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HomeMy WebLinkAboutX2014-1892 - Permits"1s,eD City of Newport Beach - Building Division IIIIICOMB Permit: X2014-1892 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 4 1 8 9 2 Project No: 1637-2014 ti Permit Counter Phone (949)644-3288- " Inspection Requests Phone (949)6443255 t r` `a■+on Combination Type - SFP ELEC PLUM Issued Date :03/24/2016 ., __,___ •..��..-�x�-��^•-`-"-'-"Inspection rear PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LA V,Ql, u ON. INSTALL OR VERIFY SMOK, E/CAIjBON. d9 ONOXlD�RETErrZORS /PLtfllh�/I�G` I� O BE UPGRADED Job Address: 1400 SAN MIGUEt_ R Nie. UQ% aY ��% refund 1 Description: SFR INSTALL OAR POOL/PATIO COVER 1,500 SF _ Legal Desc.: N TR 10625 L0721 �,���� h b Owner CHARLES SMITWEN S ILL on �tY�rtp(1!18 BL tOgfO$'1&�tTl. 1SOLL!X-.^..C.,.-,S_ - ` Address: 604 GORDON HI0,H NDS T ss: Im S O O Address: 1350 CORONADO AVE ` GLENDORA CA 9174 LONG BEACH CA 90804 �. Phone: Phone: Phone: 562-597-8760 State Li CO21173 •mo®•® momo • �'F Applicant: KOLLIN LEO Ecc' KXDOaLt( iPBIRED Engineer: TUCHSCHER JAMES TODD m • • • •� Address: 1350 CORONADO AV Address: 5318 E. 2ND ST STE 539 LONG BEACH CA 908 sBELMONT SHORE CA 90803 Phone: 562-597-8760 : Phone: 310-613-9980 State Li -Q7.649 m ° • m ° Code Edit : 2013 Worker's Compensation Insurance Designer: !!! Type of Construction: V - B- Carrier "11 dprgs y"� ji °� qvs, x Occupancy Group: U gq�p- No !i,, 1�_j ! 6.l y ° ° o ° dry, may, p�'� o m e o q^p�p °oo°o r. Added /New sq.ft. Bldg: 0 $�d_ it �41 ! ` ° 6 hone:... ° Added /New sq. ft. Garage: 0 ,g�Id ° (no lNQr{�Sf�+rte(i) No of Stories: 1 (V,NdfRg§M#led) Rear / l 'Special Conditions: O/B AUTH FORM ATTAC ED No of Units : 0 Front' / - %++-"• LLC VERIFIED ooco 0 Bldg Height: 0 Lek: / Bldg Sprinklers: NR i ht: Flood Zone: X date. arm Spaces: 0 Fire a Construction Valuation: 100 00 .00 Building Permit Fee: $1,076.00 Excise Tax: apartment - Fire Department Plan Check Fee: $774.72 1 lona as : $0.00 Plan check Fee : $0.00 Fire Inspection: $0.00 Overtime Plan Ck: $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: $34.80 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: $13.00 WQ Insp. Fee: $23.20 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access: $0.00 P/W Plan Check: $0.00 Hazardous Mat $0.00 Electrical %: $75.32 San Dist: $0.00 Building Green Fee : $4.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $107.60 $0.00 TOTAL FEE : $2,108.64 Plan Check Fee: $774.72 Fee Due at Permit Issuance : $1,333.92 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: �y�JJ�II�,__oo PLAN CHECK BY: GRADING APPROVAL: Com"' APPROVAL TO ISSUE: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for thy reason(spindicated below by the checkmark(s) I have placed next to the applicable item(-, (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 or Section,7031.5 by any applicant for a permit 'subjects the applicant to a civil penalty o% 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 U 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 0pi vements 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 ved for the purpose of sale). as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7f(44, Business and Professions Code: The Contractors' State License Law does not 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). ❑ 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 legally sell a structure thatd Clave built as an owner -builder if itMund been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Codb.j;. Ailable upon request whe th'ion is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. SlSnpill of Property Qwner or Authorized Agent Date L9CENSIED C(INTMICTOR'S DECLARATI N I hereby affirm under penalty of perjury that I am licenser provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force aaild'effack Licensa Class License No Date Contractor Signature WORKERS' COMRRSATION DECLARATION AgRNIHO: FAILURE TO SECURE 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 Cp$5 sQ F�COMPENShTI6$ DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _ I rIrpp% affirm und&VIbMalty of perjury one of the following declarations: - - ®.I.have and will maintain 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 the o$rfdrmaDce of Wo yvpXfor which this permit is issued. Policy No. 120 have -and will maintain 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' compensatior nsucarlce carrier and?pWicy number are: i of Agent Policy Number Expiration Date Phone # 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, and agrer I, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant Date_ CLARATION REGARDING CONSTRUCTION LENDING AGENCY Ireby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Ider's Name Lender's Address 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 conn y ordin nces and state laws relating to building construction. I authorize representatives of this city or county t r a above -identified property for inspection purposes. nature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Name 'e -b A-- Dat '?`�A ACTHN! DATE V Ry DECLARATIVROFCOMPIIANCERUHCODEOF IVADPHLEU5kimy FEDERAL REGULATIONS PAIRTG! OFTiRE,10i,ANO AOMORULE140, PFRMfTFXP1RA)� yf P �� ❑ Isfonwirri)sLSfY:SImPhamirAmyTo. ❑ EPA © AQMD r - Ar9IXTCAPICCLLCD PEW91TEFTENDED ASBESTOS NORFICARONIS NOT APPLICABLE TO POSED UMAL PERMITTINAL GEAPFICATEEOF OCCUP,ANCyrS5VED. SIGNA I W&. 0'c y 0 �yY _ Ea ° m p o _ v LL w F O om c... 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