HomeMy WebLinkAboutf2022-0033 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 115 41ST ST NB
Inspector Area: 1
Owner: OVERFELT SHEA & BRENT
Address: 1919 PORT PROVENCE PL
NEWPORT BEACH CA 92660
Phone:
Applicant: DOUGHERTY HOLT
Address: 22672 LAMBERT ST
LAKE FOREST, CA 92630
Phone: 801-647-6161
Code Edit : 2019
Type of Construction:
V-B-SPR
Occupancy Group:
R3/U
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
3
No of Units :
0
Flood Zone:
Bldg Sprinklers:
Y
1pI11� 1111111 1111111111111111111111JillFIRE Permit: F2022-0033
2 �0f 0 q3,« 3 �p"' Project No : 0155-2022
6 V p c °�i�' it a Ins tion Requests Phone (949)644-3255
g�A fs
Description: SFR FIRE SPRIRKLU' /55�W, DS (X2021-0281)
n'
Legal Description:
RIVER SECTION BILK 41 LOT 21
Contractor:
ALL STAR PLUMBING & FIRE
Architect:
Address:
22672 LAMBERT ST #619
Address:
LAKE FOREST CA 92630
Phone:
949-470-0072
Phone:
State Lic:
Con State Lic:
715588
Engineer:
Lic Expire:
08/31/2023
Address:
Bus Lic:
BT30059737
Lic Exp Date:
07131/2022
Phone:
State Lic:
Worker's Compensation
Insurance
Designer:
DOUGHERTY HOLT
Carrier:
BENCHMARK INS CO
Address:
22672 LAMBERT ST
Policy No:
CST5018455
LAKE FOREST, CA 92630
Expire:
02/07/2022
Phone:
Issued Date: 02/0112022
Special Conditions:
Setback- Front:Rear:Left
^ gam✓
�-T
1�
Right:
,
� V � `
FEES
Construction Valuation:
$7,500.00
Building PC Fee:
$222.00
Fire Residential Alarm PC Fee :
$0.00 Records Management:
$6.00
Building Overtime PC Fee:
$0.00
Planning Counter Review:
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee :
$0.00
Building Investigation Fee :
$0.00
$0.00
Fire Plan Check Fee:
$0.00
Public Works PC Fee:
$0.00
$0.00
Fire Permit Fee :
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$269.00
TOTAL FEE :
$497.00
Plan Check Fee:
$222.00 Fee Due at Permit Issuance :
$275.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
••
OTHER DEPeARTIGIENT: ° o • "°,� `
PLAN CHE(;RE®BY:: ¢) " � 3 Y
o` r
C7n— APPROVAL TO ISSUE:
0 a •
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST b,ILID'NS-PECTION �
)WNER-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
is 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
'rofessions 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
of 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,
Usiness 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
nprovements 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
nproved for the purpose of sale).
1 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
pply 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:
ly 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 legally
ell 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
Irofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Iignature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 70 0) of Division 3 of the Business and rofessi e, and my license is in full force
nd effect.
icense Class License No Date 22 Contractor Signatur
VORKERS' COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN RED THO SAND DOLLARS ($100,000), IN ADDITION TO THE
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
1 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<
e rl ance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
ie of Agent
certify that, in the performance of the work
, if I should become subject to the workW
of
Policy Number Expiration Date
Phone #
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
ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr4isionsl
CLARATION REGARDING CO 10 LENDING AGENCY V `
�reby affirm under penalty of perjuF�that th is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Ider's Name Lender's Address
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 ordmanc Ia
I authorize representatives of this city or county toeyde a e- t ec
rs relating to building construction.
property for inspection purposes.
Print Property Owner's or Authorized Agent's Name
ACTION
DATE
R
DECLARATION OF COMPLIANCE MTH CODE OF
FOR OFFICE USE ONLY
.., . •• -
�'•
••PEDERALREGULATIONSPART61OFTITLE40AND
�-AQMDRULE1403.
•
PERMITEXPIREO
�•�
1 SUBMITTED ASBESTOS NORFICATIOM TO:.
❑ EPA
❑ AQMD'
PERMIT CANCELLED
�•
• •• • •
PERMITD(TENDEO
❑ ASBESTOS NOTIRCARON IS NOT APPLICABLE TO
•,PROPOSEDDEMOLITION.
SIGNATURE:
PERMIT FINAL
Z
m. • •,•
CERTIFICATEOF
• • • ;
• '
OCCUPANCYISSU€D
• m m
s • •mm