HomeMy WebLinkAboutM2019-0034 - Permits (2)�rlv City of Newport Beach Building Division 111111111111111111111111111111111111111111111111111111 11111
o 100 Civic Center Drive, Newport Beach, CA 92660 M 2 0 1 9 0 0 3 4
Permit Counter Phone (949)644-3288
HARBOR Permit: M2019-0034
Project No: 0194-2019
Inspection Requests Phone (949)644-3255
Job Address: 3900 CHANNEL PL Floor: Suite: Bldg: 0
Description of Work: DELTA 1/ADD'L SCOPE -REVISE SEAWALL TO ADD 28' OF RETURN WALL & ADD'L TIEBACKS (REV19-0781)
Inspector Area: 1
Legal Description: CANAL SECTION LOT 1 BILK 539 ALL -INC BET SAME & HIGH TIDE LINE -(AND
Owner:
3900 CHANNEL PLACE #1, LLC
Contractor:
EKEDAL MASONRY & CONCRETE INC
$287.00
Engineer:
PETROV P�AMEN
Address:
15 CORPORATE PLAZA#150
Address:
220 NEWPORT CENTER DR #11-288
Address:
28161 CASITAS CT
°•"°'
°
NEWPORT BEACH, CA 92618
$1.00
NEWPORT BEACH OA 92660
TOTAL FEE :
LAGUNA NIGUEL CA 92677
Phone:
Phone:
949/729-8082
Phone:
714-717-7542
®°m.
State Lic:
C-066947
Applicant:
LINSDAY BRANDON
Con State Lic:487590
Designer:
° .
Address:
151 KALAMUS DR #G-1
Lic Expire:
02/28/2020
Address:
COSTA MESA CA 92626
Bus Lic:
BT00005971
° ° ° < < °
Phone:
714-754-4040
Lic Exp Date:
0 9/3 012 01 9
Phone:
Special Cond:
Issued Date 06/14/2019
Valuation:
$20,000.00
Fire Inspection Fee:
Inspection Fee:
$287.00
Fire Plan Check Fee:
Plan Check Fee
$0.00
Records Mangement:
OT Plan Check Fee:
$0.00
Harbor Plan Check Fee:
Investigation Fee:
$0.00
Building Green Fee:
$1.00
TOTAL FEE :
$419.00
/\ Plan Check Fee
PROCESSED BY:
PLAN CHECK BY: J M FIS
Longshoremen's and Harbor Workers' Compensation Declaration -
Carrier : EMPLOYEE SERVICE GROUP
Policy No: 2246
FEES
$0.00
$0.00
$0.00
Plan Dep - Counter Review: $0.00
$0.00
Plan Dep - Zoning Plan Check: $0.00
$131.00
Plan Dep - OverTime Plan Check: $0.00
$0.00 Fee Due at permit Issuance: $419.00
HARBOR RESOURCES:
APPROVAL TO ISSUE:
OTHER DEPARTMENTS:
FINAL INSPECTION:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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)
:tion 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 fo
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 an
'essions 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 I
more than five hundred dollars ($500).
1, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
iness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built of
roved for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
ly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
***o
I am exempt from licensure under the Contractors' State License Law for the following reason:
n signature AMA acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legaill
A sfrtcture t4AC101%ve built as an owner -builder if it has not been constructed in its entirely by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business anc
`esejons Cock, is -available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
miurs of Property Owner or Authorized Agent Date
FN$ED CONTRACTOR'S DECLARATION
rd" affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (com en 'ng with Section 000) of Division 3 of the Busin ss a rofessions de n y license is in full force
.effect. License Class License No. Date — - Contractor Signature �0—
HGb'HOREMEIVS 8 HARBOR WORKERS' COMPENSATION DECLA TIOT
jdgdJAILURE TOSECURE LONGSHOREMEN'S a HARBOR WORKERS' COMPENSATION COVERAGE IS U LAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
1,00n: IN ADDITION TO.THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following
larabons: "
�:1 have and wig 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
My',,; ydtkers' compensation insurance carrier and policy number are:
rier Policy Number Expiration Date
— _f A—f Phone # _
I certify that, in the pierformance 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,
that, if I should becomf subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. p
rture of Applicant: /� r / r „ , ,
DECLARATION REGA DING CO`ISSTRUCT)F14ADING AGENCY
I hereby affirm der 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 Cade).
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 com ly with all applicable city and county ordinances and state laws relating to building construe ion.
I authorize re esentatives of this city or county to enter the above -identified property for inspection purpo�s. /
PERMITFINAE
CERTIFICATE OF
OCCOPANCYISSUEO
BY RvGsLr lvTONSPFEDERAL ARr_6ferOs sFuTsT.TwLE�WvA,
NO
D f SUBMITTED ASBESTOS NOTIFICATION TO.-
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O.❑ EPA
AOMO
ASBESTOS NOTIFI ARONIS NOT APPLICABLE TO
PROPOSEOOEMOLITIOM
SIGNATURE: