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Home My WebLink AboutX2021-1393 - Permitswt t� City of Newport Beach - Building Division e9 4„ 100 Civic Center Drive, Newport Beach, CA 92660 v Permit Counter Phone (949)644-3288 "+ Inspection Requests Phone (949)644-3255 Combination Type -SFP IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit: X2021-1393 Project No : Issued Date : 06/02/2021 Inspection Area : 3 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0610212024 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 Sundays or Holidays Job Address: 1801 DEBORAH LN NB Description: SFR -CHANGE OUT (5) WINDOWS AND (1) SLIDER (INTO EXTG) Legal Desc.: Owner: WENTZEL DOUGLAS BRYANT Contractor: RENEWAL BY ANDERSEN OF OC Architect: Address: 1801 DEBORAH LN Address: 22982 ALCALDE DR #100 Address: �..e NEWPORT BEACH CA 92660 LAGUNA HILLS CA 92653 Phone: 3101670-5317 Phone: 714-259-5120 Phone: State Lic: pZ� U) Applicant: RENEWAL BY ANDERSEN OF OC Con State Lic: 990416 Engineer: Address: 22982 ALCALDE DR #100 Lic Expire: 02128/2022 Address: LAGUNA HILLS CA 92653 Bus Lic: BT30046925 Phone: 714-259-5120 Lic Exp Date: 04130/2022 Phone: State Lic: Code Edit: 2019 Worker's Compensation Insurance Designer: 0 Type of Construction: VB Carrier: OLD REPUBLIC INS CO Address: Occupancy Group: R3/U Policy No: MWC31415820 Added /New sq.ft. Bldg: 0 Expire: 10/01/2021 Phone: Added /New sq. ft. Garage: 0 No of Stories: 1 Building Setbacks Rear: 1 Special Conditions: No of Units : 1 Front: I Bldg Height: 0 Left: / Bldg Sprinklers: Right: I Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $5.500.00 Building Permit Fee: $178.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee : $0.00 Fire Inspection: Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share: $0.00 Fire Plan Rev 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 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department - General Service CA Seismic Safety: $0.00 WO Insp. Fee: $0.00 Park Dedication: $0.00 _ Refund Deposit Disabled Access : $0.00 PAN Plan Check: $0.00 Grading Bond: Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 Plumbing %: $0.00 TOTAL FEE: $179.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: 0000 0 0000 om�0 0000 0 00000 00 u 0 0 0000 m 00 0 00 p00000 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $179.00 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: no0,� 0 0 000 , o � 0 0 oo0ooc 0000r 00000. 0 0 m 0o0o0n 0 00000 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) action 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 ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, siness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the )rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or )roved for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not Ay to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). I am ej&MM1from licensure under the Contractors' State License Law for the fallowing reason: my signatur0 below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot Iega11: I:S structuiattlet I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and ifession$C84Ee is available upon request when this application is submitted or at the following Web site: htl leginfo.ca.gov/calaw.html. nature of Property Owner or Authorized Agent to vENSED C,JUTRACTOR'S DECLARATION ireby affirm:� penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7l}00) D ision 3 of the Business and Profe ion ode, d license is in full force i effect. Llcense Class License No Date Contractor Signature )RKER&ICOMPENSATION DECLARATION X2j�MG: 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 OF COMPENEIATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. y affirm -unJd9r:)en a Ity of perjury one of the following declarations: 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 thl ance of24%w(irk for which this permit is issued. Policy No. 7• ve 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' compensatiol ance carrier and poli number are: ly)Wc g:)g1SW0 Ex Jd -I -2J rier � Policy Number Expiration Date ne of Agent Phone # certify that, in the pe ce of th 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 agre t, if I should become su je the w rs' 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 :reby 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 pertlu wner's behalf. I have read this application and the information I he, a provide i correct. I agree to comply with all applicable city and county or in nce d state laws relating to building construction. I authorize representatives of this city or county o e it t e ab a entified property for inspection purposes. ry7 � nature of Propertv Owner or Authorized Agent s�-1 Print Property Owner's or Authorized Agent's Name/ t`-" ACTION DATE BY DECLARREGULAAT PAHTI OF 0MPLICE WITH 61 OFTNTLE 40 AND CGA FEDERAL I FOR OFFICE USE ONLY PERMITEXPIRED I UIS BMITTEO ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA PERMIT EXTENDED qMD PERMIT FINAL ry AS STOS NOT) ATION IS NOTAP ABLE TO CERTIFICATEOF K a-��I Av, P OPO D DEMOLI OCCUPANCYISSUED V SIGNATU _