HomeMy WebLinkAboutF2018-0480 - Permits1rr City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
}" Permit Counter Phone (949)644-3288
Job Address: 1045 W BALBOA BLVD NB
Inspector Area: 1
Owner:
PACK INVESTMENT GROUP LLC
Address:
1041 BALBOA BLVD W
Occupancy Group:
NEWPORT BEACH, CA 92661
Phone:
0
Applicant:
CASEY MONTY
Address:
1101 KINGSTON
No of Units :
LAHABRA CA 90631
Phone:
714-476-5370
Code Edit: 2016
N TR 234 BLK 10 LOT 12 \
Type of Construction:
V -B -SPR
Occupancy Group:
R3/U
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
3
No of Units :
0
Flood Zone:
0.2
Bldg Sprinklers:
Y
e
N TR 234 BLK 10 LOT 12 \
Contractor:
FIREPROOF FIRE PROTECTION
Address:
1101 KINGSTON DR
NORGUARD INS CO
LA HABRA CA 90631
Phone:
714-476-5370
0 211 512 01 9
Issued Date:
0910512018
Setback- Front:
Planning Zoning PC Fee
Rear:
$0.00
Left:
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$0.00
Public Works Traffic Plan Check Fee;
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Plan Check Fee:
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N TR 234 BLK 10 LOT 12 \
Contractor:
FIREPROOF FIRE PROTECTION
Address:
1101 KINGSTON DR
NORGUARD INS CO
LA HABRA CA 90631
Phone:
714-476-5370
0 211 512 01 9
Issued Date:
0910512018
Setback- Front:
Planning Zoning PC Fee
Rear:
$0.00
Left:
fi
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•
••
$0.00
Public Works Traffic Plan Check Fee;
0
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Plan Check Fee:
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Description: SFR FIRE
Legal Description:
N TR 234 BLK 10 LOT 12 \
Contractor:
FIREPROOF FIRE PROTECTION
Address:
1101 KINGSTON DR
NORGUARD INS CO
LA HABRA CA 90631
Phone:
714-476-5370
Con State Lie: 876004
Lie Expire: 04130/2020
Bus Lie:
BT30040107
Lie Exp Date:
08131/2019
Worker's Compensation Insurance
Carrier:
NORGUARD INS CO
Policy No:
MOWC901180
Expire:
0 211 512 01 9
Issued Date:
0910512018
Setback- Front:
Planning Zoning PC Fee
Rear:
$0.00
Left:
Fire Plan Check Fee:
Right:
Public Works PC Fee:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
FIRE Permit: F2018-0480
Project No: 2114-2018
Inspection Requests Phone (949)644-3255
(X2017-3959)
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
$0.00
$0.00
$0.00
$0.00
$0.00
State Lie:
State Lie:
CASEY MONTY
1101 KINGSTON OR
LA 90631
714.476-476 5-537070
Records Management
$419.00 Fee Due at Permit Issuance
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 190 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
$4.00
$0.00
$0.00
$0.00.
FEES
Construction Valuation:
$3,600.00
Building PC Fee:
$190.00
Fire Residential Alarm PC Fee:
Building Overtime PC Fee:
$0.00
Planning Counter Review:
Building Extention Fee :
$0.00
Planning Zoning PC Fee
Building Investigation Fee:
$0.00
Fire Plan Check Fee:
$0.00
Public Works PC Fee:
Fire Permit Fee:
$0.00
Public Works Traffic Plan Check Fee;
Building Permit Fee :
$225.00
TOTAL FEE :
$419.00
Plan Check Fee:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
FIRE Permit: F2018-0480
Project No: 2114-2018
Inspection Requests Phone (949)644-3255
(X2017-3959)
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
$0.00
$0.00
$0.00
$0.00
$0.00
State Lie:
State Lie:
CASEY MONTY
1101 KINGSTON OR
LA 90631
714.476-476 5-537070
Records Management
$419.00 Fee Due at Permit Issuance
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 190 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
$4.00
$0.00
$0.00
$0.00.
•e •
OWNER -BUILDER DECLARATION o a •; : • •.
1 hereby affirm under penalty of perjury that I am exempt from the CDnteaGL%%' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s)
(Section 7031.5, Business and Professions Code: Any city or county that rE$uires 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.Contragto0To' 2tafe 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 tl}e allegata cxe•mMioR. Rey violatQn 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 coonpetsation,`Win de t✓') 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 98t appfy 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
im 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 legal)
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.html.
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 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class License No Contractor Sign u _
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL R" $700,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
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 I
performance of the work for which this permit is issued!" Policy No.
I 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' compensatio
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
13certify 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 ogre
that, if I should becomp.,subjectito the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thosee2rrowisions.
Signature of Applicant - Date
DECLARATION REGA IDIAC6NiTRUCTION LE AGENCY t_z�
I hereby affirm under penalty of perjury that there isco struction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By 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 above -identified propeqyJDr4nspeCtl6n purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name Date `l zJk ASBESTOS
ACTION BATE " BY LARAT/ON OF COMPL7ANCEMRTN CODEOF � FOR OFFICE OSEONLY
FEDERAL REGULATIONS PART fit' OFTtTLE40AND
PERMITEXPCRED AOMDRULE 1$03.
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QCCi1PANCYtSSQED SIGNATURE: