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HomeMy WebLinkAboutX2013-2255 - Permitsewe y City of Newport Beach - Building Division �_ IIIIIIIIIIIIIIIIIYIIIIIIIIIIIIIulllll II 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 3 2 2 5 5 Permit Counter Phone (949)644-3288 u ws ;' Combination Type - SFP ELEC MECH PLUM GRAD Job Address: 2904 BROAD ST NB Description:RES ADD 684 SF, GARAGE ADD 35 SF, RMDL 1637 SF "CHANGE OF CONTRACTOR TO O/B`• Inspector Area: 2 Legal Desc.: FIRST ADDITION TO NEWPORT HEIGHTS BLK 22 LOT 4 AND POR ABAND STIR Owner: KELLEY VALLERIE Address: 2904 BROAD ST NEWPORT BEACH CA 92663 Phone: 949-355-9109 Applicant: KELLEY VALLERIE -r Address: 2904 BROAD ST g NEWPORT BEACH CA 92463 Phone: 949-355-9109 _. Code Edit : 2007 Type of Construction: VB Occupancy Group: R3/U Added /New sq.ft. Bldg: 684 Added /New sq. ft. Garage: 35 No of Stories: 2 No of Units : 1 Bldg Height: 24 Bldg Sprinklers: N Construction Valuation: $0.00 Building Permit Fee: $0.00 Plan Check Fee: $0.00 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $2.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access: $0.00 Fee Increase: Fee: $0.00 Additional Fee : $34.00 Hazardous Mat : $0.00 Building Green Fee: $0.00 TOTAL FEE: $36.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: COMB Permit: X2013-2255 Project No : 1284-2009 Inspection Requests Phone (949)644-3255 r f t Issued Date : 0812112013 INSPECTOR Contractor OWNER/BLDR� Architect: Address: ELLLEY,Y, uyl. Rt , d'rgpk'ICab�e. O%refund a Ar(�� Phone: 0 Of © 1 V fate Lic: \ C n t�Lisk � � E�J0 KHATCHADOURIAN VICKEN ao 0 1E 9950 Address: 1101 E BROADV1l ayta� Lucsxi)Daf AQ 81818-500-0360A912 State Lic:S00141 %ork Compe n Designer: ADKINSON TERRY rier . - oddress: 647 CAMINO DE LOS MARESo: SAN CLEMENTE CA 92673Expire: ne: 949-240-6591ilding s ea 1E cial Conditions: CANCEL LTR AND O/B AUTH a a nitP2O FORM ATTACI m ua X259 Right. 4 one: R-1 Parkins Soaces: 2 r VreUQ151i111 Solar kste :Oi l��nanning Department Efi ca0. 0 Plan check Fee 1 - ,h ,,t Fair Share: (�� �( $ta, `ed) SJH Trans Grading Permit Fe -WO $0.00 In -lieu Hous' Grading PC Fee: $0.00 orks Departn ,WQ Insp. Fee : $0.0 Park Dedications. $0.00 �no Fire Department $0.00 Fire a,� $O Ln1 PI $0.00 ve 15Ian R $0.0D(. $0.00 {{iS•Ti%.p �h mg Dept $0.00 nt - _-� rvsit $0.00 $g�06� Refund Deposit $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $36.00 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. INSTALL OR VERIFY SMOKE AND CARBON MONOXIDE DETECTORS ARE EXISTING PER CRCR 314.1 & 315.2 omo°o 0 o° cm o 0 0 m m o °a o om000 000mm .:Doom 0 0 �amo mV ° ��m 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) action 70,31.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structum prior to its issuance, also requires the applicant fbr perm)ppto file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law;(Chapter-9'(`commencing wAth Section 7000) of Division 3 of the Business and ess'dns Code) or that he or she is exempt from licensure and the basis for the alleged exemptio elaN sfl'64 Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of re than five hundred dollars ($500). as owner of the property, or my employees wit o e compensation, will do L) all of or ,�3Cthe�'"work, and the structure is not)lintended or offered for sale (Section 7044, siness and Professions Code: ato Lice s w does not apply to an owner of prope 0! rough employees' or,persp%effer j bu;Ids or improves the property, provided that the )rovements are In Or offered Sale. ,�£r �.ql,,",9rt� t wilding orim r t-is�0 within one year of,�c�mpletlori, th�e,�0y�r[e"r-Bul`l el' Witr hale the burden of proving that it was not built or )roved for the pure a of sale). `�`70 I, as owner of the ape ml ontractIng with licensed Contra t project (Section 7044, Business and Professions Code The Contractors' State License Law does not )ly to an owner of p perty who builds or improves thereo nd co a or a licensed Co�a�ctncoursu�theZoMractors State License Law). I am exempt from l ensure Contr tat ns t folio _ asorc '4...ro VY Ii FED my signature below ackn -- edge t , ex f r my r in m r e (least one year prior to completion of the improvements covered by this permit, I cannot legally a structure tTiat i bud s an o r-bui nst ted m I S entirety by I' Ed contractors. I understand that a copy of the applicable law, Secti n 7044 o the B siness and �fessions Cdde; is av table pon re -yvh fo s s bmi ow" http://w .leg' fo ca gov/calaw.html. i Aure of Prope y" er o _ ant it a X.. Da a `-22 -E14SED b6m,rRA TOR'S DEC RATIO ` f g } Aeby affirm under pen Ity of am d uKrsoe" f 'co e n ection 7000) of Division 3'of the Business and Professions Code, and my license is in full force IOffect. LiopnssElas - Date _ Contractor Signature AKERSAMIM'EN Tlt l C TI " MING: FAILURE TO SI! ORK(•.R �' ATION COVERAGE IS UNLAWFUL, AND SHALL SUB.IECT AN EMPLOYER TO CRIMINAL PENALTIES A,i�D IL } O�,NE TIUNDRED THOUSAND DOLLARS (E100,000), IN ADDITION TO THE WOF COMPEYSw�rCN� DAM ES Aa`R ED OR IN SECTION WO6 OF THE LABOR CODE, INTEREST, AND A Y'S -� T a seatiy affirm under penalty of pery ry one of the following declarations: ��,,++qq _ ' +�' r "ve and will mentalr�a certlflce of sent to a ur f lompensatio L by the Drec,LotO pf ridisstne7 R lations as provided for by Section 3700 of the Labor Code, for the Formance of fn�Svciik for which mit')is s2ie y s o. . 99 �9.j �1�tE+- �' nape and will mSlrtam workers ensn Insurance, as.,,fCu d by Section 3700of the Labor Code, for the pertormance of the wo for -this permit is issued. My workers' compensation 7Idhoe carricEarscEpollcy nElmbe - 0r �t l lCva 1 Tier _ Policy Number Expiron +t@• ne of Agent � "•, -•' PNdne # " - certify that, in the pertormance of"FhP�"�vork f ,permit Is Issued, I shall not emplo a erenymanrLe eeolYie subject to the workers' compensation laws of California, and agreE if I should become sub/echto4he workers' compensation provisions of SectiDa87e a Labor with comply with those provisions. .nature of Applicant 1_1; .-- -- '�— Date__ CLARATION REGARDING CONSTRUCTION L�NDfNG-AGENC ;reby affirm under penaltyof per#u;tFatfhere is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). ider's Name - Lenders Address my signature below, I certify fo-each.of the_ following:") I am the property owner or authorized to ac"d he. property owners behalf. _ I have read this application and the inform n have proviadd'Is correct. - I agree to comply with all applicable city an my ordinances and state jaw "elating. to building construction. I authorize representatives of this cit 9r count enter the 6v�f tiff property for inspection purposes. Y �� mature of Property Owner or Authorize Agent Print Property Owners -or -Authorized Agent's N�e ArTHM i)ATF AV ' UtS:LAWIIlDPIOa`(X]VNOfN-U]PICt WII liGU!)t DY iDIt UFH{i tt}t iMiT) FEDERdL REG("TEWS PART6l OF ]TILE40AND \ PFRIXTFXPfRFO ' ( tc� Al2MORILE140. ❑ f 4;l fnUITTFA.A4TY STf1S NDTf(N-ATION TO. PEX0rTC4,m1CZLLED ❑ EPA 0 ASBESTOS M071RC RON1S NOT APPLtCASLETO PERMITTMIAL PROPOS€DDi5il4OLf7fON_ CER-17F CATECF 0CCUDXJCt'iS5UED NIGNA1 LNIE.