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COMMUNITY
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DEVELOPMENT
Pr'n For City of Newport Beach RIN 2 6 2020
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
%%/�^�� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8` lf� OF
RBR# `L..I / OS Z C www,newportbeachca.gov (949) 644-3200 "I� PORT BF -I'll
Application for Report of Residential Building Records
Application Feer- $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection. Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: I ` Address: 320 MARINE AVENUE City: Newport Beach State: CA ,Zip: 92662
PropertyOwner: Picante Martin's, LLC --� Zip Code: 92662
owner Address: 320 MARINE AVENUE city: NEWPORT BEACH
State: CA Zip Code: 92662 Home Phone:
Owner's Authorized Agent: Hector H. Herrera Work Phone: 714-376-6670
Agent Address: 17561 E. 17th Street City: Tustin
State: Ca zip Code: 92780 i Agent Email Address: HectorHerreraRemax@outlook.com
Escrow Company: FIRST AMERICAN TITLE -NCS IRVINE Escrow #: NCS -1017387 -SAI -DB
Escrow Address: 18500 VON KARMAN AVE, STE 600
State: CA Zip Code:92612
City: IRVINE
Escrow Phone 949-885-2448
Email Report to: I dbell@firstam.com, HectorHerreraRemax@outlook.com, aaceves@firstam.com
For Inspection call (Name): Direct Phone: -
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
W
Owner/Agent's signature to decline inspection:
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Building DIvlslan\Fortes\RBB 9-18-18
Date:
Date:
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