HomeMy WebLinkAboutX2022-0247 - Permits�y,w.rokZ City of Newport Beach - Building Division `X2022-0247" COMB Permit: X2022-0247
100 Civic Center Drive, Newport Beach, CA 92660
Project No : 0224-2022
Permit Counter Phone (949)644-3288
v Inspection Requests Phone (949)644-3255 Ca Issued Date : 0612212022
i,
Combination Type - SFP ELEC MECH PLUM ! �\i t- C k rR
a.�' red' i 1 Inspection Area : 4
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 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: 3069 CORTE MARIN NB
Description: SFR INTERIOR ALTERATION. 325
BE. KITCHEN/STAIRS, NEW MULTI -SLIDE DOOR
Legal Desc.: N TR 12271 LOT 108
Owner: SHETH LEENA
Contractor:
OWNERIBLDR
Architect:
-
Address: 3069 CORTE MARIN
Address:
SHETH LEENA
Address:
�' • - ,
NEWPORT BEACH, CA 92660
O/B FORM ATTACHED
,
Phone:
Phone:
818-207-7232
Phone:
State Lic:
Applicant: BALANTA HEBERT
Con State Lic:
O/B
Engineer:
CZAJKOWSKI MACIEJ W.
Address: 12212 SAPPHIRE ST
Lic Expire:
Address:
2702 HARBOR BLVD
GARDEN GROVE CA 92845
Bus Lic:
COSTA MESA CA 92627
Phone: 714-588-3408
Lic Exp Date:
Phone:
714-928-6220 State Lic:C-032946
Code Edit : 2019
Worker's Compensation Insurance
Designer:
BALANTA HEBERT
Type of Construction: V-B
Carrier:
Address:
12212 SAPPHIRE ST
Occupancy Group: R3/U
Policy No:
GARDEN GROVE CA 92845 -
Added /New sq.ft. Bldg: 0
Expire:
Phone:
714-588-3408
Added /New sq. ft. Garage: 0
No of Stories: 2
Building Setbacks
Rear: /
Special Conditions:
No of Units : 1
Front: I
Bldg Height: 0
Left: I
Bldg Sprinklers: N
Right: I
90ou Lone: A
Construction Valuation: $90 000.00
Building Permit Fee:
$1,129.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $982.23
Additional Fee:
$0.00
Plan check Fee :
$52.00
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:
$40.00
Grading Permit Fee:
$237.00
In -lieu Housing Fee :
$0.00
Building Dept Adm
$0.00
Energy Compliance:
$63.00
Grading PC Fee:
$199.00
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 :
$0.00
PAN Plan Check:
$0.00
Grading Bond:
$0.00
Hazardous Mat
$0.00
Electrical %:
$79.03
San Dist:
$0.00
Building Green Fee :
$4.00
Mechanical %:
$45.16
NMUSD Fee:
$0.00
$0.00
Plumbing %:
$101.61
$0.00
TOTAL FEE : $2,932.03
Plan Check Fee:
$1,034.23
Fee Due at Permit
Issuance :
$1,897.80
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
CN L
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
Vt 1
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
ie 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
rofessions Code) or that he or she is exempt from Iicensure 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
of more than five hundred dollars ($500).
7 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,
lusiness 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
nprovements 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
nproved for the purpose of sale).
A1, 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
pply 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 from Iicensure under the Contractors' State License Law for the following reason:
Iv 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 the improvements covered by this permit, I cannot legally
ell a St. ucture'ha' I hive built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of t e Business and
'-ofes.sions Code, is available upon request when this applic@Lion i,u miffed or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
',ignature of Property Owner or Authorized Agent _JC Date :Z--
ICENSED CGNTRACTOR'S DECLARATION
hereby affirm u,n�er 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
nd effect. License ;'lass License No Date Contractor Signature
✓ORKERS' C_—,MPENSATION DECLARATION
'ARNING: 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
091 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:
I I h; ve and .ill n-1ntain 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 IN
erformance or rh= 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'
rance carrier and policy number are:
Policy Number Expiratir
of Agent Phone #
Date
(,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 agree
t, if I should become subject to the a cers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant 'K Date
CLARATION REGARDING CONSTRUCTION LENDING AGENCY
areby 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).
Ider's Name Lender's Address
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.
I authorize representatives of this city or county to ente�the a7/�,de�ntified property for inspection purposes. X /
nature of Property Owner or Authorized Agent K 92 ✓� Print Property Owner's or Authorized Agent's Name IXX.I�I Ot l�W \° \ Date v I 2J Z
DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED LI I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED EPA
PERMIT EXTENDED OMD
PERMIT FINAL
CERTIFICATEOF
OCCUPANCY ISSUED
NOTIFICATION IS NOT APPLICABLE TO
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