HomeMy WebLinkAboutX2019-2038 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIII��IIIIII�IIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2019-2038
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100 Civic Center De10_ Newport Bp a. CAm92660 X 2 1 9 2 9 3 6 Project NO : 2230-2018
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Permit Countea Phone,(94 )04 -3d8 m
Inspection Re4uest9,F`ho% 1944644m4255:m°
O, Combination Type - SFP
Issued Date : 2019
Inspection Arearea : 6
-
-:PERIV
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f'S EXPIRE. 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Cons4rtnctn en=Houa s .Men day -Friday i: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 18 VIA AMBRA NB
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Description: DELTA 2- REVISE TO SLIDING GLASS DOOR & CHANGING BACK DOOR TO SLIDER (REV19-1081)
Legal Desc.:
Owner: MASOUD BOKAIE
Contractor: OWNERIBLDR
Architect:
Address: 18 VIA AMBRA
Address: BOKAIE MASOUD
Address:
NEWPORT COAST CA 92667
Phone: 949.302-8092
Phone:
Phone: State Lic:
Applicant: MASOUD BOKAIE
Con State Lic: O/B
Engineer: BOKAIE MASOUD
Address: 18 VIA AMBRA
Lic Expire:
Address: 2211 MICHELSON DRIVE 450
NEWPORT COAST CA 92657
Bus Lic:
IRVINE, CA 92612 _
Phone: 949.302-8092
Lic Exp Date:-:.
Phone: 949/261-4862 State Lic:S-002751
Code Edit: 2016
Worker's Compensation Insurance
Designer:
Type of Construction: V-B
Carrier:.
Address:
Occupancy Group: R31U
Policy No:
Added /New sq.ft. Bldg: 0
Expire:.
Phone:
Added /New sq. ft. Garage: 0
E^TC
No of Stories: 2
Building Setbacks Rear:. I
Special Conditions:.AA ' '
No of Units : 1
Front: I
Bldg Height: 0
Left:
Bldg Sprinklers:
Right: /
.'n. 7---.
11- 7-- Do WL Cm _& A
Ciro U.-M 7- - KI
Construction Valuation:. $1,000.00
Building Permit Fee:
$104.00
Plan Check Fee: $0.00
Overtime Plan Ck
$0.00
Investigation Fee:
$0.00
Record Management:
$0.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
,Building Green Fee :
$1.00
TOTAL FEE: $105.00
Excise Tax:.
$0.00
Additional Fee :
$0.00
Grading Bonds Fee:
$0.00
Grading PC Consultant :
$0.00
Grading Permit Fee:
$0.00
Grading PC Fee:
$0.00
WQ Insp. Fee:
$0.00
Electrical %:
$0.00
Mechanical %:
$0.00
Plumbing %:
$0.00
Planning Department -
Plan check Fee
Fair Share:
-
SJH Trans :
In -lieu Housing Fee:
Public Works Department -
Park Dedication ::
$0.00
PM Plan Check:
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
Fire Department
$0.00
Fire Inspection:
$0.00
$0.00
Fire Plan Rev
$0.00
$0.00
Demolition Fee
$0.00
Building Dept Adm
$0.00
General Service
$0.00
Refund Deposit
$0.00
Grading. Bondi
$0.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance
PROCESSED BY: )'1 PUBLIC WORKS APPROVAL:
ZONING APPROVAL:yr" PLAN CHECK BY: �W
GRADING APPROVAL: APPROVAL TO ISSUE:
$0.00
$0.00
$105.00
OWNER -BUILDER DECLARATION .. ... .. ... ...
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the aheclfmaric(s,} I have placed rtoxt to the applicable iteri
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair $ny',stri pno;to jts jssyai also requires the applicant fu'
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 (CORIMMeing with Section•70011i 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).
❑ 1, 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 atruoiure is aoUntended or offered Tn sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or belSoi effdrt„ bOjJk1i improy6i pjnperty, 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 OwOgr�B iili Nave the burden o Fi that it was not built or
im roved 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
a to an owner of property who builds or im oves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
am exempt from licensure under the Contr ctors' State License Law for the following reason:
By m signature below 1 acknowledge that, exce t for my personal resibence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
structure that I have built as an owner -build r 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 his application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Q Lam)
Signature of Property Owner or Authorized Ag nt Da V
LICENSED CONTRACTOR'S DECLARA
I hereby affirm under penalty of perjury that I am licensed under provisions of Cha er 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect. License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
NARNING: 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 1$100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
I 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
'ormance of the work for which this permit is issued. Policy No.
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' compensa
trance carrier and policy number are: 1
Policy Number
of Agent
rtify that, in the performance f the work for which this perm'
I should become subject to t le workers' rovisio
of
Date
not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
3700 of the Labor Code, I shall forthwith comply with those provisions. // + n
Dated
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
ender's Name Lender's Address
',y my signature below, I certify to each of the following:
I am the property owner or authorized to act on tpe property owner's behalf.
I have read this application and the information 1 have provided is co
1 agree to comply with all applicable city and co my oLdlipemeviand state laws relate g to building construction.
I authorize representatives of this city or county er the above -identified prope for inspection purposes. ®�
Name
ACTION DATE BY T DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY "
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE
PERMITEXPIRED I Ll I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT EXTENDED
I
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PERMITFINAL
of.—
UASBEST05 NOTIFICATION IS NOTAPPLICABLE TO
CERTIFICATE OF
PROPOSED DEMOLITION
OCCUPANCY ISSUED
Cry
SIGNATURE:
Civil Code).
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