HomeMy WebLinkAboutX2017-3543 - Permits�pwno City of Newport Beach - Building Division IIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2017-3543
100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 1 7 3 5 4 3
Project No: 2465-2017
�,- _ � Permit Counter Phone (949)644-3288
v Jk Inspection Requests Phone (949)644-3255
r`rkrpn� .b Combination Type - BLDG GRAD PLUM Issued Date : 11106/2017
: �. Inspection Area : 8
PERMITS EXPIRE 160 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 6:00 a.m. to 6:00 p.m. No work on Sundays or Holidays
Job Address: 19 OCEAN VISTA NB �''•
Description: MFR -FIREPLACE F& YARD DRAINAGE
Legal Desc.: TR 9676 LOT 4 UNIT 21 OF PROJECT LOCATED ON AP 442-361-31 TOGETHER
Owner: MEUER STEPHANIE
Address: 19 OCEAN VISTA
NEWPORT BEACH, CA 92660
Phone
Applicant: MCCLOSKEY SHANNA
Address: 540 N GOLDEN CIR 4212
SANTA ANA CA 92705
Phone: 949-945-4163
Code Edit: 2016
Type of Construction:
Occupancy Group: U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 0
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Construction Valuation:
Building Permit Fee: $292.00
Plan Check Fee: $254.04
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management :
$6.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $1,202.82
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Excise Tax:
Additional Fee:
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
$0.00
Planning Department -
Fire Department
$0.00
Contractor:
GROVE JAMES A
Architect:C;
$0.00
$0.00
Fair Share:
Address:
540 N GOLDEN CIRCLE 212
Address:
$0.00
SJH Trans :
$0.00
Demolition Fee
SANTA ANA CA 92705
$293.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
Phone:
949-945-4163
Phone:
State Lic:
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°
Con State Lic:
512565
Engineer:
RAHMAN MOKSUDUR
•oaaa �:a
Lic Expire:
0212812018
Address:
14616 MCKENDREE AVE
$0.00
$0.00
Bus Lic:
BT30037477
CHINO CA 91708
$0.00
`:
Lic Exp Date:
12/31/2017
Phone:
213-400-8078 State Lic:C-069263
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eco'`pibw
$0.00
Plan Check Fee:
$547.04 Fee Due at Permit Issuance :
$655.78
0
Worker's Compensation Insurance
Designer:
•++ o
°O oco
Carrier:
CALIFORNIA INS
Address:
PLAN CHECK BY:
Policy No:
4678346801
_
APPROVAL TO ISSUE:./v
Expire:
1210312017
Phone:
Building Setbacks
Rear: /
Special Conditions:
Front: /
Left: /
Right: /
Excise Tax:
Additional Fee:
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
$0.00
Planning Department -
Fire Department
$0.00
Plan check Fee :
$37.50
Fire Inspection:
$0.00
$0.00
Fair Share:
$0.00
Fire Plan Rev
$0.00
$0.00
SJH Trans :
$0.00
Demolition Fee
$293.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
$0.00
$293.00
Public Works Department-
General Service
$0.00
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
PAN Plan Check : $0.00
Grading Bond:
$0.00
$0.00
San Dist: $0.00
$0.00
NMUSD Fee: $0.00
$0.00
$26.28
$0.00
Plan Check Fee:
$547.04 Fee Due at Permit Issuance :
$655.78
_
PUBLIC WORKS APPROVAL:
p
PLAN CHECK BY:
r�\`
_
APPROVAL TO ISSUE:./v
\-
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), '
ction 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
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
fessions 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
more than five hundred dollars ($500). ,q
1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
:iness 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
Irovements 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
iroved foj2%apose of sale).
1, 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
112 to an In1gp%property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
ram exempt from licensure under the Contractors' State License Law for the following reason:
My signaturtbelow 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
-a structure.thst°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 applicAlaw,Sec7044 of the Business and
fessions Cgdi iGavailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
ppture of Prpg@r+°y Owner or Authorized Agent TENSED COtiTAACTOR'S DECLARATIONj%iSy affirmurder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 of i isi n 3 of the Business and Pand my license is in full force
I effect. License Class License No Date Contractor Signatu)RKERS'Cb MWENSATION DECLARATIONNII�g-, FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDLARS ($700,000(, IN ADDITION TO THE
MdF'°COMPEN6A'[ICDT, bAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
II&8by affirm lirlder penalty of perjury one of the following declarations: ,J
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,
Knce of the work for which this permit is issued. Policy No.
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
nsurance carrier and policy number are:
3arrier Policy Number Expiration Date
Jame of Agent Phone #
:1I certify that, in the pe rmance f 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' compensaf n law of California, and agree
hat, if I should become bject a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. i -
3ignatureofApplicant Da 1 t
)ECLARATION RE RDI G„CONS RUCTION LENDING AGENCY
hereby affirm uncle penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3 7, 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 authorii d to act on the PPro rty owner's behalf.
I have read this application and the information I h V p Ovided is correct.
I agree to comply with all applicable city and coun ordi ances and state laws relating to building construction. IWS
I authorize representatives of this city or coun t°j enter above-identi#i d property for inspection purposes.(/�'`,p �' �� /3i nature of Pro ertOwner or Authorized Agen 4 �_ Print Property Owner's or Authorized Agent's Name vF-�� "� Dat
/ k2
ACTION DATE BY DEC RATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGU TIONS PART 61 OFTITLE 40 ANDAQMD RULE
1403
PERMITEXPIRED IS BMITTE SBESTOS NOTIFICATION TO
PERMITCANCELLED EPA
PERMIT EMENDED QM
PERMITFINAL ESTO OT ILATION N 8LE TO
CERTIFICATE OF �,4^I1 / PROPOSED MOI ON
OCCUPANCY ISSUED 1 SIGNATU E:
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