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Home My WebLink AboutX2019-3641 - PermitsL�, City of Newport Beach - Building Division II�IIIIIIIIII�IIIIII�IIIIIIII�IIIIIIIIIIIII II COMB Permit: X2019-3641 4 * 100 Civic Center Drive, Newport Beach, CA 92660 - 9 Project No: 2687-2018 °` Permit Counter Phone (949)644-3288 3 Inspection Requests Phone (949)644-3255 ,�ati9.'' Combination Type - BLDG Issued Date: 11113/2019 Inspection Area : 5 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. 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: 4500 ROXBURY RD NB Description: TEMP SHORING 222 LF Legal Desc.: N TR 3357 LOT 11 Owner: ROWSHAN KASRA Contractor: GABAY DAVID JOHN JR Architect: TEALE MARK Address: 4500 ROXBURY RD Address: 31726 RANCHO VIEJO RD Address: 2900 BRISTOL ST BLDG A203 CORONA DEL MAR, CA 92625 SAN JUAN CAP CA 92675 COSTA MESA CA 92626 Phone: Phone: 949.370-0478 Phone: 949-975-0123 State Lic:CO22162 Applicant: GABAY DAVID JOHN JR Con State Lic: 529750 Engineer: PATEL SHARAD Address: 31726 RANCHO VIEJO RD Lic Expire: 06/3012020 Address: 9283 RESEARCH DR SAN JUAN CAP CA 92675 Bus Lic: BT30033857 IRVINE CA 92618 Phone: 949-370.0478 Lic Exp Date: 1213112019 Phone: 949.943.8080 State Lic:S-004488 Code Edit : 2016 Type of Construction: V-B Occupancy Group: 2016 Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Building Permit Fee: $526.00 Plan Check Fee: $457.62 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $0.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee: $2.00 TOTAL FEE: $985.62 PROCESSED BY: OJ I ZONING APPROVAL: �SS GRADING APPROVAL: '�itQ Worker's Compensation Insurance Carrier: CALIFORNIA INSURANCE Policy No: 468264410 Expire: 04/01/2020 Building Setbacks Excise Tax: Additional Fee Grading Bonds Fee: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee: Electrical %: Mechanical %: Plumbing %: Rear: / Front: I Left: I Right: I king Spa $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0 Designer: Address: Phone: Special Conditions: 3 � � IS, Planning Department - Plan check Fee Fair Share: SJH Trans : In -lieu Housing Fee Public Works Department - Park Dedication : $0.00 P/W Plan Check: $0.00 San Dist: $0.00 NMUSD Fee: $0.00 Fire Department $0.00 Fire Inspection: $0.00 $0.00 Fire Plan Rev $0.00 $0.00 Demolition Fee $0.00 Building Dept Adm $0.00 General Service $0.00 Refund Deposit $0.00 Grading Bond: $0.00 $0.00 $0.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $985.62 °PLBLI ,WORKS APPROVAL: I XL_� o °P;LA�CHECK 0: o� ° °o • o � APPROVAL`Or Ssriil ° - o• 0 n o 0 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 L) 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 residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal 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 B siness 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 r--Bste LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Vvision 3 of the Business and Pr' �fes�� p e, and r lip'ense in full force and effect. License Class License No Date 11 1 Contractor Signatu'eV WORKERS' COMPENSATION DECLARATION 'ARNING: 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 DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 qrmance 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: Policy of Agent Date certify that, in the performance of the work for which this p rmit 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 t, if I should become sgjaje rs' compensation rovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant Dat �f7 l CLARATION REGA G NSTRUCTION LENDING AGI&NCY ;reby affirm under penalty of perjury that there is a constructiolh lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). rder'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 and state laAating building construction. I authorize representatives of this city or count ,,to t`nter the ab = tifiedinspection purposes. of ProDertv Owner or Authorized Name Date ACTION DATE BY V f IT REGULATIONS PART0610F TNCEW TL 0 AND'AD F F IDLE ALAI R�F-O OFFICE USE ONLY / PERMIT EXPIRED PERMIT CANCELLED PERM/TEXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED SBESTOS NOTIFICATION TO _IFIftATIOR IS NOTIATPLICABLE TO I ITIDN o o _ � o 0 o a o�� a o0 c oco .. 0° n o