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HomeMy WebLinkAboutM2019-0045 - Permitswh City of Newport Beach - Building Division I IIIIIIIIIIIIIIIIIIIII�III�IIIIIIIIIIIIIIII III a4' 100 Civic Center Drive, Newport Beach, CA 92660 M 2 0 1 9 0 0 4 5 Permit Counter Phone (949)644-3288 Job Address: 1150 POLARIS DR Floor: Suite: Description of Work: SFR REMOVE/REPLACE (3) PILES Inspector Area: 3 Legal Description: N TR 4224 LOT 115 Owner: LEYTON NADINE Address: 1150 POLARIS DR NEWPORT BEACH, CA 92660 Phone: State Lic .Applicant: MARISA/SWIFT SLIP DOCK Address: 6351 INDUSTRY WAY WESTMINSTER CA 92683 Phone: 949-631-3121 Special Cond: Issued Date 0611912019 Valuation: $14,000.00 Inspection Fee: $287.00 Plan Check Fee $302.00 OT Plan Check Fee: $0.00 Investigation Fee: $0.00 Building Green Fee: $1.00 TOTAL FEE : $725.00 Bldg: 0 Contractor: SWIFT SLIP DOCK/PIER BUILDERS Address: 6351 INDUSTRY WAY µ� 3 ai WESTMINSTER CA 92683 Phone: 949-631-3121 C-066947 6 Con State Lic:797052 Lic Expire: 07/31/2019 Bus Lic: BT01122734 Lic Exp Date: 11/30/2019 Fire Inspection Fee: Fire Plan Check Fee: Records Mangement: Harbor Plan Check Fee: Plan Check Fee: $0.00 $0.00 $4.00 $131.00 $0.00 HARBOR Permit: M2019-0045 Project No : 1403-2019 Inspection Requests Phone (949)644-3255 $0.00 Plan Dep - Counter Review: $0.00 Plan Dep - Zoning Plan Check: $0.00 Plan Dep - OverTime Plan Check: $0.00 Fee Due at permit Issuance: $725.00 II PROCESSED BY: HARBOR RESOURCES: L ANJ PLAN CHECK BY: APPROVAL TO ISSUE: OTHER DEPARTMENTS: FINAL INSPECTION: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION FN. µ� 3 ai 6 i kJ, e Engineer: PETROV PLAMEN •mme 00 ° m e mmuoa` Address: 28161 CASITAS CT LAGUNA NIGUEL CA 92677 Phone: 714-717-7542 ° m m m mmm°° ommm ° Designer: ° Address: omemco c u Phone: 0 Longshoremen's and Harbor Workers' Compensation Declaration - Carrier: AMERICAN LONGSHOR Policy No: ALMA01662-01 $0.00 Plan Dep - Counter Review: $0.00 Plan Dep - Zoning Plan Check: $0.00 Plan Dep - OverTime Plan Check: $0.00 Fee Due at permit Issuance: $725.00 II PROCESSED BY: HARBOR RESOURCES: L ANJ PLAN CHECK BY: APPROVAL TO ISSUE: OTHER DEPARTMENTS: FINAL INSPECTION: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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) Ilion 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 fc 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 an 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 c 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, 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 th rovements 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 c 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 no ly 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). I am exempt from licensure under the Contractors' State License Law for the following reason: -- - 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 thispern a structure tlydt9 h%jfe 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 fessiors Code!is•.1 ailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. ■atu6e.of Propeirly0 ner or Authorized Agent Date e ,%NSgD CONTRACTOR'S DECLARATION irelxyaffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (comlyInging with S ctiio 7000) of Division 3 of the Busin s Pro sic ode, and my license is in full force yeffect. Licens4cless License No. Date W Contractor Signature N%SAOREMEN'S' & HARBOR WORKERS' COMPENSATION DECLA TION tNSNG1 FAILURE' JO S%CU:RE LONGSHOREMEN'S S HARBOR WORKERS' COMPENSATION COVERAGE IS U LAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 0,000), W ADDITION Qa.THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following ,Mgtfbns: •..• � . l;have and will maintain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is felt. • My ••Wbfl�ars' compensation insurance carrier and policy number are: Fier• • • Policy Number Expiration Date eao4 gent . . . Phone# Business I 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, that, if I should becom subject to the workers' cam tion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. rture of Applicant: /te: 1 Gt 1 .ARATION REGA DING CONSTRUCTION LE IN AGENCY I hereby affirm ufnder penalty of perjury that there is a construction lending. agency for the performance of the work for which this permit is issued (Section 3097., Lenders Name Lender'sAddress By my signature below, I certify to each of the following: I am the property owner or authorizedto 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 rep s Ives of this city or u y to enter the above -identified property for inspection pu Dees. f� Signature: � Print Name: MrAn`IJSA t v Id1 L� S 17 CTION DATE BY CLARATION CO PLIANILL MTH CODE OF FOI FEDERAL REG. LATIONS PART Of OF TITLE40AND CERTIFICATE OF OCCUPANCYISSUED 1 SUBMTTED ASBESTOS NODFICATION TO: © EPA AQMD ASBESTOS NOTIFICARONIS NOT APPLICABLE TO PROPOSEDDEMOUTIOM SIGNATURE: Code).