HomeMy WebLinkAboutX2021-1851 - Permits (3)City of Newport Beach - Building Division
T 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
'Combination Type - MFP MECH ELEC PLUM
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IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2021-1851
x 2 0 2 1 1 8 5 1 Project No : 1595-2021
Issued Date : 0312912022
Inspection Area : 1
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 03/29/2025 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: 919 E BALBOA BLVD NB
Description: MFR ALT 195 SF (3) BATHROOMS UNIT #B
Legal Desc.: BALBOA TR BLK 14 LOT 9
Owner:
JERGENSEN JEREMY/ELIZABETH
Contractor:
OWNER/BLDR
Architect:
MORGAN JOHN T. JR
Address:
17244 FIRST LIGHT LN
Address:
ELIZABETH JERGENSEN
Address:
18682 BEACHMONT AVE
RIVERSIDE CA 92503
N. TUSTIN CA 92705
Phone:
Phone:
951-255-0908
Phone:
714-730-2723 State Lic:CO22567
Applicant:
MORGAN JOHN T. JR
Con State Lie:
O/B
Engineer:
Address:
18682 BEACHMONT AVE
Lie Expire:
Address:
N. TUSTIN CA 92705
Bus Lie:
Phone:
714-730-2723
Lie Exp Date:
Phone:
State Lic:
Code Edit :
2019
Type of Construction:
VB
Occupancy Group:
R3/U
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
3
No of Units :
2
Bldg Height:
0
Bldg Sprinklers:
N
Flood Zane:
X
$55,000.00
Building Permit Fee: $849.00
Plan Check Fee: $806.63
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$6.00
Energy Compliance:
$0.00
CA Seismic Safety :
$0.00
Disabled Access:
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$3.00
TOTAL FEE : $2,056.04
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Worker's Compensation Insurance
Carrier:
Policy No:
Expire:
Building Setbacks
Use Zone:
Excise Tax:
Additional Fee
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: /
Front: I
Left: /
Right: /
3arkina Spaces
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$118.86
$93.39
$76.41
Plan Check Fee
Designer:
Address:
Phone:
Special Conditions: HIGH DENSITY AREA
O/B FORM ATTACHED
0
Planning Department -
Plan check Fee:
Fair Share :
SJH Trans:
In -lieu Housing Fee
Public Works Department -
Park Dedication :
$0.00
PAN Plan Check :
$50.75
San Dist:
$0.00
NMUSD Fee:
$0.00
Fire Department
$52.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$841.38 Fee Due at Permit Issuance : $1,214.66
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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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' Stale 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 L) 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
ved for the purpose of sale).
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
'.. p5 ply`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).
I am exempt f:crl'icensure under the Contractors' State License Law for the following reason:
By my signature helow 1 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 structure that I have built as an owner -builder if has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Sec'on7044 of the Business and
'rofessicns CoCa, :s available upon request whe h" application' s bmitted r at t ollowing Web site:http://www.leginfo.ca.gov/calaw.htmi.
Sinnah're of Property Owner or Authorized Agent D 3Ia.-
L ICEMSED CON TRACTOR'S DECLARATI N
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
sad affect. Licer,s.e ClLss License No Date Contractor Signature
COMPEdSATION DECLARATION
WARNINC'FAILURE 10 S2IURE WORKERS' COMPENSATION COVERAGE 15 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 ATTORNEYS FEES.
I nereoy affirm un�+er penalty of perjury one of the following declarations:
I 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 the
p 3r ormance of thD wo-k for which this permit is issued. Policy No.
I 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'
urance carrier and policy number are:
Policy Number
Date
lame of Agent Phone #
I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agref
lat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
signature of Applicant 7, —_ e ��(( �L-tI— C//13-e Dat aa—
IECLARATION REG D CONSTRUG.SION LENDING NCY
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 ode).
ender's Name Lender's Address
ly 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 count ordinances and state laws relating to building construction.
I authorize representatives of this city or count a er the above-ide tified property for inspection purposes.
'ionature of Prooertv Owner or Authorized ADent alzz:l t =i Print Prooertv Owner's or Authorized Agent's Name
ACTION
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYISSUED
DATE I BY
-(3-Ed J
OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND ACIMD RULE
1403
I SUBMITTED ASBESTOS NOTIFICATION TO
ISNOTAPPLICABLE TO
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