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M2021-0042 - Permits
ovtny4,', City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 3902 RIVER AVE Floor: Suite: Bldg: 0 Description of Work: SFR REPLACING BOARDS ON DOCK "LIKE FOR LIKE" Inspector Area: 1 Legal Description: CANAL SECTION BILK 239 LOT 2 Owner: REESE LINDA Address: 3902 RIVER AVE NEWPORT BEACH, CA 92663 Phone: State Lic: Applicant: REESE TOM Address: 3902 RIVER AVE NEWPORT BEACH, CA 92663 Phone: 949-813-8708 Special Cond: Issued Date 07/01/2021 Valuation: $200.00 Inspection Fee: $0.00 Plan Check Fee $0.00 OT Plan Check Fee: $0.00 Investigation Fee: $0.00 Building Green Fee : $1.00 TOTAL FEE : $62.00 PROCESSED BY: PLAN CHECK BY: 2I�0 2I00�II42�� II Contractor: OW N ER/BLDR Address: REESE TOM O/B AUTH ATT Phone: 949-813-8708 Con State Lic:O/B Lic Expire: Bus Lic: Lic Exp Date: Engineer: Address: Phone: Designer: Address: HARBOR Permit: M2021-0042 Project No : Inspection Requests Phone (949)644-3255 Er O U UJ � JCL V) z e ••ee o emmm e m ..ee a ommm ° m ®mmeme Phone: mm m o m o ® mm Longshoremen's and Harbor Workers' Compensation berlafton Carrier: Policy No: FEES Fire Inspection Fee: $0.00 $0.00 Fire Plan Check Fee: $0.00 Plan Dep - Counter Review: $0.00 Records Mangement: $0.00 Plan Dep- Zoning Plan Check: $0.00 Harbor Plan Check Fee: $61.00 Plan Dep- OverTime Plan Check: $0.00 Plan Check Fee : $62.00 PUBLIC WORKS: APPROVAL TO ISSUE: OTHER DEPARTMENTS: FINAL INSPECTION: PERMITEXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Fee Due at permit Issuance : $0.00 • o o . o ee o Ommp0 m m0000 moomo" o m " m " mpmmm0 ° ammo" 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) ction 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 fc 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 an, fessfDns 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 c more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, 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 the property, provided that the ov 6ents 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 c ed 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 no'! 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). J I am exempt from licensure under the Contractors' State License Law for the following reason: Iy my signature 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 legall, all a structure that I have built as an owner -builder if it has ee constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 o the B Isiness an( 'rofessions Code, is available upon request wherythis 5lication is ubmitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. >ignature of Prgp@aA Owner or Authorized Agent / / Date 2 .ICENSED c6AthACTOR'S DECLARATION btl'eby affirmLnder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full ford Ip d egect. LicErtse Class License No. Date Contractor Signature .ON9SHOREM'EN'S & HARBOR WORKERS' COMPENSATION DECLARATION VARrr33ING: FAILURE•T06ECURE LONGSHOREMEN'S & HARBOR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS M0.0,0t101, IN ADF%Q%Te THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following 3• • •. I hav22r1d fill maintain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is aeweck My • workers' compensation insurance carrier and policy number are: ;1aT1Bi Policy Number Expiration Date d.n,o t Ancn/ _ • _ Phone # I certify=Ilal,il the performance of the 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, that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ature of Applicant: REGARDING CONSTRUCTION LENDING AGENCY I 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 Lender's Name Lender'sAddress By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with Ic city and county ordinances and state laws relating to building construction. I authorize represe ives of this,Bjt or county to enter the above -identified property for inspection purposes. _ Print Civil Code). AL7f0 DATE BY DECLAJMTIOM OF COMPLIANCE MTH CODEOF FOR OFFICE USE ONLY FE L REGULATIONS PART 61 OF TITLE40AND MD RULE 16AS 1 SUBMITO5 NORFICATiONToPERMITCANCELLED /115 D EPPERMfTEXTENDED AQASBESTTION PERMIT EXPIRED IS NOT APPLICA8L O PROPOSED. PERMITFINAL%/() 7j CERTIFICATE OF SIGNATURE: OCCUPANCYISSUED •�i ds ��roN (omN do �r �c$0=moa oj a '�<a&W0=5.Fm°roDroq g3CDmammroroCD am my°wQp y pEmo<maa0 Yom 1° v�mm41 m yya �� ��a om=ro�'mm CO O°yo nEa�c ama ro w no: a �a—� Er ro o c� 3m d c 5 cro cCD ? 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