
Energy Compliance: $0.00 Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety : $0.00 WQ Insp. Fee:
$23.20
Park Dedication :
$0.00
Refund Deposit
$0.00
Disabled Access : $0.00
P/W Plan Check:
$0.00
Hazardous Mat $0.00 Electrical %:
$0.00
San Dist:
$0.00
Building Green Fee : $1.00 Mechanical %:
$0.00
NMUSD Fee:
$0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $366.48 n
Plan Check Fee
: $0.00
Fee Due at Permit Issuance : $366.48
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
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 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
improvei, cents 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 Iegall.
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. MITI.
Signature of Preoirty Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I her=by affirm under penalty of erjury that I am licensed under provisions of C t@� (commencing with Section tf ) f Divi 3 of the Business and Pro d , an my ippense Is In full force
a„o Hffect. ''c3,,ISE Class C_ Z`� License No �o`���I� Date_ Contractor Signature C
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 DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I heresy affirm'under penalty of perjury one of the following declarations:
1 hgq 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 thi
2erfopf,.ialce of the work for which this permit is issued. Policy No.
I �sv 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' compensatioi
insuFa carry: al,(, policy number are:
k� _ _ Policy Number Expiration Date
te. of Agent; Phone #
certify that, in the performaMT
rk 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
if I should becom subjec' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
IatureofApplicay----il./
a ADArFru I nZlL. . cunwr_ Ar_cury
!reby affirm under penalty oiperjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Ider's Name Lender's Address
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 prr ' d is correct.
I agree to comply with all applicable city and cou t c16 t`es and state laws relating to building construction.
I authorize representatives of this city or coun f v -identified property for inspection purposes.
nature of Property Owner or Authorized Age Print Property Owners or Authorized Agent's Nawer Dat�
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