HomeMy WebLinkAboutX2022-0020 - Permits`twrra�' City of,Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - SFP ELEC MECH PLUM
*X2022-0020* COMB Permit: X2022-0020
Project No : 0020-2022
Issued Date : 01/1212022
Inspection Area : 2
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 01112/2025 OR PERMIT WILL BE INVAL-jD ° °
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: 288E BAY SHORE DR NB Y+ - 13
Description: MFR INTERIOR REMODEL R/R (2) WINDOWS (1) SLIDER 1420 SF
Legal Desc.: IRVINE SUB LOT 171 BILK 54 POR OF LOT a
Owner: PRESTA.ALLYSON
Contractor.
OWNER/BLDR
Architect:
GOETZANDREW
a
aa000a
Address: 10 CHERRY HILLS LN
Address:
ANDREW GOETZ
Address:
2855 E COAST HWY #234
a
NEWPORT BEACH CA 92660
CORONA DEL MAR CA 92625
Phone: 949/874.1725
Phone:
949-673-3152
Phone:
949-673.3162 State Lic:C018499
0 'O
Applicant: GOETZ ANDREW
Con State Lic: O/B
Engineer:
a
ao
Address: 2855 E COAST HWY #234
Lic Expire:
Address:
°
a o 0
CORONA DEL MAR CA 92625
Bus Lic:
o ao
Phone: 949-673-3152
Lic Exp Date:
Phone:
State Lic:
Code Edit : 2019
Worker's Compensation Insurance
Designer:
a °o
Type of Construction: V-B
Carrier:
Address:
Occupancy Group: R2
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: 0/8 FORM ATTACHED
No of Units : 1
Front: I
Bldg Height: 0
Left: /
Bldg Sprinklers:
Right: /
Flood Zone:
Use Zone: Parking Spaces:
0
Fire Hazard Zone : N
Construction Valuation: $100,000.00
Building Permit Fee: $1,209.00
Excise Tax:.
$0.00
Planning Department -
Fire Department
Plan Check Fee: $1,051.83
Additional Fee :
$0.00
Plan check Fee :
$52.00 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: $4.00
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
P/W Plan Check:
$0.00
Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical %:
$84.63
San Dist:
$0.00
Building Green Fee : $4.00
Mechanical %:
$48.36
NMUSD Fee:
$0.00
$0.00
Plumbing %:
$108.81
$0.00
TOTAL FEE: $2,562.63
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL: _
Plan Check Fee:
$0.00 Fee Due at Permit Issuance : $2,562.63
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
T
U
S
V
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slats License Law for they mason(s) indicated below by the checkmark(s),I have Placed next to the applicable item(s) -
ction 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repatrany 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
morefesslonsthan
Code) u that he ll she is exempt from licensors 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 is ex.
1, as owner of the property,. or my employees with wages as their solo compensation;: will do
Iness 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 theproperty,
(,all of or (j portions of the work; and the Structure is not intended or offered forsale (Section 7044,
rovemerits are not intended or offered forsale: 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
rd4ed for the purpose of sale). provided that the
I, as owner`D011e property, am exclusively contracting with licensed Contractors to construct the Project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
i!an awne .1,,of property who builds or improves thereon, and who contracts fOrthe projects with. a licensed Contractor pursuantto the Contractors'State License Law).
I am exempt fro n Ifcensure underthe Contractors' State License Lawforthe following Mason:
ryesrgnaturebelow 1 acknowledge that, except formypersonal restd in which ust hav .sided forrat least one year prior to completion of thaimprovements covered bythis pe it, 1 cannot legalh
3, ions to that 1 havebuiltas, an owner -builder if it has. been co sfru r tt nFi yiicensed contractors. I understand that copy of the applicable law, Section 70by(of the �uslness and
=_ssions Copg, le afallable upon request wheQ tyisapp coif n. is su mi
more of Property Owner or Authorized Agent lowing fNeb-site:http://W Ww.legtnfo.ca:cov/caiaw_btml --
,.auerpenalry or perjury that l am licensed under provislor�seF Chapter c0 �—
&rwafi'eet. vv P ( encing with Section 7000) Of Division 3 of the Business and Professions Code, and my license is in full force
210Erzu-class .license No
WORKERS, CQM1PENSATION DECLARATION Date Contractor Signature
WdSVGdu.,FAILURE'(,O $E,,rURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARSIsloo e6Cl, IN ADDITION TO THE
q$,T7f COMPENSATION, LRAMAGES AS PROVIDED FOR IN SECTION 3766 OF THE LABOR CODE, INTERES$.AND ATTORNEPS FEES:
hereby affirm una'r penalty of perjury one Of the following declarations:
I 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 IN
erformance Of the work forwhich this permit Is issued. Policy No.
71 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' compensation
isurnce carrier and policy number are:
artier
,Me Of Agent Expiration Date
if certify that, in the perfonnan o work - Phone #
It, if I should become ubje to the rs om h this p I Is Issued, I shall not employ any person in any manner so as to become subject to the workers' Mpensation laws of California, and ogre
Is
Of Section 3700 of the Labor Code, . Ishall forthwith Comply With those provi ions. (nature of.Applicent
CLARATION REGA D G CONSTR TION L GE.— Date
rreby affirm under penalty of perjury that ere Is a- on lending agency for the performance of the work for which this permit is issued (Section 3097, Civil ode).
rder's Name
my signature below, I certify to each of the following: Lender's Address
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the Information I hav ad is c qt.
1 agree to comply with. all applicable city and county rdinann s an si to la r lating to building construction.
I authorize representatives of this city or county o nter tti boas tiff,
tature of Property Owner or Aathnd,.H a....I /F for inspection purposes, �I
DATE al BY
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