HomeMy WebLinkAboutXR2023-0264 - PermitsaEvuaoRT City of Newport Beach
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COMB Permit : XR2023-0264
p� A Community Development Department -Building Division
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100 Civic Center Drive, Newport Beach, CA 92660
Plan Check No : PC2023-0196
Permit Counter Phone: (949) 644-3288
Inspection
Issued Date : 03/01/2023
co- r Requests Phone: (949) 644-3255
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Inspection Area : 6
newportbeachca.gov/inspections
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Combination Type - SFP
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 : 50 VIA BURRONE
Legal Desc : N TR 14070 BILK LOT 81
Description: SFR - (N) 2ND FLOOR PERGOLA 35D SF
Owner: JACOBSON STEVEN TR
Contractor :
Architect
Address : 50 VIA BURRONE
Address :
Address
NEWPORT COAST, CA 92657
Phone:
Phone:
Phone:
Con State Lic :
State Lic
Lic Expire :
Applicant: JACOBSON STEVEN TR
Bus Lic:
Engineer : SIVUSHENKA MIKITA
Address: 50 VIA BURRONE
Bus Lic Expire :
Address : 22121 CLARENDON ST
NEWPORT COAST, CA 92657
WOODLAND HILLS, CA 91367
Phone:
Workers' Compensation Insurance
Phone: (323) 448-4682
Carrier :
Owner/Builder : JACOBSON STEVEN TR
Policy No:
Designer : CARTER ESTATE INVESTMENTS
Address: 50 VIA BURRONE
W. C. Expire:
Address : 20929 VENTURA BLVD, 47-344
NEWPORT COAST, CA 92657
WOODLAND HILLS, CA 91364
Phone:
Phone: (818) 350-4991
Code Edition : 2022
Fire Sprinklers : NO
Construction Valuation : $15,O 3=a o
Type of Construction : V-B
Fire Hazard Zone : YES
Added/New/Ti sq. ft. Bldg : 0
Occupancy Groups : U
No of Units : 1
Alteration sq. ft. Bldg :
Bldg Height :
No of Stories : 2
Added/New sq. ft. Garage: 0 -
TOTAL sq. ft.: 0
Building Setbacks
Flood Zone : X
... -
Use Zone: PC - Newport Coast
- -
PROCESSED BY:
SPECIAL CONDITIONS:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable items)
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, irn prove, 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 liceosure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for apermit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
111, as owner of the property, or my employees with wages as their sole compensation, will do L) 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
Impr 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
Ira oved 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 of improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law),
El I am exempt from licensors 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 legally
sell a structure that I have built as an owrtar-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 B 8usinoss and
Professions Code, is available upon request when this ap on i5 ubmitted orat the following Web site:http:iiwww.teginfo.ca.gov/calaw.btml.
Signature of Property Owner or Autharizad Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am license under pro isions Of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force
and affect. License Class License No Date Contractor Signature
VORKERS' COMPENSATION DECLARATION
1ARNING: 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
:CST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
I 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
performance 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'
trance carrier and policy number are!
Policy Number
Date
7of Agent Phone #
catify 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 agfe
, if I should become subject to the work compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 3 %Z 3
iature of Applicant .,, —_ _,..,._..__ �Date
/
hereby affirm under penalty Wperjury that thillira is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097, Civil Cade).
ender's Marne Lender's Address
y my signature below, I certify to each of the following:
I ar the property owner or authorized to act on the property owner's behalf.
I have read this dppl)cation andthe information I have provided is correct.
I agree to comply A;lh all applicable city and county ordinances and state laws relating to building construction. `
I authorize rep.esentatives of this city or county to enter abCvf -identified property for inspection purposes.
of Property OY.ner or
PERMIT EXPIRED
PERAfVTCANCELL,:G
PERMIT FXTENDED
I;rTL1 T FW L
CERTIFICATEOF
OCCUPANCYISSUED
BY
y-1I',ls 1 r30. 1L
COMPLIANCE WITH CODE OF FEDERAL
RT St OF TITLE 40 AND AQMD RULE
NOTIFICATION TO
NOT] FICA I[ON 15 NOT APPLICABLE TO
FOR OFFICE USE ONLY
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