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HomeMy WebLinkAboutX2021-1423 �F a City of Newport Beach - Building Division 11111111111111111111111111111111111111111111111111111111 Jill COMB Permit : X2021-1423 " 100 Civic Center Drive,Newport Beach, CA 92660 x 2 0 2 1 1 4 2 3 Project No i Permit Counter Phone(949)644-3288 'a Inspection Requests Phone(949)644-3255 Issued Date:06/04/2021 ' Combination Type-MFP �� Inspection Area : 1 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.PROJECTS MUST BE COMPLETED BY 0610412024 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: 3711 1/2 W BALBOA BLVD NB Description: MFR-REPL DECKING&WATERPROOFING ESR 2505 Legal Desc.: I N S E T Owner: SCHROEDER CHRIS Contractor: OWNER/BLDR Architect: Address: 3711 1/2 W BALBOA BLVD Address: Address: 0000 NEWPORT BEACH CA 92663 Phone: 714-547-3222 Phone: Phone: State Lic: Applicant: SCHROEDER CHRIS Con State Lic: O/B Engineer: Address: 3711 112 W BALBOA BLVD Lic Expire: Address: NEWPORT BEACH CA 92663 BusLic: Phone: 714-547-3222 Lic Exp Date: Phone: State Lic: ° o oo°° °O o Code Edit: 2019 Worker's Compensation Insurance Designer: ° °ooe °0000 Type of Construction: VB Carrier: Address: ° Occupancy Group: R3/U Policy No: Added/New sq.ft. Bldg: 0 Expire: Phone: Added/New sq.ft.Garage: 0 No of Stories: 2 Building Setbacks Rear: / Special Conditions: O/B AUTH ATTACHED ° ° °°°°°° No of Units: 2 Front: / s°°°°° 0009° Bldg Height: 0 Left: / Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone:N Construction Valuation: $1,500.00 Building Permit Fee: $110.00 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 PAN Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0. Electrical%: $0.00 San Dist: $0.00 Building Green Fee: (LFEEE 1.00 Mechanical%: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing%: $0.00 $0.00 TOT : $111.0 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $111.00 PROCESSED BY: PUBLIC WORKS PROVAL: V ZONING APPROVAL: PLAN CHECK B GRADING APPROVAL: APPROVAL TO ISSUE: P 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) (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 U 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-Builder will have the burden of proving that it was not built or improved 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 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). ❑ 1 am exempt from licensure under the Contractors'State License Law for the following reason: By my signature below I acknowledge that,except for my personal re ' nce in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal) ° mow sell a structure•tha!I have built as an owner-builder if it has not be ns cted in its entirety by licensed contractors. I understand that a copy of the applicable law,Section 7044 of the Business and Professions Voee,is available upon request wh n this p licatio is sub rat the following Web site:http://www.leginfo.ca.gov/calaw.htm1. _ Z ® .igaature of f1dp'Irtty Owner or Authorized Agen Date _ • LiftNSED CONTRACTOR'S DECLARATIO • htWby affirm4under penalty of perjury that I am lic nsed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. 4ic«wae Class License No Date Contractor Signature • �V015KERg'°CsOMPENSATION DECLARATION • WAIQNING:FAIL&WF WO 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 • GQST OF COMPEN,,, N,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. • I•h;,aeby affirm under penalty of perjury one of the following declarations: • ?Dave and.will•rnaintain 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 PE btt�a work for which this permit is issued. Policy No. °t Aiave and w will�m;lntain 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' compensatio insMlance carver a4*4policy number are: a r. Policy Number Expiration Date Nam f ent Phone# certify hat,in the performance of the or 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 that,if I ould become subject to the or s'com sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ature of Applicant pa DECLARATION REGAralty CONSTRUCTION LENDING AGENCY I hereby affirm under pf perjury that there is a construction lending agency for the performance of the work for which this permit is issued(Sectio 97,Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner' ehalf. I have read this application and the information I have provided' co ect. I agree to comply with all applicable city and county ordinanc a sta aws relating to building construction. 1 authorize representatives of this city or county to enter the ab a-ides'Ie operty for inspection purposes. _Z Signature of Property Owner or Authorized Agent — Print Property Owner's or Authorized Agent's Name V`�`S S<- � `�'E� .Dat ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED DEPA PERMIT EXTENDED QMD PERMIT FINAL /�� J SBESTOS NOTIPIN 10 IS NOT APPLICABLE TO CERTIFICATE OF ` PROPOSED DEMOL OCCUPANCY ISSUED SIGNATURE: �EWP0 CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT v z BUILDING DIVISION 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915 c'94IF0R��P www.newportbeachca.gov 1 (949)644-3200 OWNER-BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION (HSC 19825) NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS:Read and initial each statement below to signify you understand or verify this information. J�i- I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers ory,my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner-Builder" I am the responsible party of record on the permit. understand that I may protect myself from potential financial risk by hiring a licensed Contractor and h ing the permit filed in his or her name instead of my own. understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 1116. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor materials, I may be considered an "employer" under state and federal law. understand if I am considered an "employer" under state and federal law, I must register with the s ate and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide C t ese laws may subject me to serious financial risk. I understand under California Contractors' State License Law, an Owner-Builder who builds e-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building contractor. o 0, understand as an Owner-Builder if I sell th©�pr�operty fpi-�#[ico this)p�rMit�is issued, I may be eld liable for any financial or personal injuries sustaic•'ed` �y any suDsequent oki e�(sj that result from any latent construction defects in the workmanship or materials. Forms\owner builder verif.doc 08/12/16 L4_9. understandI ma obtain more information regarding m obligations "I y g g yob gat ons as an employer from the Internal Revenue Service, the United States Small Business Administration, the California Department of r Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the j California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the f tll wing address: � 11. 1 agree that, as the party legally and financially responsible for this proposed construction tvkvvlity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as 11 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the City of Newport Beach, Building Division,for issuing the permit. Note: A copy of the property owner's driver's license or form notarization is required to be presented when the permit is issued to verify the property owner's signature. SC v_eC Print name of property owner: ►-�:5 � � Property Owner's Signature: Date: 212 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. i Property Owner's%Pattrg: ••• Date: Note:A copy of the ovAmer's driver's license or form notarization is required to be presented when the permit is issued to verify the property owner's s igggture. •a• iy� •�# . s Forms\owner builder verif.doc 0 9f12/16„ . Y °• , 4f 2 — — a u► . n •.• �.• �.. s ..• �• I