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HomeMy WebLinkAboutF2022-0205 - PermitsCity of Newport Beach - Building Division 1111111111111111111111111111111111111111111111111111 Jill +a y 100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 2 0 2 0 5 Permit Counter Phone (949)644-3288 ��rtza�et�.�s Job Address: 333 HOLMWOOD DR NB Inspector Area: 3 Owner: ATKINS JEFFERY S Address: 333 HOLMWOOD DR NEWPORT BEACH, CA 92663 Phone: Applicant: CASEY MONTY Address: 1101 KINGSTON DR LA HABRA CA 90631 Phone: Code Edit : 2019 Type of Construction: Occupancy Group: Added lNew sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units Flood Zone: Bldg Sprinklers: Construction Valuation: V-MPR R31U 0 0 FIRE Permit: F2022-0205 Project No : 1033-2022 Inspection Requests Phone (949)644-3255 Description: SFR FIRE SPRINKLERS (X2019-0547) 47 HEADS Legal Description: N TR 1136 LOT 15 Contractor: FIREPROOF FIRE PROTECTION Address: 1101 KINGSTON DR LA HABRA CA 90631 Phone: 714-476-5370 Con State Lic: 876004 Lic Expire: 04130/2022 Bus Lic: BT30040107 Lic Exp Date: 07131/2022 Worker's Compensation Insurance Carrier: SECURITY NATIONAL INS Policy No: SWC1325710 Expire: 02115/2023 3 Issued Date: 04/1912022 0 Setback- Front: X Rear: Y Left: Right: Building PC Fee: Building Overtime PC Fee: Building Extention Fee: Building Investigation Fee: Fire Plan Check Fee: Fire Permit Fee : Building Permit Fee TOTAL FEE PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL: $4,700.00 $222.00 $0.00 $0.00 $0.00 $0.00 $0.00 $269.00 $497.00 FEES Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: INrC: i Fire Residential Alarm PC Fee Planning Counter Review Planning Zoning PC Fee: Public Works PC Fee : Public Works Traffic Plan Check Fee; Plan Check Fee : $0.00 $0.00 $0.00 $0.00 $0.00 State Lic: State Lic CASEY MONTY 1101 KINGSTON DR LA HABRA CA 90631 714-476-5370 Records Management $0.00 Fee Due at Permit Issuance : OTHEFeMPARSMENT" Via° a m o o o e o PLAN OI eCRF6 BY::° ° ° ®° _ rK APPROVAL TO ISSUE: •o emo o • ®oe e m © ® e • a•• a 0 o m a• a PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR L)tS7-VAL10 INSPECVON $6.00 $0.00 $0.00 $497.00 rNER-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). 1 J I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throu nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of a nproved for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7C pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contra I am exempt from licensure under the Contractors' State License Law for the following reason: ;y my signature below I acknowledge that, except for my personal residence in which I must have resided for at least o ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://Www.1( signature of Property Owner or Authorized Agent .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 nd effect. icense Class _ License No Date work, and the structure is not intended or offered for sale (Section 7044, oloyees' or personal effort, builds or improves the property, provided that the on, the Owner -Builder will have the burden of proving that it was not built or Business and Professions Code: The Contractors' State License Law does not pursuant to the Contractors' State License Law). year that a copy of the applicable law, Section 7044 of the Business and Date Division 3 of the Business and Professions Code, and my license is in full force Contractor Signa;Of I,ry PORKERS' COMPENSATION DECLARATION IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENWLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 7 I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Directors of Industrial Relations as provided for by Section 3700 of the Labor Code, for th rformance of the work for which this permit is issued. Policy No. have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatioi urance carrier and policy number are: farrier Policy Number Expiration Date of Agent certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall of so as to become subject to the workers' compensation laws of California, and i comply with those provisions. nam 4JIe it DECLARATION REGARDING CONSTRUCTION LENDING AGENCY 1 411' ` 1 I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf.' I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. lauthorize representatives this city county to)ter the above -identified property for inspectionpurposes. Signature of Property Owner or Authorized Agent / ✓vr Print Property Owner's or Authorized Agent's Name � �M r�,r f. �� Dateq ACTION DATE ' ' '$' "' DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY . • ._ EEffERAL REGULATIONS PART 69 OF RILE 40AND A QMDROLE 14C13: PERMITEXPIRED a •' • • ❑ •1 SUBMITTEDASBESTOS NODFICATION TO:. • ❑ EPA ❑ AOMD PERMIT CANCELLED • PERMIT EXTENDED ❑ ASBESTOS N077RCA77ON IS NOT APPLICABLE TO PFOPOSEDDEMOLITION SIGJYATURE: PERMIT FINAL �:� • . „•. :• C€RTIFICATEOF •e •• " • • OCCUPANCYfSSU€D e m o o o e e o o c o I ..