HomeMy WebLinkAboutX2019-3317 - Permitsr,$ City of Newport Beach - Building Division
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COMB Permit: X2019-3317
C 100 Civic Center Drive Newport Beach CA 92660
X
2 0 1 9 3
3 1 7
Project No: 2302-2019 1i
E~ Permit Counter Phone (949)644-3288
ii Inspection Requests Phone(949)644 3255
Combination Type - SFP
Issued Date.: 11101/2019
Inspection Area: 5
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION,
1.
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
-Job Address: 4721 CORTLAND DR NB>'
Description. SFR REMOVE (E) WINDOWSIDOORS AND INSTALL (2) SLIDERS
Legal Desc : ' TR 3519 LOT 4ALL -EXSWLY 1 FT -
Owner PSG CAPITAL PARTNERS. INC Contractor
HARKINS CONSTRUCTION
Architect:
INSPECTION
i
-:.Address: 4721. CORTLAND DR - Address:
:34167 PCH #D
'..Address:
-
`CORONA DEL MAR, CA 92625
- DANA POINT CA 92629
-
Phone Phone:
949-245-9028
Phones
State Lie:
-
Applicant. BURKE LEO Con State Lie:
935372
Engineer:
BURKELEO
Address: 34167 PACIFIC COAST HWY #D Lic. Expire,
03/31/2020
Address:
34167 PACIFIC COAST HWY #D °
` DANA POINT CA 92629 Bus Lie.
BT30066134
DANA POINT CA 92629
Phone. 949-226-7130......Lie Exp Date:
02/2912020
Phone:
949-226-7130 :; State Lic C-067404
®
°
Code Edit - .2016 Workers Compensation Insurance
Designer:
Type of Construction V -B Carrier
NORGUARD INS CO
Address:
Occupancy Group: R31U Policy No:
HAWCO21004
Added /New sq.ft:: Bldg: 0 Expire:
02122/2020.
Phone:
Added /New sq. ft. Garage 0
No of Stories: (: 1 - Building Setbacks
Rear: I
Special Conditions:-
NoofUnits -1 -"Front:
I
Bldg Height. 0.-
Left I
Bldg Sprinklers ..;Right
/
Flood Zone'Use Zone: Parking Spaces:
0
Fire Hazard Zone,: N
Construction Valuation: $18.000.00:
Building Permit Fee: .$360.00 Excise Tax:
$0.00
Planning Department-
Fire Department
Plan Check Fee: $313.20 Additional Fee.:.' :..:$0.00
Plan check Fee : -
"$40.00
Fire Inspection $0.001
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: $18.00 Grading Permit Fee:
$0.00
In lieu Housing Fee
$0.00 Building Dept Adm. $0.00
Energy Compliance: $56.00 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
PAN 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 %:a '-'
$0.00
: $0.00
TOTAL FEE: $788.20 Plan Check Fee :
$353.20
Fee
Due at Permit Issuance : $435.00
PROCESSED BY: PUBLIC WORKS APPROVAL:
ZONING APPROVAL: '' PLAN CHECK BY:
GRADING APPROVAL: APPROVAL TO ISSUE:
I
OWNER BUILDER DECLARATION
I hereby afRtm under penalty of perjury that I am exempt from. the Contractors' State License Lawfor the reasons) indicated below by. the checkmark(s),I have placed next to the applicable items)
(S ction 7031.61, 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 applicant to a civil penalty of
rsnt more than five hundred dollars ($500). '
u I 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;
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
as!iroved 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
p 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).
❑ 1 am exempt from licensure under the Contractors', State License Law for thefollowing reason:
Bi 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 legal)
sell a structure that I 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
Professions Code, is available upon request when this application is submitted or the following Web site:http://www.leginfo.ca.gov/calaw.html.
:. Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
. ....
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 �) of ivisi n 3 of the Business and Profess' ns ode, and E Iic Te is in full force
alI ggeg.. Licenge Clags License No Date ! Contractor Signature
MRKERS' COMWOSATION DECLARATION
WQI%NG! FAILURE TO SECURE WORKERS'. COMPENSATION COVERAGE IS'. UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDR D THO ND DOLLAR ($100;000), IN ADDITION TO THE
COST OFCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I h�reb affirm u
I � yrK�e�. � - , ;er?ralty of perjury one of the following declarations:
I Mabe and �wiq 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 th
mance: of:thewmRfor which this permit is issued. Policy No::. -
'liabe 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' compensatio
$ d carrier slid policy number are:
.....
rier ' Policy Number - Expiration Date
.
III Igent Phone #
Icertify that in tAC pErfor ante 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' gompensation laws of California, and agre
if I
O GLARATI
I hereby affir
Lenders Nal
By my sighs)
I am the
I have rE
I agree t
,I authori
A( TION
I become su 1edChe worker ' o ensatton provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
pplicant CIS �i. /�I
'IN REGAR I NSTRU TION LENDING AGENCY
under pealt of Jerjury that there is construction lending agency for the performance of the work for which this permit is issued. (Section 30 ,Civil Code).'
e%. Lender's Address.
re below, I certify to each of the following:
roperty owneror authorized to act on the property owner's behalf..
dithis application and the information I have provided is correct. -
comply with all applicable city and coup rdinances 3p tate laws relating to building construction.
I representatives of this city or county t n er the ab&fe ide}ltif roperty for inspection purposes.///
roperty Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam : � II C ate l% i.
i II
P < `DATE BY DE LARAT N OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
E UI NS PART 61 OF TITLE 40 AND ACM RULE .:
i
.D I SUBMITTED ASBESTOS NOTIFICATION TO
ILE i EPA
DED QMD.':y
`y ASBESTO NOTIFI ATION IS NO AI�PUCAQLE TO
F! PR POSED EMOLITI N
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