HomeMy WebLinkAboutX2019-1771 - Permits0Q'-
City of Newport Beach - Building Division100 Civic Center Drive, Newport Beach, CA 92660x 2 0 1 9 t 7 7 1
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - SFP ELEC MECH PLUM
COMB Permit: X2019-1771
No: 1274-2019
Issued Date : 06125/2019
FTER ISSU day from 8.00�LAST
6.30 Sundays"
Job Address:
Construction Hours:
26 HERMITAGE LN NI3
Monday - Friday 7 00 apm. to p.m. and
.-
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Vv
3
Description:
SFR REMODEL EXTG GUEST BATHROOM & ADD ADD'L BATHRO 0 SF)
Legal Desc.:
N TR 7223 LOT 109
O i
Owner:
CALISTOGA INVESTMENTS
r ct OW LDR
f3 Ar,Chi�i(tN KNITTER MICHAEL L
Address:
21 CALISTOGA
Ad s VERIANN�,
°+ ASdress: 1401 DOVE ST#240
Phone:
IRVINE, CA 92602n
714-614-8568
i"�
Pi `•t�
�i
.k'. NEWPORT BEACH, CA 92660
Phone: 949-752-1177 State Lie,
Applicant:
DEVERIAN JOE
Address:
21 CALISTOGA
IRVINE CA 92602
Phone:
714-614-8568
Code Edit 2016
Type of Construction: VB
Occupancy Group: R3/U
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 1
No of Units : 1
Bldg Height: 0
Bldg Sprinklers: N
Flood Zone:
Construction Valuation: $7,500.00
Building Permit Fee: $200.00
Plan Check Fee: $174.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$20.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $516.25
PROCESSED BY:
ZONING APPROVAL:
rC : X I Co State w
,
Ire V
tus Llc t?,Y
E :
.. orker's Compensa
Carrie
r,
PollExpuilS
"" gineer
F ress:
t, one:
�s pric�& '�'t•,A_ S Designer: l
3f�5� Add r s P�
ho e, ,,((11��j�i�C�
Rear: I pecialyortditions: O/B AU H A
Front: I Ilc do ri1+
Left: /p
Ad !one
R-: \"- $0.00
Gra g Bonds Fee: $0.00
Gradi P\-00�
Consultant
Gradint Fee: 0.00
Gradin$0.00
WQ IElectri- "$14.00
Mech$8.00
Plumbin%. $18.00
check
Fair
eIn-' ousing Fee:
is Works Department -
Park Dedication: $0.00
PAN Plan Check: $41.25
San Dist: $0.00
NMUSD Fee: $0.00
0-�-
Fire Department
40.00
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 : $0.00 Fee Due at
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL: APPROVAL TO ISSUE:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$516.25
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury
that I am exempt from the Contractors' State License Law for the reasons) 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
Pro ions 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
than five hundred dollars ($50
).
Oe
as owner of the property, or my employees
with wages as their sole compensation, will do (_) all of or L) portions of the work, and the stru of tended or offered for sale (Section 7044,
si ass and Professions Code: The Contractors'
State License Law does not apply to an owner of property who, through employees' net effort butoror improves the property, provided that the
improvements are not intended or offer
If for sale. If, however, the building or improvement is sold within one year of com a Owner -Builder will Eva he burden of proving that it was not built or
improved for the purpose of sale).
'h
❑ I, as owner of the property, am excl
isively contracting with licensed Contractors to construct tt action 7044 useless and Professions Cc : TF a Contractors' State License Law does not
apply to an owner of property who build
or improves thereon, and who contracts for the with a licensed ConJe5_11 vant to the ConetLa_gt �j St to License Law).
❑ I am exempt from Iicensure under t
s Contractors' State License Law - owing reason: A t'``\ IIUU r'
By my signature below I acknowledge t
iat, except for my person nce in 'ch I must have resided or at least qne io ompletion of the im over is covered by this permit, I cannot legal)
the tic ble. Section 7044 the Business and
sell a structure that I have built as an o
ner-builder if een on tr ed its ant' licensed c ra�1�/m erstand that a copy of a of
Professions Code, is available upon re
uest s a C on i b i t e following Web site:h�t�p.//5dww. leginfo.ca.gov/calaw.htm
Signature of Property Owner or Au
nt Date
LICENSED CONTR DE
-A TIO ( ;= (tU
I hereby affirm under natty of perjury
hat I a ed under provisions of Chapter (commencing wit c�t�n -00) of Division 3 of the meiss and Pro ssions Code, and my license is in full force
and effect License C as P1
License No Co tra r Signature
WORKERS' COMPE SA N DE
LARATI :-
WARNING: FAILURE TO SECU E WORKERS' C99
SATI OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOXER.Tt 121M1 AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED OUSAND DOLLARS ($1D0,000), IN ADDITION TO THE
COST OF COMPENSATION, DA AGESQ
- OR IN CTION $]O6AF THE LABOR CODE, INTEREST ANO.ATTCSRNEI^e FEES:;i
reby affirm under an y of
`- f he fdFeclarationsI
have and will mainta a
onsent to self Insur� for workers' compensation Issued by'the Director of Industrial Relations s pro d for b Section 3700 of the Labor Code, for th
rman' of the work for hlc(lTIIt
Is Issued
ave and will maintain rkers' C
Ion Il�u,`ra a aS rbqulred by Section 3700 of the Labor Code for the perrormsrice of the' which this pe it is issued. My workers' compensatio
urance carrier and policy n mbe e:
w
vl -,
Carrier
F umber Expdajion to --
-' Phone # 1
e of Agent
erforman of th
ertify tyuldome
work for which this permit is Issued J sfiall not employ any person In any manner so as to become subject cord nSaticn laws of California, and agre
t, if I shosubjec
rs compensation Provisions of Section 3700 of the Labor Code, shall forthwith comply with t OWs a
/f
`*:?°'"'•
Signature o
t ate
---
-` �-
DECLARATION RdEeGAR S
CTION- ING AGENCY
It ofC er
hereby P Y P 1 rY
h,
al?here is a construction lending agency for the Performance of the work for which this permit Is issued {Section 3097, Civil Code).
-
Lender's Name '
Lender's Address - �"
By my signature below, 1 certify to as In
of the following:
I am the property owner or author
ed to act on the property owner's behalf.
I have read this application and th
information I have provided is correct. -
I agree to comply with all applicabl
' i11y and county or Dances and state laws relating to building construction.
authorize representatives of this c
,or unty toe a ova-identifieiiproperty for inspection purposes. _
Signature of Props Owner or Autho
A ant - Print Property Owner's or Authorized Ageii;s-(Jame
ACTION
DATE
B, .,..
DECLA ION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONL
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED
17j /I
EIEPA
PERMIT EXTENDED
L1AQMD
PERMIT FINAL
OASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
CERTIFICATE OF
PROPOSED DEMOLITION
OCCUPANCYISSUED
SIGNATURE:
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