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Home My WebLink AboutF2018-0506 - PermitsCity of Newport Beach - Building Division *F2018-0506* FIRE Permit: F2018-0506 100 Civic Center Drive, Newport Beach, CA 92660 Project No :0988-2018 =� Permit Counter Phone (949)644-3288 P"r�lw�scs Inspection Requests Phone (949)644-3255 Job Address: 19 MONTGOMERY NB Description: SFR FUEL MOD. "A" ZONE ONLY Inspector Area: '4J V- NS Legal Description: N TR 15409 LOT 58 FEES Construction Valuation;, Owner: HOPKINS DAVIDIHOPKINS ELIZABETH Contractor: M B CONSTRUCTION Architect: BAILEY DAVID Fire Residential Alarm PC Fee : $0.00 Records Management : Address: 19 MONTGOMERY Address: 27161 CALLE DELGADO Address: 23183 LA CADENA DR #101 .... ° NEWPORT BEACH, CA 92660 Planning Zoning PC Fee: $0.00 - SAN JUAN CAPISTRANO CA 92675 Building Investigation Fee : LAGUNA HILLS CA 92653 e o • •_ Phone: Phone: 949.378-9291 Phone: 949-573-1050 State Lie: CO27454 • ° °. ° ° ° Fire Permit Fee : $118.00 Public Works Traffic Plan Check Fee; $0.00 Building Permit Fee: $0.00 Applicant: BAILEY DAVID Con State Lie: 761252 Engineer: WILSON KALEN a ,v Address: 23183 LA CADENA DR #101 Lie Expire: 07131/2020 Address: 1371 WARNER AVE #A LAGUNA HILLS CA 92653 Bus Lie: BT30651149 TUSTIN CA 92780 0 • e e ° �' w"" o Phone: 949-573-1050 ' Lie Exp Data: 05131/2019 Phone: 714.576.6524 State Lie: C-083753° ° ° --, . -*• ° Code Edit :2016 Worker's Compensation Insurance Designer: ° a ti 'U0000 ... • Type of Construction: Carrier: STATE COMP Address: 0000 Occupancy Group: U Policy No: 9228890 e • ° Added /New sq.ft. Bldg: 0 Expire: 03131/2019 Phone: ...... ,e. Added /New sq. ft. Garage: 0 ° ° ° No of Stories: 0 Issued Date: 09/14/2018 Special Conditions: SPECAIL FIRE PROTECTION • e ° ,' • • ° - • e ° ° No of Units : 0 Setback- Front: 3 AREA e e Flood Zone: X Rear: 15 010% - Bldg Sprinklers: N Left: 5 Right: 5 FEES Construction Valuation;, $500.00 Building PC Fee : $0.00 Fire Residential Alarm PC Fee : $0.00 Records Management : $0.00 Building Overtime PC Fee: $0.00 Planning Counter Review: $0.00 Building Extention Fee: $0.00 Planning Zoning PC Fee: $0.00 - Building Investigation Fee : $0.00 $0.00 Fire Plan Check Fee: $131.00 Public Works PC Fee : $0.00 $0.00 Fire Permit Fee : $118.00 Public Works Traffic Plan Check Fee; $0.00 Building Permit Fee: $0.00 TOTAL FEE : $249.00 Plan Check Fee: $0.00 fee Due at Permit Issuance : $249.00 PROCESSED BY: OTHER DEPARTMENT: ZONING APPROVAL: PLAN CHECKED BY:: FIRE APPROVAL: APPROVAL TO ISSUE: C _ PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION JYYIYCR-OUILV CR YCNLfiR/inVn 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) (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 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt -from licensure under the Contractors' State License Law for the fallowing reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legall ISP,%$ structur@ Shat 1 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 Codgyia 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 ELGENSED CbNTRACTOR'S DECLARATION I hereby affir{rj yrujea' penalty of perjury that I am licensed under provisions of Chapter 9 (commencing/ERTO ec' n 7 0) of Division 3 of the Busine Prof salon od license is in full force an,Vffect. • ) License Clasen • • License No Datt Contractor Signal ... 0f�gRKERS' COICIFENSATION DECLARATION NARNING: FAILURa TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOCRIMINAL PENALTIES AND CIVIL FINES UP T ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE CQSi$F COMPEIISATIQK, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. her€oy affirf ifnhg�penalty of perjury one of the following declarations: '� .. I have anA w}Ihmaintain 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 thf aerformanceloE 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' Lance carrier and policy number are: Policy Number is of Agent vnone 1 certify that, in the pe o once of the work fQr whi tis permit is issued, I shall not employ any person in any manner so as to become su . if I should become cWo thaworkerg' cpmpe s ovisions of Section 3700 of the Labor Code, I shall forthwith comply with those Date to the worker' compensation laws of California, and Signature of Applicant ` 6' ua r DECLARATION REGA I G C STRUCTI LENDING AGENCY I hereby affirm under p nalty of perjury that there is a construction lending agency for the performance of the work for which this permit is i sued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature belo , 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 inform ion I provided is correct. I agree to comply with all applicable city and rdin nces an stat I ws relating to building construction. dhav I authorize representatives of this city or coun t bo Ent f' perty for inspection purposes. 1Y Lm Signature of Property Owner or Authorized A ent Print Property Owner's or Authorized Agent's Name Dat ACTION DATE BY DECLARATION OF COMPLIANCEWITHCODEOF FOR OFFICE USEONLY FEDERAL REGULATIONS PART BIOF TIILE40AND AQMORULE9403. ❑ ISUBMfTTEDASBESTOSN071FICATIONTO., P€RMITEXPIRED PERMITCANC€LLED ❑ EPA ❑ AQMD ❑ ASBESTOS NOIIRRCAAONIS NOT APPLICABLE TO PERMITEXTENDED PERMITFINAL ,7 LZ 2aICI -4 PROPOSED DEMOLITION. OCCUPANCYISSUED SIGNATURE,