HomeMy WebLinkAboutX2019-2398 - Permitsi
sur $ City of Newport Beach- Building Division
rss 100 Civic Center Drive, Newport Beach, CA 92660
R = Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
r�crsmv�'' Combination Type - SFP
COMB Permit: X2019-2398
X 2 0 1 9 2 3 9
Project No:
Issued Date : 0810112019
Inspection Area : 2
No of Stories: 1 - Building Setbacks Rear: / Special Conditions:
No of Units: 1 Front: /
Bldg Height: 0 Left: /
Bldg Sprinklers; Right:.
Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone
11 Cnncfnicfinn Valuatinn- $11 nnn_nn
-
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. -
Excise Tax:
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:
1120 DOLPHIN TER NB.
Additional Fee
$0.00
Overtime Plan Ck
Description:
SFR -(2) SLIDER REPLACEMENTS, LIKE
FOR LIKE
-
$0.00
Legal Desc.:
N TR 5130 LOT l l
Record Management :
$0.00
Grading Permit Fee:
Owner:
BRENNER MICHAEL
Contractor:
RENEWAL BY ANDERSEN OF OC
Architect:
Address:
1120 DOLPHIN TER
Address:
22982 ALCALDE DR #100
Address:
$0.00
CORONA DEL MAR, CA 92625
LAGUNA HILLS CA 92653
$0.00
Phone:
$0.00
Phone:
.714-259-5120
Phone: State Lie:.
Applicant:
RENEWAL BY ANDERSEN OF OC
Con State Lie:
990416
Engineer:
Address:
22982 ALCALDE DR #100
Lie Expire:..
0212912020
Address:
LAGUNA HILLS CA 92653
Bus Lie:
BT30046925
Plan Check Fee
Phone:
714-259-5120
Lie Exp Date:
04/30/2020
Phone: State Lie:
Code Edit:
:2016
Worker's Compensation Insurance
Designer:
Type of Construction: V -B
Carrier:
EVEREST NATIONAL
Address:
Occupancy Group: R31U
Policy No:
MWC31416800
Added /New sq.ft. Bldg: 0
Expire:
1010112019
Phone:
Added /New sq. ft. Garage:. 0
No of Stories: 1 - Building Setbacks Rear: / Special Conditions:
No of Units: 1 Front: /
Bldg Height: 0 Left: /
Bldg Sprinklers; Right:.
Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone
11 Cnncfnicfinn Valuatinn- $11 nnn_nn
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
INSPECTOR
0000
$0.00
Building Permit Fee:
$248.00
Excise Tax:
Fire Department
Plan Check Fee: $0.00
Plan check Fee:
Additional Fee
$0.00
Overtime Plan Ck
$0.00
Grading Bonds Fee:
Investigation Fee:
$0.00
Grading PC Consultant
SJH Trans :
Record Management :
$0.00
Grading Permit Fee:
$0.00
Energy Compliance:
$0.00
Grading PC Fee:
Building Dept Adm
CA Seismic Safety:
$0.00
WQ Insp. Fee:
General Service
Disabled Access:
$0.00
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
Building Green Fee :
$1.00
Mechanical %:
Ban Dist:
$0.00
Plumbing %:
$0.00.
TOTAL FEE : $249.00
k
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
INSPECTOR
0000
$0.00
Planning Department-
Fire Department
$0.00
Plan check Fee:
$0.00
Fire Inspection:
$0.00.
Fair Share :
$0.00
Fire Plan Rev
$0.00
SJH Trans :
$0.00
Demolition Fee
$0.00
In -lieu Housing Fee :
$0.00
Building Dept Adm
$0.00
Public Works Department-
General Service
$0.00
Park Dedication :
$0.00
Refund Deposit
PM Plan Check:
$0.00
Grading Bond:
$0.00
Ban Dist:
$0.00
$0.00.
NMUSD Fee:
$0.00
$0.00
Plan Check Fee
; $0.00
Fee Due at Permit Issuance
PUBLIC WORKS APPROVAL
PLAN CHECK BY:
APPROVAL TO ISSUE:
00 ¢
0 0 0
$0.90
$0.00
o s
$eB.Obr�
$
x000
v$0..00
$0.00
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o$d11B ¢
0$0401
0 C
$249.00
0
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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)
lection 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
ie 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
'rofessions 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
of more than five hundred dollars ($500).
7 I, 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,
lusiness 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
nprovements 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
nproved 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
pply 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).
7 I am exempt from licensure under the Contractors' State License Law for the following reason:
ly 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,
ell 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 acopy of the applicable law, Section 7044 of the Business and
'rofessions 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 - Dat
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pro essi Cod pd my license is in full force
nd effect. License Class License No Date w i Contractor Signatu
I/ORKERS' COMPENSATION DECLARATION
ARNING: 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
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
rh�ereby affirm under penalty of perjury one of the following declarations:
k2 I 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
e rmance 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'
carrier and polic,��,\\number are: _
R F YVSyG, /0
Policy Number Ly)6'st`i')S Expiration Date
of Agent
�I certify that,'ip•F2rtormomcetho,tlhework 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
lg,� �l�hould bsc rri t tri kers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
• •
iyi nature of Applicant• • y
15CL•ARATION REGARIRt G CONSTRUCTION LENDING AGENCY -
he&6y affirm updeir 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).
.%der''s Name+ • Lender's Address
ly rMysignature a ow, I certify to each of the following:
• • i®m the propMpowner or authorized to act on the property owners behalf.
• • l leave read this application and the information I ave provided is correct.
• • i agree to corliply with all applicable city and co�P ordina ces and state laws relating to building construction..
I althorize ripre.lontatives of this city or county Co er the yhoove identified property for inspection purposes. /�'
Sranature of Prnnariv owner nr Authorized ADenA V-1-) Print Prooertv Owner's or Authorized ADent's Nameb Yom" �t ' v �t Date ' )
AN19014 + • . DATE BY —)►DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
•••• ,///� REGULATIONS PART61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED I U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITEXTENDED LIAQMD
PERMITFINAL .1q_14 ASBESTOS NOTIFI TIONI NOS�LICABLE TO
CERTIFICATE OF ii PROPOSED DEMO N
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