HomeMy WebLinkAboutX2019-2719 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIillillillillillillilliillillilillilljlI
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 2 7 1 9
Permit Counter Phone (949)644-3288
c" Inspection Requests Phone (949)644-3255
Combination Type - SFP
Alf -N --
COMB Permit X2019-2719
Project No :
Issued Date: 09103/2019
Inspection Area : 1
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE*RtQ�7jK9LID INSPECTION.
Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from -8: 6p1SPq0 p.m. No work on Sundays or Holidays
Job Address:
4206 RIVER AVE NB
Type of Construction:
VB
' Occupancy Group:
Description:.
SFR REMOVE WALL & DOOR NEAR LINEN CABINET TO RESTORE TO ORIGINAL CONDITION
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Legal Desc.:
CANAL SECTION BILK 242 LOT 4
2
No of Units :
w
Owner.
BENSON NUEUJUDI
Contractor:
OWNERIBLDR N
�®y"'�ut ct
�,4r1�re�
Address:
4206 RIVER AVE
Address:
JUDI BENSON
Phone:
NEWPORT BEACH, CA 92663
949.749.3717
Plan Check Feer $0.00
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Overtime Plan Ck:
Phone:
949-749-3717
Phone: State Lie:
Applicant:
OWNER/BLDR
Con State Lie:
OIB
Engineer:
Address:
JUDI BENSON
Lie Expire:
CA Seismic Safety:
Address:
Phone
Code Edit :
2016
Type of Construction:
VB
' Occupancy Group:
R3IU
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage: 0
No of Stories:
2
No of Units :
1
Bldg Height:
0
Bldg Sprinklers:
Left: I
$0.00
Flood Zone:
X
Construction Valuation: $2.00
Building Permit Fee:
$104.00
Plan Check Feer $0.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $105.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Bus Lic:
$0.00
Lie Exp Date:
$0.00
Worker's Compensation Insurance
Carrier:
Grading PC Consultant:
Policy No:
Grading Permit Fee:
Expire:
Grading PC Fee:
Building Setbacks
Rear: /
$0.00
Front: I
$0.00
Left: I
$0.00
Right: I
Excise Tax:
$0.00
.Additional Fee :
$0.00
Grading Bonds Fee:
$0.00
Grading PC Consultant:
$0.00
Grading Permit Fee:
$0.00
Grading PC Fee:
$0.00
WO Insp. Fee:
$0.00
Electrical %:
$0.00
' Mechanical W
$0.00
Plumbing %:
$0.00
Phone:
Designer:
Address:
Phone:
State Lie:
Special Conditions: LIQUEFACTION AREA
Fire
Planning Department-
Fire Department
Plan check Fee
Fire Inspection:
Fair Share:
Fire Plan Rev
SJH Trans :
Demolition Fee
In -lieu Housing Fee
Building Dept Adm
Public Works Department-
Park Dedication :
$0.00
PAN Plan Check:
$0.00
- San Dist:
$0.00
NMUSD Fee:
$0.00
NO PLANS PER (MK)
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee: $0.00 Fee Due at Permit Issuance : $105.00
® oo e o oEc eo
c e o c o m o
u a w c o a 0U$I,IC 1y0,`RKS APPROVAL:
VIA 9
PLAN CHECK BY:
°cWRO AGTOISSUE:
c � m
occ :,� vc c � occ tion
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee: $0.00 Fee Due at Permit Issuance : $105.00
® oo e o oEc eo
c e o c o m o
u a w c o a 0U$I,IC 1y0,`RKS APPROVAL:
VIA 9
PLAN CHECK BY:
°cWRO AGTOISSUE:
c � m
occ :,� vc c � occ tion
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)
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
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) ol�.PivisioD 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).
I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) 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
tor
for the purpose of sale).
, 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 doe_, not
pply to an owner of property who builds or improves thereon, and who contracts for the projects with a,.licenn d -Contractor pursuant to the Contractors' State License Law).
I am exempt from licensure under the Contractors' State License Law for the following reason: `X°i-f�i4
ly my signature below I acknowledge that, except for my personal residence in which I must have residEtVor 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 a copy of the applicable law, Section 7044 of the Business and
'rofessions Code, is available upon request whthi pplica' n isubmitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. C,
signature of Property Owner or Authorized Agen s Dat�A/ ��
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed er provisions of Chapter 9 (commencing with Section 7nnn� -f Division 3 of the Business and Professions Code, and my license is in full force
nd effect. License Class License No Date Contractor Signature
VORKERS' COMPENSATION DECLARATION
IARNING: 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 0700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
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
erformance of 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'
rance carrier and policy number are:
Policy Number
Date
1e of Agent -rnone w
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
, if I should become suubb'ect two tthh/e,}\�'orrkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. cY
lature of ApplicanUC \"�C/✓��L Dak 9 _ 3 ^ /
_.-_._._.. __tee__..._ _�. __..__._... _............_.....
ereby affirm under penalty of peyury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Ider's Name Lender's Address
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 toynter the above -identified property for inspection purposes. y ^�
DATE BY DECLI ATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403 •• ••• • a a•
EXPIRED 15UBMITTED ASBESTOS NQLFICAT10NT0• • • ••
CANCELLED EPA • • •.
PERMIT EXTENDED
PERMITFINAL
CERTIFICATEOF
OCCUPANCYISSUED
NOTIFICATION 15 NOT APPLICABLE TO
M ITION •• ••• • • e •••
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