HomeMy WebLinkAboutF2021-0593 - Permitsrxw3r,�- City of Newport Beach - Building Division `F2021 0593* FIRE Permit: F2021-0593
` `y�r 100 Civic Center Drive, Newport Beach, CA 92660 ` ' r-- �`
` p -" 7 Project No : 2765-2021
wE �� _� Permit Counter Phone (949)644-3288 i; L +_j 1 '. I i
r:��ry{.uv�+ Inspection Requests Phone (949)644-3255
Job Address: 504 SEAWARD RD NB Description: SFR -FUEL MODIFICATION (X2021-3188)
Inspector Area:,ef' I" Legal Description: N TR 1237 LOT 190
Owner: M AND C CARDELUCCI REVOCABLE TRUST Contractor: OWNER/BLDR
Address: 504 SEAWARD RD Address: CARDELUCCI CATHERIN
CORONA DEL MAR, CA 92625
Phone:
Applicant: TEALE MARK
Address: 2900 BRISTOL BLVD A-203
COSTA MESA CA 92626
Phone: 949-975-0123
Code Edit:2019
Type of Construction
Occupancy Group: U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 0
No of Units : 0
Flood Zone: X
Bldg Sprinklers: N
Phone: 949-975-0123
Con State Lic: O/B
Lic Expire:
Bus Lic:
Lic Exp Date:
Worker's Compensation Insurance
Carrier:
Policy No:
Expire:
Issued Date: 01/27/2022
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
TEALE MARK '
2900 BRISTOL ST BLDG A203
COSTA MESA CA 92626
949-975-0123 State Lic: CO22162
TRAN JOHN DINH o o
11251 GARDEBAIRE LN
GARDEN GROVE CA 92841
714-815-2356 State Lic: C-062653
FEES
Construction Valuation:
$10,000.00
Building PC Fee :
$222.00
Fire Residential Alarm PC Fee :
$0.00 Records Management:
$0.00
Building Overtime PC Fee:
$0.00
Planning Counter Review:
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee:
$0.00
Building Investigation Fee:
$0.00
$0.00
Fire Plan Check Fee:
$0.00
Public Works PC Fee:
$0.00
$0.00
Fire Permit Fee .
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$269.00
TOTAL FEE :
$491.00
Plan Check Fee:
$222.00 Fee Due at Permit Issuance :
$269.00
PROCESSED BY: p
ZONING APPROVAL:
FIRE APPROVAL:
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
LDER 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 Hcensure 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 U 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
improved for the purpose of sale).
4p yas 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
to an owner of Drcperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
am exempt r,om linensure under the Contractors' State License Law for the following reason:
By my signature be;cv. ; 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 Iegall)
sed a structure that I have built as an owner -builder if it has t een conaLucted in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 f the B siness and
Profeccions Code, is available upon request when t ' appl'catio is fitted or followin eb site:http://www.leginfo.ca.gov/calaw.html. / �i/ aD,�—
Sionablre of Propartv Jwner or Authorized Agent WIN l ii
I.ICFNSED CONTRACTOR'S DECLARATI N
I hereby affirm unde. penalty of perjury that I am licensed un er provisions of Chapter 9 (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
COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE 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
:UST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
iier&y affirm unde.. ponalty 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 th
erformance of the work 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:
me of Agent
I certify that, in the p
It. if I should become
Policy Number
Date
this permit is issued, I shall not employ any person in any manner so as to become subject to the
atjon provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions.
lignature of Applicant � C/
IECLARATION REGA IN RUCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is
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 beha I.
I have read this application and the information I have pro Ed is cOrr
ec
I agree to comply with all applicable city and county or anc s a d sta s relating to building construction.
I authorize representatives of this city or county en r the Ilbov -i for inspection purposes.
lignature of Property Owner or Authorized Agent Print Property Owner's or Authorized. Agen
compensation laws of California, and
Civil
ACTION
DATE
BY
DECLARATION OF COMPLIANCE IMTN CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE40AND
AQMD RULE 1403.
PERMIT EXPfRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMIT EXTENDED
❑ ASBESTOS N07IBCATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FfNAL
CERTIFICATE OF
SIGNATURE:
OCCUPANCYISSUED