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Home My WebLink AboutX2018-3193 - Permitsnq i, COMB Permit: X2018-3193 •tatyof Nqvtipir.Beabh -Building Division IIIIIIIIIIIIIIIIIIIII'IIIIIIIIIIIIIIIIIIII II 100 Civic Center 6rive°.ygwpor(,°Beach, CA 92660 X 2 0 1 8 3 1 9 3 Project No: 2484-2018 Permit Counter Phone (949)644-3288 : Inspection Requests Phone (949)644-3255 ° o • Issued Date : 10/30/2018 Combin2jioR T$pe-JZRAD, t , o Inspection Area : 4 - - ° ' 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: 10 TRAFALGAR NB Description: SFR YARD DRAINAGE, RE -WATERPROOF RETAINING WALL, ADD FRENCH DRAIN AS NEEDED Legal Desc.: N TR 9589 LOT 5 Owner: KALFAPINA Contractor: BROWN CONSULTING & CONSTRUCITON Architect: Address: 10 TRAFALGAR Address: 1961 E MIRALOMA AVE #C Address: NEWPORT BEACH, CA 92660 PLACENTIA CA 92870 Phone: Phone: 714-223-0531 Phone: State Lie: Applicant: KISLIG MATT Con State Lie: 725404 Engineer: Address: 1961 E. MIRA LOMA AVE STE C Lie Expire: 07/31/2020 Address: PLACENTIA, CA 92870 Bus Lie: BT30064971 Phone: 714.223-0531 Lie Exp Date: 10/31/2019 Phone: State Lie: Code Edit: 2016 Worker's Compensation Insurance Designer: Type of Construction: Carrier: STARSTONE NATL INS CO Address: Occupancy Group: U Policy No: T20180146 Added /New sq.ft. Bldg: 0 Expire: 07/01/2019 Phone: fit, Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: / Special Conditions: No Units: 1 Front: / of Bldg Height: 0 Left: / Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $0.00 Building Permit Fee: $0.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee : $40.00 Fire Inspection: $0.00 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: $0.00 Grading Permit Fee: $312.00 In -lieu Housing Fee: $0.00 Building Dept Adm $0.00 Energy Compliance: $0.00 Grading PC Fee: $312.00 Public Works Department- General Service $0.00 CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access: $0.00 P/W Plan Check : $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $0.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $664.00 Plan Check Fee : $352.00 Fee Due at Permit Issue/an_ce : $312.00 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: F1/- PLAN CHECK BY: GRADING APPROVAL: 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 reasons) indicated below by the checkmark(e) P•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 7004) of tNJfSion 3:o%he 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 perp* subjeets the applicant to°a citl,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 (_) all of or U portions of the work, and the structure is not intprIdecLor offeted 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 of 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 ErIm roved 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.htmi. 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 70 0 of Division 3 of the Business and Profusions ' ens an my is in full force and effect. License Class License No Date 16170—f,51 Contractor Si naturgl WORKERS' COMPENSATION DECLARATION �l NARNING: 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 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: IT-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 th, mance of the work for which this permit is issued. Policy No. Sri h ve 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' compensatior insOrAnce carrier and policy number are: Policy Number Date Jame of Agent vnone IF :1I certify that, in the performance 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 hat, if I should become subject t orker ' com/yensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ) 3IgnatureofApp. icant ( G r Dat )ECLARATION REG A IN0 CONSTRUCTION LENDING #GENCY hereby affirm under penalty of perjury that there is a cons lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). -ender's Name Lender's Address 3y 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 to enter the abov -identified property for inspection purposes. 3ignature of Property Owner or Authorized A ent r ��.sL� Print Property Owner's or Authorized Agent's Name °� Date ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED PERMITCANCELLED NOTIFICATION TO PERMITFINAL UASBESTOS NOTIFICATION IS NOTAPPLICABLE TO CERTIFIC4TEOF17 /q `lit' PROPOSED DEMOLITION OCCUPANCYISSUED I t� SIGNATURE: