HomeMy WebLinkAboutXR2023-1872 - PermitsW oRT City of Newport Beach 111IIIIIIII111111111111111111111 11111111 jj COMB Permit : XR2023-1 872
@ Community Development Department- Building Division X R 2 0 2 3 1 8 7 2
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2023-0606
Permit Counter Phone: (949) 718-1888 Issued Date : 07/11/2023
o- newportbeachca.gov/civic Final Date:
cgroaN�P Combination Type - Permit Status: Issued
Work Class - Other Inspection Area : 8
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 : 2904 BROAD ST Legal Desc : A TR FIRST ADD TO NEWPORT HEIGHTS BLK 22 LOT 4 FIR
Description: SFR BLOCK WALL S HIGH X 27 LF INSIDE P/L
Owner: CLYMER FAMILY REVOCABLE LIVING TRUST
Contractor: MASON POOL CO
Architect
Address : 2904 BROAD
Address : 27651 SOLTERO
Address
NEWPORT BEACH, CA 92663
MISSION VIEJO, CA 92691
Phone : (949) 783-8541
Phone : (949) 677-8169
Phone
Con State Lie : 1085859
State Lie
Lie Expire : 01/31/2024
Applicant : MASON POOL CO
Bus Lie: BT30080052
Engineer : BIEDENBACH CHRISTOPHER JAMES
Address : 27651 SOLTERO
Bus Lie Expire : 11/30/2023
Address : 1201 N TUSTIN AVE
MISSION VIEJO, CA 92691
ANAHEIM, CA 92807
Phone: (949) 677-8169
Workers' Compensation Insurance
Phone: (714) 630-6100
Carrier: EXEMPT -NO EMPLOYEES
Owner/Builder :
Policy No: EXEMPT
Designer
Address :
W. C. Expire:
Address
Phone:
Phone:
Code Edition : 2022
Fire Sprinklers : NO
Construction Valuation : $2,000.00
Type of Construction : V-B
Fire Hazard Zone : NO
Added/New/Ti sq. ft. Bldg : 0
Occupancy Groups : U
No of Units : 0
Alteration sq. ft. Bldg :
Bldg Height :
No of Stories : 0
Added/New sq. ft. Garage: 0
TOTAL sq. ft. 0
Building Setbacks : Front: 20, Side: 4, Side: 4, Rear: 5
Flood Zone : X
Use Zone : R-1 - Single -Unit Residential
PROCESSED BY:
SPECIAL CONDITIONS:
3
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate License Law for the reason(s) indicated below by the checkrnark(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, after, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
is 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
'rofessions 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 ponalty Of
of more than five hundred dollars ($500).
S 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,
lushness and Professions Code: The ContractorsSlate License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
nprovemanls are not intended or offered for sale, It, 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
unproved for the purpose of sale).
-1 I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Stale License Law does not
poly to an owner of property who builds or improvesthereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
I am oxempl from licensure under the Cantractors' Stale License Law for the following reason
iy 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
of 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
rofessions Code, is available upon request when this application is submitted or at the following IVVeb site:httpaiwwhv.leginfo.ca.gov)calaw,html,
lignature of Property Owner or Authorized Agent
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 7 00 v' }'on of the Business and Pro ns Coda, and vl"censetis in ful-forte_
nd effect. License Class License No Data Ga 2 eContractor Signature l/
VORKERS' COMPENSATION DECLARATION
,ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THO O DOLLAR 100,000), IN AOOrTION TO THE
DST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATIORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
I 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 Cade, 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 this permit is issued. My workers` compenso
prance carrier and policy number are:
Policy Number Expiration Date
of Agent
.certify that, in the performance 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
1, if I should be,
"old the work s' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /7
naturaofApplicant_ ._ "_j71FO-k-JEC�6
DaCLAFtATION REGA DI [. ST CTNG AGENCYereby affirm under penalty per. that tnstruction 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 bal9w, 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 end the information I have provi d is correct.
I agree to comply with all applicable city and county mantas nd state laws relating to building construction.
I authorize representatives of this city or COIN+, tb ntar the a6 Ide rfled property for inspection purposes, �t///� %
nature of Prooertv Owner or Authorized ADery `F. i �✓�� Print Prooertv Owner's or Authorized Aaent's Name X Ir-�L2 /"'''QSU,•n/ Nate G //,le
ACTION DATE BY U I CL TtoN O COMPLIANCE W1714 CODE OF FEDERAL FOR OFFICE USE ONLY I/ y
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PERMIT EXPIRED ? I SUBMITTED ASBESTOS NOTIFICATION TO
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