HomeMy WebLinkAboutX2020-1731 - PermitsN�r,7 City of Newport Beach - Building Division
�§ s 100 Civic Center Drive, Newport Beach, CA 92660
H rg �n Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
`a ra,us` Combination Type - CIP
COMB Permit: X2020-1731
X 2 0 2 0 1 7 3 1�� II
Project No: 1375-2020
Issued Date : 10/29/2020
Inspection Area : 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 10/30/2023 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: 2751 W COAST HWY NB
Description: COMM TI - 2200 SF. R/R WINDOWS, BALCONY GUARDRAIL, INT DEMO, ADD NEW WINDOWS, ADA UPGRADES TO RESTROOMS
Legal Desc.: TR 919 LOTH SELY 100 FT NWLY 250 FT
Owner: 2751/2801 PCH ILL
Contractor:
OWNERIBLDR
Architect:
LUSHBAUGH WILLIAM
Address: 1111 BAYSIDE DR STE 120
Address:
TETZLAFF BRYAN
Address:
17191 CITRON
NEWPORT BEACH CA 92625
IRVINE, CA 92612
Phone: 949-945-2645
Phone:
626-905-2181
Phone:
949-584-2166 State Lic:CO24887
Applicant: LUSHBAUGH WILLIAM
Con State Lic:
OIB
Engineer:
NELSON DAVID
Address: 17191 CITRON
Lic Expire:
Address:
43180 BUSINESS PARK DR STE 200
IRVINE, CA 92612
Bus Lic:
TEMECULA CA 92590
Phone: 949-584-2166
Lic Exp Date:
Phone:
951-695-7101 State Lic:C-076318
Code Edit: 2019
Workers Compensation Insurance
Designer:
Type of Construction: V-B-SPR
Carrier:
Address:
Occupancy Group: B
Policy No:
Added /New sq.ft. Bldg: 2200
Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2
Building Setbacks
Rear: 0'
Special Conditions: LIQUEFACTION AREA
No of Units: 0
Front: 0'
Bldg Height: 0
Left: 0'
Bldg Sprinklers: Y
Right: 0'
Flood Zone:
Use Zone: Parking Spaces:
0
Fire Hazard Zone : N 7 �" =n
Construction Valuation: $98.000.00
as e �
I
Building Permit Fee: $1,193.00
Excise Tax:
$0.00
Planning Department
-
Fire Department
Plan Check Fee: $1,037.91
Additional Fee :
$335.00
Plan check Fee :
$46.25 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: $28.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee
:
$0.00 Building Dept Adm
$0.00
Energy Compliance: $68.60
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 : $98.00
PM Plan Check:
$0.00
Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical %:
$0.00
San Dist :
$0.00
Building Green Fee : $4.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE: $2,810.76
PROCESSED BY:
ZONING APPROVAL:
Plan Check Fee
$1,913.89 Fee Due at Permit Issuance : $896.87
PUBLIC WORKS APPROVAL: Qy
PLAN CHECK BY: �+
GRADING APPROVAL: APPROVAL TO ISSUE:
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).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) 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
im roved 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
a ly 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).
am exempt from licensure under the Contractors' State License Law for the following reason:
By signature below I acknowledge that, except for my personal residence in which ust have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal!
sell structure that I have built as an owner -build r if it has no been c tru d Its nbret 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 is a pl tion is mi do a e 'ng Web site:http://www.leginfo.ca.gov/calaw.htmi.2-=20
Signature of Property Owner or Authorized Age Da
LICENSED CONTRACTOR'S DECLARATIO
I hereby affirm under penalty of perjury that I am licensed under provisions of Cha (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect. License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
NANNING: 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 ($100,000), IN ADDITION TO THE
COST 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:
1 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 th
Dertormance of the work for which this permit is issued. Policy No.
:1I 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' compensatiol
nsurance carrier and policy number are:
Carrier Policy Number Expiration Date
a e of Agent Phone #
�I rtify that, in the performance of the work for ich t ' rmit is ' sued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
:hat, f I should become subject to the orke c 'pen ns of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /� /
ature of Applicant Date V "10
DECLARATION REGAR61hP COMSTRU&ION LENDI GENCY l_V_
hereby affirm under penalty of perjury that there is a co struction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
-ender's Name Lenders Address
3y 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 an tat relaf uilding construction.
I authorize representatives of this city or county to t e ab -Ide if pr for inspection purposes.
31nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam 1 iP 5h ' "�Z'�G Date I U'Z`1 -Zuz
ACTION DATE BY DECLARATION OF OMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO -
PERMITCANCELLED EPA
PERMIT EXTENDED K e _ QMD
PERMIT FINAL ASBESTOS NOTIFICATION 15 T PU TO
CERTIFICATEOF PROPOSED DEMO T
OCCUPANCYISSUED SIGNATURE:
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