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HomeMy WebLinkAboutXR2022-2795 - Permit ApplicationPrint Form IWorksheet for Combo Building & Solar Permit Application Comm" fG,esidential City of Newport Beach - Building Division o��EW�q@ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X�R F +-wilding Grading p �14: �1qS f rainage f— Elec 1,0�,� Mech f plum�- Project Address (Not mailing address) f Flood CucYd CutI Cu Yd Fill r %C4C j � (- Fire �' Liq f— Landslide 7N/A Floor Suite No Description of Work / n ram ' ��T i©ry Use Const Type F/X_ # Stories #Units ,(� t (if Res) � New/Add SF %Ta/' iu _...._._ _/ SF Garage/New/Add I Valuation $ Material/Labor OWNER'S NAME Last ` ._......... Owner's Address / - �fN --. _ _ First ..._-------------- _.__ —� Owner's E-mail.Address City - State Zip APPLICANT'S NAME - Telephone _- LastApplicant's Address - - ---- First ..._.._... Applicant's E-mail Address .............. City- -._.A State � � Zip Telephone ,¢� ARCHITECT/DESIGNER'S NAME Last 1L,10,,v11,f5 Architect/Designer's Address First ,�,/ �r�, Lic. No - Architect/Designer's E-mail Address -~ City -- �S ate Zip Telephone ENGINEER'S NAME F7�� Last Engineer's Address - First --- Lic. No. ........... . ..___ Engineer's E-mail Address City _ State _ Zip Telephone CONTRACTOR'S NAME/COMPANY Contractor's Address lk Lic. No.��� Class Contractor's E-mail Address - City State _ . Zip - Telephone TRACKS REAR SETBACKS FRONT SETBACKS LEFT SETBACKS RIGHT USE ZONE PERMIT NO. PLAN CHECK NO. ��� Costa Mesa Sanitary District ...an Independent Special District SEWER PERMIT BUILDING ADDRESS:20171 Orchid St, Newport Beach, California, 92660 PARCEL NO: 439-031-02 PROPERTY OWNER NAME: NEIL TREFFER APPLICANT NAME:Mario Marquez PHONE NO.: 562-912-4884 CONTRACTOR NAME:P S A ENTERPRISES INC dba C T I CONSTR PHONE NO.: (949) 584-8966 CONTRACTOR ADDRESS:24962 AVENIDA VERANEO CITY: LAKE FOREST STATE LICENSE NO:797104 STATE: CA ZIP: 92630 WORK TO BE DONE: SFR: Tie -In (Adding Fixtures, and Clean -Out). CCTV required prior to final approval. I hereby acknowledge that 1 have read this application and state the above is correct and agree to comply with State laws, City and County oridinaces and Sanitary District ordinances pertaining to sanitary sewers. I c I possess the above valid State of California contractor's license or am legal owner of property described abovey� 01/182022 SignatureWof Permittee Date Pursuant to the Costa Mesa Sanitary District Operations Code, section 6.8.060, Orange County Sanitation District pretreatment requirements are herein incorporated by reference. PERMIT FEE: FIXTURE FEE: PLAN CHECK FEE OCSD FEE: TOTAL FEES: $ 140.00 $ 241.50 $ 250.00 $ 1,016.00 $ 1,647.50 Notes: No Excavating in Public Right -of -Way CCTV Approval Required Prior to Final OFFICE USE ONLY PERMIT NO.: SD22-0003 PERMIT ISSUED BY: Andrew Wong INSPECTED BY: CCTV: YES APPROVED: YES 1/18/22 DATE NO DATE NO IMPORTANT INFORMATION The Sewer Permit is not effective without an authorization signature. This Sewer Permit is not a contract until it has been accepted. Acceptance is subject to the following: 1. All sewer connections must be inspected- call CMSD (949) 645-8400. 2. This sewer permit is subject to all Terms and Conditions that are stated separately but incorporated herein unless this sewer permit specifically states otherwise.