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Home My WebLink AboutX2018-1709 - Permitsto City of Newport Beach - Building Division *X2018-1709* COMB Permit: X2018-1709 100Civic Center Drive, Newport Beach, CA 92660 a Project No F , � Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 ` surf Combination Type - SFP PLUM Issued Date: 0610512018 - Inspection Area : 6 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: 15 VIA PALLADIO NB Description: SFR PEX REPIPE Legal Desc.: N TR 14070 LOT 88 Owner: HAGHIGHAT DARIUSH Contractor. PIPELINE RESTORATION PLUM Architect: Address: 15 VIA PALLADIO Address: 3921 E LA PALMA AV UNIT R Address: NEWPORT COAST, CA 92657 ANAHEIM CA 92807 Phone: Phone: 949-510-2281 Phone: State Lic: Applicant: PIPELINE RESTORATION PLUM Con State Lic: 965054 Engineer: ?= �:.. Address: 3921 E LA PALMA AV UNIT R Lic Expire: 08/31/2079 Address: Qs_ ANAHEIM CA 92807 Bus Lic: BT30044701 ° Phone: 949-510-2281 Lic Exp Date: 09/30/2018 Phone: State Lic ° • ° ° Code Edit : 2016 Worker's Compensation Insurance Designer: • °. Type of Construction: V-B Carder: OAK RIVER Address: ° • ° , ° Occupancy Group: R3/U Policy No: PIWC812004 Added /New sq.ft_ Bldg: 0 Expire: 06/13/2019 Phone: _ Added /New sq. ft. Garage: 0 No of Stories: 2 Building Setbacks Rear: I Special Conditions: °�,.`u.. ° • • • ° o No of Units : 1 Front: / • ° b�^^ Bldg Height: 0 Left: I Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $7,500.00 Building Permit Fee: $187.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 Additional Fee : $0.00 Plan check Fee : $0.00 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: $0.00 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 P/W 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 %: $16.83 $0.00 TOTAL FEE : $204.83 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $204.83 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: 1\ / 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 (_) all of or (_) 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 legall) sell a strupture t1vtl 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 C58e, is available upon request when this application is submitted or at the following Web site:hftp://w .leginfo.ca.gov/calaw.html. gnature of Pfd%rty Owner or Authorized Agent ate • LICENSdD OONTRACTOR'S DECLARATION • I Tltreby affiml under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section DO) of �Di'v�isi�obn 3 of the Business and Prof s i s Code nd my license is in full force �� eed effect. J.Jcosse Class License No Dat es Contractor Signatur • RKE12549MPENSATION DECLARATION • NATtNING: FA$141iE i0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUN RED THOUSAND DOLLARB ($700,000), IN ADDITION TO THE •• CIST OF COMPE"SgbN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. • • JiV71aby affirm. nder penalty of perjury one of the following declarations: .• -have and willrnaintain 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 erformancC 8MA8 work for which this permit is issued. Policy No. • ve and. ilf 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' compensatiol • w"lrr ce c&h erema policy number are: Carrier Policy Number Expiration Date Name of Agent n Phone # I certify that, in the p=naltyedury rk f r which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' mpensation laws of California, and agree that, if I should becomrs' ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 0 Signature of Applicant e_ DECLARATION REGATION LENDING AGENCY I hereby affirm under pthere is a construction lending agency for the performance of the work for which this permit is issued (Section Z97, 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 pr ert owners behalf. I have read this application and the information ro�7 rovi ed is rrect. I agree to comply with all applicable city and co dina 'ces state laws relating to building construction. I authorize representatives of this city or coun ert abo -identified property for inspection purposes. Signature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Name */ ~ D e 6 ACTION DATE BY CLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE tl PERMIT EXPIRED PERMITCANCELLED I SUBMITTED TO PERMITFINAL /i�BESTOS NOJJFICATI dOT PPLICABLE TO CERTIFICATE OF IFS f Fp to OPOSED DE"!'�/ ITION OCCUPANCYWUED 7 SI NATURE: