HomeMy WebLinkAboutX2021-1855 - Permitswt City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
u. ar Inspection Requests Phone (949)644-3255
Combination Type - SFP
COMB Permit: X2021-1855 IIIIIIIII�IIIIIIIII�IIIII�IIIIIIIIIIIIil�ll II
Project No: 2306-2020
NO CONSTRUCTION WORKIssuedDate : 07/15/2021
9 YV IlrlInspection Area : 2
i
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE'L COMPLETED BY UH5/2024 OR PERMIT WILL BE INVALID
Construction Hours: Monday- Friday 7:00 a.m. to 6:30 p.m. and Saturdayy{rQgtO,Q,�,pi,ZgOgp,pr� No work on Sundays or Holidays
Job Address: 120TOPAZAVENB `,j��! jji u�.j �Y
Description: DELTA 1, ADD PLATFORM IN GARAGE FOR FUTURE HVAC (REV21-1098)
Legal Desc.: BALBOA ISLAND RESUB SEC 1 BLK 13 LOT 33
Owner: KEASEY DAVIDIANITA
Contractor:
SANTANIELLO JAMES
Architect:
Address: 120 TOPAZ AVE
Address:
3419 VIA LIDO #115
Address:
NEWPORT BEACH, CA 92662
NEWPORT BEACH CA 92663
� d
Phone:
Phone:
714-815-5097
Phone:
State Lic:
Applicant: KEASEY DAVID
Con State Lic:
361862
Engineer:
HUSZCZ MARIAN JOHN
Address: PO BOX 293
Lic Expire:
08/31/2022
Address:
8 CORNWALLIS
NEWPORT BEACH CA 92662
Bus Lic:
BT30035015
IRVINE CA 92620
Phone: 949-400-9672
Lic Exp Date:
03/31/2022
Phone:
949-551-3316 State Lic:S-003555
-J
Code Edit : 2019
Worker's Compensation Insurance
Designer:
JAUERT DENNIS`!
Type of Construction: V-B-SPR
Carrier:
STATE COMP
INS
Address:
17504 WINDCREEK CIR
Occupancy Group: R3/U
Policy No:
9266012
RIVERSIDE CA 92503
Added /New sq.ft. Bldg: 0
Expire:
0110112022
Phone:
9514-688-5421
Added /New sq. ft. Garage: 0
No of Stories: 3
Building Setbacks
Rear: I
Special Conditions: LIQUEFACTION AREA
No of Units : 1
Front: /
HIGH DENSITY AREA
Bldg Height: 0
Left: /
Bldg Sprinklers: Y
Right: /
Flood Zone: A01
Use Zone: Parking Spaces:
0
Fire Hazard Zone : N
Construction Valuation: $8,000.00
Building Permit Fee: $212.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $184.44
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
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 : $453.44
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Plan Check Fee
$0.00 Fee Due at Permit Issuance : $453.44
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' 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 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
fessions 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
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
rovements 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
roved 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 not
ply 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).
V 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 cover
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
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 Sec:tion.7QQQ1 o DMVISIO 3 of the Business and Fies " ns Co
and effect. License Class License No Date Contractor Signature
COMPENSATION DECLARATION
his permit, I cannot
of the Business and
and my licpgse is in full force
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PPIIALTIES AND dIVIL FINES UP TO ONE HUNDRED TKO AND POLL—=s ($XW,0r00), IN ADDITION TO THE
:DST 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:
KK1 h e 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 thI
rmance of the work for which this permit is issued. Policy No.
Km
and will maintain workers' compensation insurance, as requify by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatioi
isurance carrier and polity member are: ;n
Date
Name of Agent W � Phone 9
I certify that, in the performance of the work for wI this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensaibn laws of alifornia, and agre
that, if I should become 1e t the workers' co ns 'on provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant Da'�
DECLARATION REGA - ONTZ
S RU ION EN ING AGENCY
I hereby affirm under pelfelt f perjury.Kat 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 ave p ovided is correct.
I agree to comply with all applicable city and ounty ord antes and s laws relating to building construction. ,S
I authorize representatives of this city or co my to r the a e-i ad property for inspection purposes.
Signature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Name Date
ACTION DATE BY ECLA N OF C PLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AN[ AOMD RU LE
1403
PERMIT EXPIRED
PERMITCANCELLED
PERMITEXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
I SUBMITTED ASBESTOS NOTIFICATION TO
L.f ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION