HomeMy WebLinkAboutX2021-1560 - Permitsv �, City of Newport Beach - Building Division
*X2021-1560*
COMB Permit: X2021-1560
o �?� 100 Civic Center Drive, Newport Beach, CA 92660
Project No: 1376-2021
` Permit Counter Phone (949)644-3288
9
Inspection Requests Phone (949)644-3255
-'`^ittra5u�_. Combination Type - SFP
,
Issued Date : 06117/2021 '.
Inspection Area : 3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, PROJECTS MUST BE COMPLETED BY 0611712024 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 or,,�Ortq�UU .
Job Address: 1608 DOVER DR NBDescription:
f-! I�11 ! iiVV�l
MIT
SFR - RMV
Legal DeRIOR BRICK FIREPLACEICHIMNEY. INSTL SKYLIGHT. *AS BUILT* -121.1771sc.: N TR 1645 LOT 3
EXPOSE ALL STRUCTURAL,
Owner: MOADIVAN Contractor:
OWNER/BLDR
Architect:
¢
ELECTRICAL, PLUMBINI1 ;,°AND
Address: 1608 DOVER DR Address:
Address:
e °
NEWPORT BEACH, CA
p�g
k' -:4.F C€ 5ANLQ, A�, COMP0MENTs° e•°
Phone: 949-587-4826 Phone:
Phone:
tate L e
Applicant: MOAD IVAN Con State Lic: O/B
Engineer:.
Address: 1608 DOVER DR Lic Expire:
Address:
......
NEWPORT BEACH, CA Bus Lic:
Phone: 949-587-4826 Lic Exp Date:
Phone:
State Lic:
mm o
Code Edit : 2019 Worker's Compensation Insurance
Designer:
Type of Construction: V -B Carrier:
Address:
®°
Occupancy Group: R3/U Policy No:
-
Added /New sq.ft. Bldg: 0 Expire:
Phone:
Added /New sq. ft. Garage: 0
o ° ° 0. ° ...
No of Stories: 2 Building Setbacks
Rear: /
Special Conditions:
PLANS ATTACHED TO `
No of Units : 1
Front: /
PERMIT
Bldg Height: 0
Left: /
O/B ATTACHED
Bldg Sprinklers:
Right: /
Flood Zone: Use Zone: Parking Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $2,500.00
Building Permit Fee: $127.00 Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $110.49 Additional Fee :
$0.00
Plan check Fee : $46.25
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: $127.00 Grading PC Consultant :
$0.00
SJH Trans : $0.00
Demolition Fee
Record Management: $2.00 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 WO 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 %:
$0.00
$0.90
TOTAL FEE : $413.74
Plan Check Fee:
$0.00 Fee Due at Permit Issuance : $413.74
PROCESSED BY:
PUBLIC WORKS APPROVAL:
,{ ,
ZONING APPROVAL: �`���V�/
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
OWNER -BUILDER
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)
(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 of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) 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
improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner-Builderwill have the burden of proving that it was not built or
improved 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
apply 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 frdMJicensure under the Contractors' State Ucense Law for the following reason:
By my signaturabe]om I acknowledge that, except for my per net �obns
'ente in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
Iructure fltaf.l.have built as an owner -builder if has n betructeits entirety by licensed contractors. I understand that a copy of the applicable law, Section 70 of the Business and
Professions CQde,, js,2vailable upon request wh s ap 'on ted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Dat
5i natuure of Property Owner or Authorized Age t
LICENSED CONTRACTOR'S DECLARA ON
],hereby affirm.1der penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, d my license is in full force
antlpjfect. License (,lass License No Date Contractor Signature
tNORKERS' CGI MNSATION DECLARATION
fyp W1418: FAILUMTO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE
COST OF COMPENSA(ION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
wati affirmed er"nalty of perjury one of the following declarations:
,..44ave and GRI m9intain 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,
opVjrglance oLtrg wptk for which this permit is issued. Policy No.
I 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
insurance carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the performanc of the work for which this ermit is issued, I shall not employ any person in any manner so as to become subject to the workers' YmPEnsation laws of California, and agre
iat, if I should becoms bject t the rkers' Ion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /
Iignature of Applicant) Date
IECLARATION REGA DI NSTRUCTION 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(iv 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 I have pro Ided is correct.
I agree to comply with all applicable city an county ordin nces�/�nd sta ag-te-building construction. .
I authorize representatives of this city or coto enter t'b e= ntified property for inspection purposes. Q . / e�� p 7 2
Ilanahrre of Pronertv Owner or Authorized ADen j Print Prooertv Owner's or Authorized Agent's Nam f , 0'L Dat�/�7
ACTION
DATE BY ' 'DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQM D RULE
1403
PERMITEXPIRED
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED
EPA
PERMIT EXTENDED
AQMD
PERMITFINAL
CERTIFICATEOF
? �ASBESTOk NOTIFICATION ISNOT APPLICABLE TO
�Z/'� PROPOSED DTLITICIJ'/h
OCCUPANCYISSUED
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