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Home My WebLink AboutX2019-2351 - Permits04o. City of Newport Beach - Building Division IIIIIIIIIICOMB Permit : X2019-2351 100 Civic Center Drive, Newport Beach, CA 92660 I�'Project No : 1692-2019 Permit Counter Phone (949)644-3288 11 NZG PRINK XRS Inspection Requests Phone (949)644-3255 REQUIRED Issued Date : 10/2212019 Combination Type- SFP GRAD ELEC MECH PLUM Inspection Area : 5 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction 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 Job Address: 4733 DORCHESTER RD NB Description: NEW SFR W/BASEMENT & ATT GARAGE 6,1241647 SF, DECK 86 SF Legal Desc.: N TR 3519 LOT 33 Owner: Address: Phone: MILLER GREGG 223 JASMINE AVE CORONA DEL MAR, CA 92625 Contractor: Address: Phone: NICHOLSON CONSTRUCTION CO 1 CORPORATE PLZ #110 NEWPORT BEACH CA 92660 949.872-6637 Architect: Address: Phone: TEALE MARK 2900 BRISTOL ST BLDG A203 COSTA MESA CA 92626 949-975-0123 State Lic:CO22162 Applicant: Address: Phone: DEMI/TEALE MARK 2900 BRISTOL ST BLDG A203 COSTA MESA CA 92626 949.975-0123 Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: 660295 12131/2020 ST98032850 04/30/2020 Engineer: Address: Phone: HAKIM FADY 124 PEONY IRVINE CA 92618 310-422-1536 State Lic:C-075736 Code Edit : 2016 Type of Construction: V-B-SPR Occupancy Group: R31U Added /New sq.ft. Bldg: 5124 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 1 Bldg Height: 0 Bldg Sprinklers: Y Building Permit Fee: $6,279.00 Plan Check Fee: $5,058.00 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $72.00 Energy Compliance: $268.00 CA Seismic Safety: $156.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee : $48.00 TOTAL FEE: $24,330.90 PROCESSED BY: ZONING APPROVAL: 'SING APPROVAL: Worker's Compensation Insurance Carrier: STATE FUND Policy No: 9074255 Expire: 10/01/2020 Building Setbacks Excise Tax: Additional Fee Grading Bonds Fee: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee: Electrical %: Mechanical %: Plumbing %: Rear: 6' Front: 6' Left: 6' Right: 6' Parking Spac $1,230.81 $0.00 $0.00 $1,644.92 $1,109.00 $361.08 $0.00 $439.53 $469.67 $665.11 Designer: Address: Phone: Special Conditions: Fire Hazard Zone Planning Department - Plan check Fee Fair Share SJH Trans In -lieu Housing Fee Public Works Department - Park Dedication: $0.00 PAN Plan Check: $247.50 San Dist: $0.00 NMUSD Fee: $5,965.28 Fire Department $417.00 Fire Inspection: $0.00 Fire Plan Rev $0.00 Demolition Fee $0.00 Building Dept Adm General Service Refund Deposit Grading Bond: Plan Check Fee : $6,252.51 Fee Due at Permit Issuance - PUHLI- WORKS APPROVAL: PLAN CHECK BY: .. APPROVAL TO ISSUE: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $18,078.39 CC W �J Z �v OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Con e t ¢ ) 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 r , 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 provi ' 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 far the r iolation 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 J all of or (_) 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 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.htm]. 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 Sectio O ) of Division 3 of the Business and PrQfe s��'QQns Code, ,�a,nd license is in full force and effect. License Class License No DatD -'��- (� Contractor Signatqr MJ,/�t Gam, WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ANO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 19100,0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under 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 3eprmance of the work for which this permit is issued. Policy No. have and wi maintain workers' compensatio insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' is of Agent J/Ck: r %J" >, VLF certify that, in the performance of the work for if I should become subject to the workers' co Number Expiration Date 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 ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �l nature of Applicant' \9AI��L,(Q ate IO CLARATION REG.9RDING CONSTRUCTION ENDING AGENCY :reby 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). 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 provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county tp enter the above-ide tified property for inspection purposes. �'^ nature of Property Owner or Authorized Agent Y ,Qn oM7Vt Knu q� Print Prooertv Owner's or Authorized Ansm's Na P 1 ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403 PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFIC4T:ON TC _ _ DEPA, PERMITCANCELLED PERMIT EXTENDED L.XOMD PERMITFINAL ZASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF /L PROPOSED DEMOLITION - OCCUPANCYISSUED () SIGNATURE: ' (1