HomeMy WebLinkAboutX2021-2579 - Permitsr City of Newport Beach - Building Division
d 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
`r'r+rrxau Combination Type - SFP ELEC MECH PLUM
'X2021 -2579* COMB Permit: X2021-2579
Project No : 2238-2021
Issued Date : 10/1812021
Inspection Area : 1
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1011812024 OR PERMIT WILL BE INVALID
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: 3407 SEASHORE DR NB
Description: SFR INTERIOR REMODEL AND REPLACE WINDOWS 1580 SF
Legal Desc.: NEWPORT BEACH CITY BLK 34 LOT 4 le -
Owner: BRICKMAN MICHAEL/BARBARA
Address: 3407 SEASHORE DR
Contractor:
Address:
MOLA BUILDERS INC Architect:
3334 E COAST
eg
N S L I v l
HWY Address:
1
,r-i
C
NEWPORT BEACH, CA 92663
NEWPORT BEACH CA 92625
Phone:
Phone:
714-924-3137
Phone:
State Lic:
Z
Applicant: PARSI SAM
Con State Lic: 831729
Engineer:
MOAYEDI KAMRAN
Address: 24257 SANTA CLARA AVE, UNIT 9
Lic Expire:
02/28/2022
Address:
26180 ENTERPRISE WAY #300
DANA POINT CA 92629
Bus Lic:
- BT30048402
LAKE FOREST CA 92630
C
Phone: 9491489-9392
Lic Exp Date:
09/30/2022
Phone:
949-636.6725 State Lic:C-035137
Code Edit : 2019
Worker's Compensation Insurance
Designer:
PARSI SAM
Type of Construction: V-B
Carrier:
SEQUOIA INSURANCE Address:
24257 SANTA CLARA AVE UNIT 9
0
Occupancy Group: R3
Added
Policy No:
QWC1167999
DANA POINT, CA 92629
/New sq.ft. Bldg: 0
Expire:
08130/2022
Phone:
949-489-9392
Added /New sq. ft. Garage: 0
No of Stories: 2
Building Setbacks
Rear: /
Special Conditions:
No of Units : 1
Front: /
Bldg Height: 0
Left: 1
_
((n
Bldg Sprinklers: N
Right: /
(�
Flood Zone: VE
Use Zone:
Parking Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $125 000.00
Building Permit Fee: $1,387.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $1,206.69
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: $22.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee :
$0.00 Building Dept Adm
$0.00
Energy Compliance: $87.50
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
P/W Plan Check: $0.00
Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical %:
$97.09
San Dist: $0.00
Building Green Fee : $5.00
Mechanical %:
$55.48
NMUSD Fee: $0.00
$0.00
Plumbing %:
$124.83
$0.00
TOTAL FEE : $3,037.59
Plan Check Fee :
$1,206.69 Fee Due at Permit Issuance : $1,830.90
PROCESSED BY:
PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
M -
PLAN CHECK BY:t
GRADING APPROVAL:
APPROVAL TO ISSUE:
C=cal
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 requiresihe 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 divvy penalty of
lot 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,
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).
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
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 legally
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 ate
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of peyVY that I am licensed under provisions Chapter 9 (co mencing with Section 0 0) of ivi on 3 of the Business and Pro si s ode, and my license is in full force
and effect. License Class (� License No �� 2� Date oC Contractor Signature
WORKERS' COMPENSATION DECLARATION
NARNING: 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,OD0), 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 the
performance of the work for which this permit is issued. Policy No.
I have 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' compensatior
�nee carrier and policv��tu�m�ber are: R� n
Carrier � YYC� iYb a'l._�� Policy Number o Expiration Date
dame of Agent
rnone S
I certify that, in the perfo nice 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 agree
hat, if I should become e t to he w rkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant
Date
)ECLARATION REG ' DI ONSTRUCTION LERQWfaZENCY
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 ode).
.ender's Name
Lender's Address
3y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the ro erty owner's behalf.
I have read this application and the information I h
pr vided is correct.
I agree to comply with all applicable city and coun
I authorize representatives of this city or coun
o di nces and state laws relating to building construction.
nt r he a ve-i mifed property for inspection purposes.
Signature of Property Owner or Authorized Agent
Print Property Owner's or Authorized Agent's Name
' v Dat
ACTION
DATE
BY
-DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
EPA
PERMIT EXTENDED
AQMD
PERMITFINAL
t -�
J
SBEST�TIFICATION IS NOTAPPLICABLE TO
CERTIFICATE OF
0 ED MOLITION
OCCUPANCY ISSUED
SIGNATURE: