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City of Newport Beach
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COMB Permit: XRZOZZ-1846
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Community Developmeni Department - Building Division
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100 Civic Center Drive, Newport Beach, CA 92660
Plan Check No : 1084-2021
Permit Counter Phone: (949) 644-3288
Inspection Requests Phone: (949) 644-3255
Issued Date :
Inspection Area : 6
newportbeachca.gov/inspections
Combination Type -
Work Class - Other
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 1227 PORTSIDE WAY
Legal Desc : N TR 6113 6LK LOT 47
Description: SFR (3) CMU PILASTERS *CITY STANDARD*
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Owner: KEITH & MARA MURRAY
Contractor: S M CONSTRUCTION- - -
Architect
Address : 1227 PORTSIDE WAY CORONA DEL MAR,
Address: 11 WILKING DR IRVINE, CA92620
Address
CA 92625
Phone:
Phone: (714)357-5893
Phone: °
Con State Lic : B90394
State Lic :
Applicant: TONYA NICHOLSON
Lie Expire : 02/28/2023
Address : 606 ORCHID AVE NEWPORT BEACH, CA
Bus Lic : BT30075266
- Engineer:
Phone: (949) 27B-1327
Bus Lic Expire : 05/31/2023
Address: - -
Workers' Compensation Insurance
Phone:
Owner/Builder :
Carrier:
- -
Address:
Policy No :
Designer: TONYA NICHOLSON .. "
Phone:
W. C. Expire:
Address: 606 ORCHID AVE NEWPORT BEACH, CAL I
Phone: (949) 278-1327i-
Code Edition t 2019
Fire Sprinklers : NO
Construction Valuation : $1,000.00
Type of Construction :
Fire Hazard Zone :. - Y-
Added/New/TI sq. ft. Bldg : 0
Occupancy Groups : U,R-3
No of Units : 1 -
Alteration sq. ft. Bldg :
Bldg Height:
No of Stories : -
Added/New sq. ft. Garage: 0
Building Setbacks: Front: 6, Front: 20, Side: 6, Side: 6
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Flood Zone : X
Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates minimum lot area)
PROCESSED BY: SS
SPECIAL CONDITIONS:
DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable items)
ction 7031.6. But Inos s and Professions Code: Any city or county [he( requires a permit to construct, alter, improve, domolish,. 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' Stale License Low (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 fat the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of
more than five hundred trailers ($500),
1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is net intended or offered for sale (Section 7044,
moose 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 trial the
fovenments are not intended or offered for sale. If, hov.'ever, the building or Improvement is sold within one year of comptetlon, the Owner -Builder will have Ilia burden of proving that It was not built or
roved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (5e0ioa 7044, Business and Professions Code: The Contractors' Stale License Law does not
try to an owner Of property who bulids or improves thereon, and who contracts for the projects with a. licensed Contractor pursuant totheContractors' State License Law).,
U I am exempt from licensors under the Contractors' Stale Liconse Law for the following reason: _
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of tl
sell a structuro that I have built as an owner -builder If It has not been constructed in its entirety by licensed contractors. I understand that a copy of the
Professions Code, is available upon request when this application Is submitted or at the following Web site:hltp:ilwww.leginfo.ca.gov/calaw.html.
Signature of P iperty Owner or Authorized Agent
Section 7044 of the Business and
Data
LICENSED CONTRACTOR'S DECLARATION
I hereby afriim under penalty of perjury that I am licensed under provisions of Chaplor 9 (commencing with Section 7000)r! �� Divoi 3 of the Business and Prof ode ode, a my license is in full force
r.,,J effect. Lica,ra Class License No Der r9-27— Contractor Signature/
WORKEF.C' COMPENSATION.. DECLARATION
wAANiNG: FAILL RE TO SECURE WORKERSGOMPENSAT ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI00.0001, IN ADORION TO THE
603T OE COMPENSATION, DAMAGES Ae PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
loaraby affirm dncarpenalty of perjury one of the following declarations:
n
u 1 have and mil maintain a cernricate 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
performance of the work for which this permit Is issued, Policy No..
have andwill 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'
Fence carrier and policy number are:
Policy Number
of Agent -
Date
certify Il t, in'he 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, aid
Ihah, if I should become sublagAdhe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
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Date--,U ^2-P
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).
ender's Name Lenders Address
y 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-
1 have road this application and the Information I have provided is correct.
I agree to comply with all applicable city and county ordinances al tale laws relating to building construction.
I authorize representatives of this city or county to entw4he aboAAentiffrod propedyfor inspection purposes.
ACTION DATE RY REGGU LATIO0NS PART OF 061 O TNITLE 40 ANDAOMDRULF.CE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
PERMIT EXPIRED
PERMIT EXTENDED i I_IAOMD
PERMITINAl SBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATEOF 0-IL•2'+- PROPOSED DEMOL T— /
OCCUPANCYISSUEO SIGNATURE: / L
Date
All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall
be In place prior to approval to fill pool/spa & shall remain in place & be maintained for the
life of the pool.