HomeMy WebLinkAboutXR2022-2578 - Permitsu4o-
`�PC limyuof owpor tDeprtmhnt-Building DivisionCOMB Permit:XR2O22-2578
100 Civic Center Dnve, Newpon Beach, CA 92660 Plan Check No
Permit Counter Phone: (949) 644-3288 Issued Date : 0912712022
Inspection Requests Phone: (949) 644-3255 Inspection Area : 2
newporCombination
Type
inspections CIO R
Combination Type - IN
� ��- L_ e.
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 : 205 AMETHYST AVE Legal Desc : A TR BALBOA ISLAND SEC 3 BLK 19 LOT 26
Description: SFR RETAINING WALL 2.4' X 31 LF (FRONT YARD) & 1.85' X 37 LF (SIDE YARD) INSIDE P/L ***CHANGE OF CONTRACTOR —
Owner: BOHLINGER PETER Y TR
Address : 1140 HIGHLAND AVE
MANHATTAN BEACH, CA 90266
Phone
Applicant: BRYCE SANTANIELLO
Address : 3419 VIA LIDO UNIT 115
NEWPORT BEACH, CA 92663
Phone: (714) 600-3719
Owner/Builder
Address :
Phone
Contractor:
BRYCE SANTANIELLO
Address :
3419 VIA LIDO UNIT 115
NEWPORT BEACH, CA 92663
Phone :
(714) 600-3719
Con State Lie
: 1070607
Lie Expire:
11/30/2023
Bus Lie:
BT30078093
Bus Lie Expire : 02/28/2023
Workers' Compensation Insurance
Carrier :
Policy No : EXEMPT
W. C. Expire:
Architect
Address
Phone :
State Lie
Engineer: FORBES DALE L
Address : 1800 E 16TH ST #B
SANTA ANA, CA 92701
Phone: (714)835-2800
Designer:
Address
Phone:
Code Edition :
2019
Fire Sprinklers :
NO
Construction Valuation :
Type of Construction :
V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg:
Occupancy Groups :
U
No of Units :
0
Alteration sq. ft. Bldg :
Bldg Height:
No of Stories :
0
Added/New sq. ft. Garage
Building Setbacks:
Front:
10, Side: 3, Side: 3, Rear: 5
Flood Zone:
X
Use Zone :
R-BI -
Two -Unit Residential, Balboa Island
PROCESSED BY:
$0.00
0
0
6J
SPECIAL CONDITIONS: ***CHANGE OF OCNTRACTOR FOR PERMIT X2021-2570***
OWNER -BUILDER 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 item(s)
3eclion 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 fur
le 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
'rofessiolis 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
of more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) 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
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)..
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7D44, Business and Professions Code: The Contractors' State License Law does not
9ply 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).
J 1 am exempt from licensure under the Contractors' Stale License Law for the Following reason . ------ .
y 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 legahl
ell a structure that I have built as an owner -builder if it has not been constructed in its entirely by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginto.ca.gov/calow.htmi.
ignature of Property Owner or Authorized Agent ., _ Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000 f D' rsion 3 of the Business and Professions ode no m t ficen full force
nd effect. License Class License No Dete 9 Z'f Z � Contractor Signature
WORKERS' COMPENSATION DECLARATION
ARMING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDSAND DOLLARS ($100,000), IN ADOrnom TO THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 1706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under 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
bnmance of the 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 compensa
vance carrier and policy number are:
_.. Policy Number Expiration Date
of Agent Phone # _
Certify that. In the performance of w rk 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
1, if I should become subje t ers',,Commp/p//ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions,
nature of Applican r+/-!� _ _ Dale �� u
CLARATION CONSTRUCTION LENDING AGENCY
ueby affirm and pe 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).
Iders Name Lendees Address
Fri, signature below, I certify to each of the following:
I am the prop Trt;, 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 reo,esentatives of this city or county to en e above-i d property for inspection purposes, yn ,l
M�e,.o �r n...,.on , rn.,,,or ,.. A,nn.,d�on Ar.o„ Prinf P,—ex, non®ram r.. A,on„�Ioan Ana„ram ,ua,,,a .nilN^ ila k./ -Vr''O
Date
'CTION
DATE.
BY
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE
1403
PEnn41TEXPIP D
LJ ISUBMITTED ASHF$TOS NOTIFICATION TO
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PrNMITEXTEIDEL........_..
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A5B€STOSNOTIFICA'r10 NOT APPLICABLE TO
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