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Home My WebLink AboutX2018-1625 - Permitsryw/•�, City of Newport Beach - Building Division IIIIIIIIIIIIIIIIUIIIIIIIIIIIIIIII'lllllll II COMB Permit: X2018-1625 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 8 1 6 2 5 Project No : 0150-2018 - Permit Counter Phone (949)644-3288 v & Inspection Requests Phone (949)644-3255 Combination Type - SFP Issued Date: Area : 2016 4saw Inspection Area 5 PERMITS EXPIRE 980 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 4701 SURREY DR NB Description: SFR -DELTA 3- REDUCTION OF SCOPES SF INCREASE TO 1ST FLR AND REDUCE GAR BY 12 SF (X2018-0177) Legal Desc.: N TR 3519 LOT 67 r @ • 1 Owner: PLEASANTVILLE ROAD PARTNERS LLC Contractor: NICHOLSON CONSTRUCTION CO Architect: TEALE MARK l i S Address: 1 CORPORATE PLAZA DR STE 110 Address: 1 CORPORATE PLZ #110 Address: 2900 BRISTOL ST BLDG A203 NEWPORT BEACH CA 92660 NEWPORT BEACH CA 92660 COSTA MESA CA 92626 Phone: 949-756.8393 Phone: 949-872.6637 Phone: 949-975-0123 State Lic:CO22162 Applicant: TEALE MARK Address: 2900 BRISTOL ST STE 203 COSTA MESA CA 92646 Phone: 949-975-0123 Code Edit: 2016 Type of Construction: V -B -SPR Occupancy Group: R3/U Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: 1 No of Units : 1 Bldg Height: 0 Bldg Sprinklers: Y Construction Building Permit Fee: Plan Check Fee: $0.00 Overtime Plan Ck: Investigation Fee: Record Management: Energy Compliance: CA Seismic Safety: Disabled Access: Hazardous Mat Building Green Fee: 5 -12 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11 TOTAL FEP: $33.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Con State Lic: 660295 Engineer: Lic Expire: 12/31/2018 Address: Bus Lic: BT98032850 In -lieu Housing Fee: Lic Exp Date: 04/30/2019 Phone: Worker's Compensation Insurance Designer: Carrier: STATE FUND Address: Policy No: 9074255 General Service Expire: 10/0112018 Phone: Building Setbacks Use Zone: Excise Tax: Additional Fee Grading Bonds Fee: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: Rear: / Front: / Left: / Right: / 3arkino Spaces $0.00 $33.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee HAKIM FADY 124 PEONY IRVINE CA 92618 esee 310.422-1536 State Lic:C-075736 ...... Special Conditions: REV18.0812 (DELTA 3) Planning Department - Plan check Fee: Fair Share e0 m e m•m`me Gm�� SJH Trans Fire Inspection: In -lieu Housing Fee: $0.00 Public Works Department - Park Dedication : $0.00 P/W Plan Check: $0.00 San Dist: $0.00 NMUSD Fee: $0.00 $33.00 PUBLIC WORKS PLAN CHECK Bl APPROVAL TO I) 0 oro e o 0 me e mot•oc e m m o • s • o o• n oarou m s•ooa moemoo o • o Fee Due at Permit Issuance : $0.00 omoomu Fire Department e0 m e m•m`me Gm�� $0.00 Fire Inspection: $0.00 $0.00 Fire Plan Rev $0.00 $0.00 Demolition Fee $0.00 Building Dept Adm $0.00 General Service $0.00 Refund Deposit $0.00 Grading Bond: $0.00 $0.00 $0.00 Fee Due at Permit Issuance : $0.00 OWNER -BUILDER 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 U all of or (_) 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 bgjldsor 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 legalll 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:l/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 000) of Division 3 of the Business and Professions Code, and my li ;7 is in full force and effect. Licenser4ass License No Date Contractor Signature_tC - NORKERS' Cbm4EIVSATION DECLARATION NaEMBI(i:hAILURE6T"ECURE 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 OOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. • •• hereby affirm under penalty of perjury one of the following declarations: and will maiDtain 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, SIT ce of ltigy/br jfor which this permit is issued. Policy No. and will.maintein 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' came? agcjgAicy number are: Policy Number Date Larne of.Agent • . Phone # •••... Gt Sib that, in the p@rformance 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 %t, i.f I should ):eco Ale- ub�g tto� the workers' comp?��nk tion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.— lignatureofApplicant _�9✓�¢i.JtJ�� lli/LI�Q_.� Date )ECLARATION RE RIDING CONSTRUCTION LENDING AGENCY hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for whichthis permit is issued (Section 3097, Civil Code). Ender's Name Lender's Address ly 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 count to en r the above-idre5ntified property for inspection purposes. C� iionature of Prooertv Owner or Authorized ADent Print Prooertv Owner's or Authorized ADent's Name ACTION DATEI BY I DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED I U I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED EPA PERMIT EXTENDED QMD PERMITFINAL ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO CERTIFICATE OFp� /`/ A 'D PROPOSED DEMOLITION OCCUPANCY 155UED /,! SIGNATURE: