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HomeMy WebLinkAboutM2019-0054 - PermitsCity ofWW'port Beach- Building Division I III�IIIIIII I IIIIIII IIIIIIIIII II HARBOR Permit: M2019-0054 IIIIII 100 Civic Center Drive; Newport Beach, CA 92660 M 2 0 1 9 0 0 5 4 Project No : 1443-2019 Permit Counter Phone (949)644-3288 P�wss.a4cT"� Inspection Requests Phone (949)644-3255 i Job Address: 3101 COAST HWY W Floor: Suite: Bldg: 0 Description of Work: BULKHEAD COPING REPAIR (SAME LOCATION) tea, *NO WORK IN OR ABOVE THE WATER Inspector Area: 7 Legal Description: TR 919 LOT M(AND NWLY 100 FT LOT G Owner: QUAY WORKS LLC Contractor: OWNER/BLDR Engineer: JAFARI MASOUD �9 1 Address: " 503 32ND ST - Address: JOHN J JAKOSKY III '' Address: 23 ORCHARD #250 NEWPORT BEACH CA 92663 LAKE FOREST CA 92630 Phone: 949-673-0500 Phone: 949-673-0500 x406 Phone: 949-206-9929 State Lic: S-003812 Applicant: JAKOSKY JACK Con State Lic:O/B Designer: Address: 50332ND ST Lic Expire: Address: NEWPORT BEACH CA 92663 Bus Lic: Phone: 949-673-0500 X406 Lic Exp Date: Phone: Special Cond: longshoremen's and Harbor Workers Compensation Declaration - Carrier : Issued Date 10/28/2019 Policy No Expire r- FEES Valuation: $30,000.00 Fire Inspection Fee: $0.00 $0.00 Inspection Fee: $297.00 Fire Plan Check Fee: $0.00 Plan Dep Counter Review: $0.00 Plan Check Fee $312.00 - Records Mangement: $4.00 Plan Dep - Zoning Plan Check: $0.00 OT Plan Check Fee: $0.00 Harbor Plan Check Fee: $135.00 Plan Dep - OverTime Plan Check: $0.00 Investigation Fee: $0.00 Building Green Fee: $2.00 TOTAL FEE,: $750.00 Plan Check Fee : $287.00 Fee Due at permit Issuance: $463.00 PROCESSED BY: ` Pl9�iLIC�SI'JR ` "///yyye j 0 C E PLAN CHECK BY: C f O S lkPPROVPjLTr)I;SUE. ` OTHER DEPARTMENTS: FINAL,INSPRCvIdN« _ PERMIT EXPIRES 180 DAYS AFT£R J4UAJJE OR AS: qLL%)) JIt.SPLQYON i I INER-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) -. ction 7031.5; Business and Professions. Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, priorto its issuance, also requires the applicant fo permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter9 (commencing with Section 7000) of Division 3 of the Business an fessions Code) or that he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfor a,permit subjects the applicant to`a civil penalty o 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 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 One property, provided that the vements are not intended or offered for sale. If, however, the building or improvement issold within one year of completion,. the Owner -Builder will have.the burden of proving that it was not built o r ved 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 1 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. ny signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year priorto completion of the improvements covered by this permit I cannot legall a structure :that I have built as an owner -builder if it has not been constructed in its entiretyby licensed contractors, I understand that a copy of the. applicable law, Se ion 7044 ofthe Business an fessions Code, is available upon request w e app I ation is s milted a follow' Web site:http://www leginfo.ca.gov/calaw.html - !O -7S iature of Property Owner. or Authorized Age - Date ENSED CONTRACTOR'S DECLARATION reby affirm under penalty of perjury that I am licen4d under provisions of Chapter 9.(commencing with Section 7000) of Division 3 of the. Business and Professions Code, and my license. is. in full fort effect. License Class License No. Date Contractor Signature NGSHOREMEN'S & HARBOR WORKERS' COMPENSATION DECLARATION NTNG: FAILURE TO SECURE LONGSHOREMEN'S & HARBOR WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 1706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty Of perjury one Of the following _ larations: i- I 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 ed. My, workers' compensation insurance carrier and policy number are: •ier Policy Number Expiration Date �artT of AgentPhone# 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, an Igrlee th 't, if I should become subject to the workers: compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions ii ure of APID ica t: JD ag Date• )ECLARATION REGA DINGCO RUCTION: LENDIN GENCY I hereby affirm under pen pf perjury that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097, Civil Code). . I.. Lender's Name Lender'sAddress 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 property for inspection puposes. , iignature: PrintName: v k �/{%�O$%�L Date: /�!� % All AcW TE BY DECLARATION Of COMPLIANCE WITH CODE OF FOR OFFICE OS ONLY FEDERAL REGULATIONS PART Of OF TITLE40AND MTTEBAgBEETOSAfO77FICATIONTO. PERM+TEXPdRED :, : [ PS • a �.©i EPA i e.. i • ❑ OAOMD '.. PERMITCANCELLED -', •' • • PERMIT EXTENDED © ASBESTOS NOTIRCATTONIS NOT APPLICABLE TO PERMIT FINALPROPOSED DEMOLITION. ••s •:•s ••, �.i• CERTIFICAT€OF • •.- • e SIGN TIVE• •.. 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