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Home My WebLink AboutX2020-1205 - Permits1 City of Newport Beach- Building Division *X2020-1205* COMB Permit: X2020-1205 J` 100 Civic Center Drive, Newport Beach, CA 92660 Project No ' Permit Counter Phone (949)644-3288 ia...� Inspection Requests Phone (949)644-3255 Combination Type - SFP Issued Date : Inspection Arearea :2020 1 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY OR PERMIT WILL BE INVALID 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 Spays or Holidays Job Address: 127 25TH ST NB jr Description: SFR -LEAK REPAIR @ DECKS @ DOORS Legal Desc.: NEWPORT BEACH CITY BLK 25 LOT 22 Owner: GOLDENBERG JAY & NANCY Contractor: OWNERIBLDR Architect: -%.p V ®® Address: 127 25TH ST Address: Address: NEWPORT BEACH, CA 92663 Phone: Phone: Phone: State Lie: Applicant: GOLDENBERG JAY & NANCY Con State Lie: OIB Engineer: ...... Address: 127 25TH ST Lie Expire: Address: . . • m • ®° NEWPORT BEACH, CA 92663 Bus Lie: Ok 9 Phone: Lie Exp Date: Phone: State Lie: e e®• Code Edit : 2019 Worker's Compensation Insurance Designer: �'• c Type of Construction: VB Carrier: Address: .• o° .`n Occupancy Group: R3/U Policy No: ° • 0 0 Added /New sq.ft. Bldg: 0 Expire: Phone: ..... o mo. r.o Added /New sq. ft. Garage: 0 No of Stories: 2 Building Setbacks Rear: / Special Conditions: O/B AUTH FORM ATTACHED No of Units : 1 Front: / . . ° Bldg Height: 0 Left: / Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $300.00 Building Permit Fee: $104.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee: $0.00 Fire Inspection: $0.00 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 : $0.00 Grading Permit Fee: $0.00 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: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 P/W 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 %: $0.00 $0.00 TOTAL FEE : $105.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $105.00 PROCESSED BY: PUBLIC WORKS APPROVAL: C. y ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: OWNER-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) lotion 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 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 )fessions 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 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 l_) portions of the work, and the structure is not intended or offered for sale (Section 7044, 3iness 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 Irovements 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 (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). I am exempt from licensure under the Contractors' State License Law for the following reason: 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 I a structure that I have built as an owner-builder 'fit h s not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Ifessions Code, is available upon request when thi pplicat' s submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. /I nature of Propgq%Owner or Authorized Agent �� Date TENSED CgUILRACTOR'S DECLARATI(3N�� web affirm underpenalty of perjury that I am license un er provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force I edict. License Gess License No Date Contractor Signature )RKERS' COMPENSATION DECLARATION 2WNG: 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 ($160,660), IN ADDITION TO THE IT OF COMPEIVATIQfS,:AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. Rg.?affirm ulider p6nally of perjury one of the following declarations: e J.heve and++wN 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 kgAnce of the work for which this permit is issued. Policy No. and will ma"ain 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' carrier and policy number are: Policy Number Expiration Date Agent! 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 , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. signature of Applicant Date_ IECLARATION REGARDING CONSTRUCTION LENDING AGENCY hereby 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). ender's Name Lender's Address ly 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 1 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,�i,',,�nt'R\r 1`i,SS�,above-identified property for inspection purposes. /� (I ;ianature of Propertv Owner or Authorized Aoenf/14 XiXl�'-� Print Property Owner's or Authorized Agent's Nam�VN<s.D_I I DATE I PERMIT CANCELLED PERMIT EMENDED REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE I SUBMITTED ASBESTOS NOTIFICATION TO PERMITFINAL 4/�/2 IWC]] SBEST�niS NOTIFICATION IS NOTAPPLICABLE TO CERTIFICATE OF i E/ PROPOSED Df�O_ITIOLV OCCUPANCYISSUED SIGNATIIRF•///��1�� /` / FOR OFFICE USE ONLY