HomeMy WebLinkAboutX2021-2684 - Permitsuq"�,o""
City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - BLDG
IIIIIII�IIIIIIIIIIIII�IIII COMB Permit: X2O21-2684
Project No: 2322-2021
Issued Date : 10/11/2021
Inspection Area : 5
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1011112024 OR PERMIT filtINVALID
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
Job Address: 119 SHORECLIFF RD NB
- $�
Description: SFR 140' LF X 6' HIGH RETAINING WALL MAX (RET T) INSIDE
PIL
Legal Desc.: N TR 1116 LOT 116
Owner: BENTLEY GREG & DONELLE
Contractor:
ADAMSON MARK Architect:
0
Address: 119 SHORECLIFF RD
Address:
14196 UXBRIDGE ST Address:
CDM CA 92625
WESTMINSTER, CA 92683
Phone:
Phone:
714-376-6301
Phone: State Lic:
Applicant: ADAMSON MARK
Con State Lic: 590874
Engineer: THOMPSON MATTHEW
-
Address: 104 OKRA
Lic Expire:
0212B/2022
Address: 12021 N TUSTIN AVE
e
IRVINE, CA 92614
Bus Lic:
BT30057889
ANAHEIM CA 92807
Phone: 714-376-6301
Lic Exp Date:
01/31/2022
Phone: 714-630-6100 State Lic:C-086051 ....
.....o
Code Edit : 2019
Worker's Compensation Insurance
°°.
Designer: MOLLY WOOD GARDEN DSIGN I CAPALNA,
. o
Type of Construction:
Carrier.
STATE FUND
Address: 1660 ORANGE AVE
Occupancy Group: U
Policy No:
9225662
COSTA MESA, CA 92627
°. , • ; s
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Added /New sq.ft. Bldg: 0
Expire:
02/0212022
Phone: 949-548-16111
•
• ° • • o
Added /New sq. ft. Garage: 0
No of Stories: 0 -
Building Setbacks
Rear: /
Special Conditions:
No of Units: 0
Front: /
Bldg Height: 0
Left: /
; • • • °'
Bldg Sprinklers:
Right: I
o • • •'
• °
Flood Zone: X
Use Zone:
Parking Spaces:
0 Fire Hazard Zone : N
......
Construction Valuation: $36,000.00
°
Building Permit Fee: $631.00
Excise Tax:
$0.00
Planning Department - Fire Department
Plan Check Fee: $548.97
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: $4.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee : $0.00 Building Dept Adm
$0.00
Energy Compliance: $0.00
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 : $0.00
P/W Plan Check : $0.00 Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical %:
$0.00
San Dist: $0.00
Building Green Fee: $2.00
Mechanical %:
$0.00
NMUSD Fee: $0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $1,237.97
Plan Check Fee:
$548.97 Fee Due at Permit Issuance :
$689.00
PROCESSED BY:
PUBLIC WORKS APPROVAL:
�I
3L/
ZONING APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
OWNER -BUILDER DECLARATION r.
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).
❑ 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).
❑ 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
apply 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).
❑ 1 am exempt from licensure under the Contractors' State License 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 the improvements covered by this permit, I cannot legall)
sell a structure 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 applicable law, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:http:/ANm.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
iI hereby affirm cinder panalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 f ivi ion 3 of the Business and Professio de, did my li s ' in full f
and effect. License Class License No Date Contractor Signature
Y!ORY.ERS' C-_MPENSATION DECLARATION
WARNING: FAILURE TD S=CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES DP TO ONE HUNDRED HCUSAND DOLLARS ($100,01M), IN ADDITION TO THE
CJST VF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
helajy affirm under penalty of perjury one of the following declarations:
hove and will mr intain 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
mance of the wo'k for which this permit is issued. Policy No.
a and will mail,tain 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'
;e carder and policy number are:
ie of Agent
rertjfy that, it "Fe p
if I should become
Iature of Applicant _
Policy Number Expiration Date
Phone #
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 agre
leers' compAnsatiop provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DIW 10/II/2.)
IECLARATION REGG CONSTRUCTION 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 issued (Section 3097
enders 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 county ordinances and state laws relating to buildin construction.
I authorize representatives of this city or county to enJerhh� above-ideptifieyj grope spection purposes.
ACTION DATE BY DECLARATION OF
LA ONS PA CO PLIANCE WIOF 4 TH O DE OF FEDERULERAL FOR OFFICE USE ONLY 01
1403
PERMITEXPIRED I LJISUBMITTEDASRESTOSNOTIFICATIONTO
PERMIT EXTENDED QMD
PERMITFINAL p ter_ ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
CERTIFICATE OF PROPOSED DEMOLITION
OCCUPANCY ISSUED SIGNATURE;
Civil Code).
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