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Home My WebLink AboutX2017-3672 - PermitsF oxzyr�hb City of Newport Beach - Building Division„ ,I@�II�I�II1��I¶��I�flul��l��l��ll� COMB Permit: X2017-3672 100 Civic Center Drive, Newport Beach, CA 92660 • .I sY i2 0. 1 ➢ 3 6 7 z II Project No : 1472-2017 Permit Counter Phone (949)644-3288 m . e . e m : o Inspection Requests Phone (949)644-3255 Combination Type - BLDG Issued Date: 04/1812018 J00 AOOreSS: 42U NUIN5hl I IA AVE NB Description: TEMP SHORING W/RETAINING WALL FOR NEW SFR (X2017-2099) Legal Desc.: CORONA DEL MAR BLK 443 LOT 16 Owner: FADAVI ALI R Contractor: A & R COROPORATION INC Architect: BUCILLA GREG Address:. 34 TALMONT Address: 34 TALMONT Address: 19782 MAC ARTHUR BLVD #270 NEWPORT COAST CA 92657 NEWPORT COAST CA 92657 IRVINE CA 92612 Phone: Phone: 949-254-8116 Phone: 949.851-9080 State Lic:CO26879 Applicant: BUCILLA GREG Con State Lie: 951076 Engineer: RIOS CALEB Address: 19782 MAC ARTHUR BLVD #270 Lie Expire: Address: 139 AVENIDA NAVARRO IRVINE CA 92612 Bus Lie: BT30062920 SAN CLEMENTE CA 92672 Phone: 949.651-9080 Lie Exp Date: 04/3012019 Phone: 949-492-8586 State Lic:C-057587 Code Edit : 2016 Worker's Compensation Insurance Designer: Type of Construction: Carrier: STATE FUND Address: Occupancy Group: U Policy No: 910051 - Added /New sq.ft. Bldg: 0 Expire: 05/30/2018 Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: 5 Special Conditions: No of Units : 0 Front: 20 Bldg Height: 29 Left: 3 Bldg Sprinklers: Y Right: 3 Flood Zone: X Use Zone: R2 Parking Spaces: 2 Fire Hazard Zone : N Construction Valuation: $25,000.00 Building Permit Fee: $442.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $384.54 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 $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee: $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE: $827.54 PROCESSED BY: �Q 1 ZONING APPROVAL: GRADING APPROVAL: Plan Check Fee $0.00 Fee Due at Permit Issuance : $827.54 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Stalp L,:censl LJw foMhe reas on(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 eonstrmct, alter, improva.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). ❑ 1, as owner of the property, or my employees with wages as their sole compensa.0% wiljdo L) pB pf orb prHorm 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, IL*rougd 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 improvementis sold whhin 5Rg 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). ❑ I 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 residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit. I cannot Iegall sell a structure that I have built as an owner -builder 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 this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw. html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 00) of Division 3 of the Business and Professions o a, and my license is in full force and effect. License Class License No D J Contractor Sign al�(r� WORKERS' COMPENSATION DECLARATION LX WARNING: 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 ($100,000), IN ADDITION TO 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 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 th ormance of the work for which this permit is issued. Policy No. In e 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' compensatio ra ce carrier and policy number are: a.. r Policy Number Expiration Date Name of Agent Phone # I certify that, in 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, and agre that, if I should become subjec) t(o the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. •• ,, //,� Signature of Applicant did Qa T��G�I� DECLARATION RE4X CO TRUCTION LENDING AGENCY "�L. 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, 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's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter tye above -identified property for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name ✓L- A T Date ACTION DATE BY kELARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED LIEPA PERMIT EXTENDED QMD _ PERMITFINAL ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF yI '� PROPOSED DEMOLITION .... OCCUPANCY ISSUED "��'ZZ- P�v� SIGNATURE: