HomeMy WebLinkAboutX2019-3176 - PermitsCity of Newport Beach - Building Divisio, IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
COMB Permit : X2019-3176
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100 Civic Center Drive, Newport Beach, CA 92660
X 2 0 1 9
3 1
7 6
Project No
Building Permit Fee:
Permit Counter Phone(949)644-3288 -
Excise Tax
$0.00
Planning Department -
"c� Inspection Requests Phone (949)644-3255
Fire Department
Combination Type - SFP.
Additional Fee :
Issued Date : 10/0412019
Plan check Fee :
$0.00
Fire Inspection:
Inspection Area : 2
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
-
Grading Bonds Fee:
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
Fair Share :
Job Address: 2405 CLIFF DR NB - -
Fire Plan Rev
$0.00
Description: SFR DOOR CHANGE OUTS (2) LIKE FOR LIKE
$0.00.
Grading PC Consultant :
$0.00
Legal Desc.: P BK 56 PG 49 PAR 1
$0.00
Demolition Fee
Owner: REISS RAY Contractor: SAMSON DOOR AND WINDOW
Architect:
$0.00
Grading Permit Fee:
Address: 2405 CLIFF DR Address:. 1325 NORTH RED GUM ST UNIT 1
Address:
......
Building Dept Adm
NEWPORT BEACH, CA 92660 '. ANAHEIM, CA 92806
Energy Compliance:
$0.00
Phone: Phone:
Phone:
eeo•
State Lic:
omsoco
General Service
$0.00
CA Seismic Safety:
-Applicant: SAMSON DOOR AND WINDOW Con State Lic: 793621
Engineer.
•
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Address: 1325 NORTH RED GUM ST UNIT 1 Lic Expire: 04/3012021
Address:
$0.00
ANAHEIM, CA 92806 Bus Lic: BT30058509
' $0.00
o e
e n
Phone. 949.445-3667 Lic Exp Date: .03/31/2020
Phone:
memo
State Lic:
e o 0
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Hazardous Mat
$0.00
Electrical %:
Code Edit 2016 Worker's Compensation Insurance
.Designer.
O
....
°OOCO
• -
.Type of Construction: V -B - Carrier: MID CENTURY
Address:.
Building Green Fee:
$1.00.
Occupancy Group:. R31U Policy No: A09599801
$0.00
NMUSD Fee: '$0.00
Added /New sq.ft. Bldg: 0 Expire: 07/02/2020
Phone:
m.....
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Added /New sq. k. Garage: 0
Plumbing %:
$0.00
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No of Stories: 3 Building Setbacks Rear:. /
Special Conditions:
TOTAL FEE : $313.00
INSPECTOR
•.. o °
No of Units : 1 - Front: /
PROCESSED BY:
PUBLIC WORKS APPROVAL:
Bldg Height: 0 Left: /
ZONING APPROVAL:
Bldg Sprinklers: Right:.
PLAN CHECK BY:
-
Flood Zone:. Use Zone: Parkino Soaces: 0
- Fire Hazard Zone N
construction vaivation:
als.uuUMU
Building Permit Fee:
$312.00 -
Excise Tax
$0.00
Planning Department -
Fire Department
Plan Check Fee: $0.00
Additional Fee :
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
Overtime Plan Ck:
$0.00
Grading Bonds Fee:
$0.00
Fair Share :
$0.00
Fire Plan Rev
$0.00
Investigation Fee:
$0.00.
Grading PC Consultant :
$0.00
SJH.Trans :.
$0.00
Demolition Fee
Record Management
$0.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
$0.00
Energy Compliance:
$0.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety:
$0.00 -
WQ Insp. Fee`.
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
Disabled Access :
' $0.00
PM Plan Check: $0.00
Grading Bond:
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
San Dist: $0.00
Building Green Fee:
$1.00.
Mechanical%:
$0.00
NMUSD Fee: '$0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $313.00
Plan Check Fee:
$0.00 Fee
Due at Permit Issuance :
$313.00
PROCESSED BY:
PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
PLAN CHECK BY:
-
GRADING APPROVAL:
APPROVAL TO ISSUE:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) 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 applicanfto a civil penalty of
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or J 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
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
ap 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:
By my signature -be to. 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 tfiatl 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
p;f@gs7ons Cocie.ibyvailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
ignatuve of PIDVgrjy,Owner or Authorized Agent JDate
LICENSED CONTRACTOR'S DECLARATION
t hereby affirm underpenaity of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) 's' the Business -an d-Rraf 1 s r an icense is in full force
apd effect. License Class License No Date Contractor Signatu
MRARS' CbWENSATION DECLARATION
WPBWARNING:FAILURE..TO.eECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU DRIED THOUSAND DOL ($700,000), IN ADDITION TO THE
COST OFCOMPENSAYIOM DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
•...•
I,I��+h+��rreby�affirm under penalty of perjury one of the following declarations:
ICJ1 have andwdill irintain 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
g jrponce of the work for which this permit is issued. Policy No.
7tillowe and will 614ain 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
nsu nce carrier eba policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
I certify that, in the -p r nce of the,work-for 7Clrthis-pa[Ln'It is issued, I shall not employ any person in any manner so as to become subject to the workers' c pensation laws of California, and ogre
that, if I should become sub' c ers' c ensation prows of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant Date
Iri
DECLARATION REGAR I G CONSTRUCTIO LENDIN AGENCY
I hereby affirm under pe a y of perjury that there is a con uction 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 certi o owing
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 pr ided is correct.
I agree to comply with all applicable city an tint ord' ances state laws relating to building construction. D
I authorize representatives of this city or county to e:abo en roperty for inspection purposes. 8
Sicnature of PrODertv Owner or Authorized ADent _ Print Property Owner's or Authorized Agent's Name
PERMITCANCELLED
PERMITEXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
DATE BV'/RECLARATONS PART 630E TNTLE 40 AND AQMD RUCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
ASBESTOS NOTIFICATION TO
APPLICABLE TO
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