HomeMy WebLinkAboutR2021-0751 - Permit ApplicationDocuSign Envelope ID: F9AB3A4C-171B-41F7-9475-62FFB5DC5F33
PnhtFomt City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
(t�l,U I r1�� BUILDING DIVISION
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�t- U 1 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Feel-$198.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please tvoe or print and complete all information
# of Units: F—
Address; 16 Castellina Dnve
' City: Newport Beach
!. State: CA ;Zip: 92657 j
P roperty Owner
Haot ie Cui
Zip Code: _ 92657,
Owner Address: -
16 Castellma Drive
City: Newport Beach
State: CA
_ Zip Code 92657
Home Phone:
(81M 879 2266
Owner's Authorized Agent: Tammy Zhu J,
Work Phone: (818)-879-2266
Agent Address:
''. 30699 Russell Ranch Road Suite 100 City;
Westlake Village E
State:_ Cahforma. I- Zip Code: 91.362 Agent Email Address:
tammy9060@msacom
Escrow Company: Landmark Escrow
Escrow # 002074-CK !.
Escrow Address:
3471 Via Lido Suite 207 City:
Newport Beach i
i
State:. fornia _ Zip Code: 92663 Cali
Escrow Phone
(949)-204 2194 t
Email Reportto;
colleen@landmarkescrow,com
For Inspection call (Name):
Tammy Zhu
Direct Phonei-.
(818) 879-2266
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW):
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection::
Date:
'�`bQRSiBned bbb . ��
Owner/Agent's signature to decline inspection; 1 a*m� �"'^'" Date: 9/21/2021
Account # 01050504-521040...... __...... Make checks payable to: CITY OF NEWPORT BEACH
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