HomeMy WebLinkAboutX2021-1721 - Permits,�atna�t City of Newport Beach - Building Division COMB Permit: X2021-1721
100 Civic Center Drive, Newport Beach, CA 92660 Project No : 0959-2021
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - SFP MECH ELEC Issued Date :
Inspection Arearea :2021
3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 07/02/2024 OR PERMIT WILL BEINVALID
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 Hol'yays
Job Address: 2411 ORCHID HILL PL NB f s
Description: SFR - ADDL SCOPE FOR CANNED LIGHTS, EXHAUST FANS AND PANEL UPGRADED,
Legal Desc.: N TR 6407 LOT 9
r�Owner: HEIMALL BLAKE Contractor: DEDICATED CONSTRUCTION SVCS INC Architect:
Address: 2411 ORCHID HILL PL Address: 21032 SHACKLEFORD CIRCLE Address:
NEWPORT BEACH, CA 92660 HUNTINGTON BEACH CA 92646
Phone: 949-244-5475 Phone: 714-330-6604 Phone: State Lic: 00
Applicant:
ULLMAN TOBIAS
Address:
9138 RESIDENCIA
NEWPORT BEACH CA 92660
Phone:
949-350-6758
Code Edit: 2019
Type of Construction: V-B
Occupancy Group: R3/U
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 1
No of Units : 1
Bldg Height: 0
Bldg Sprinklers:
Flood Zone: X
11 Construction Valuation:
Building Permit Fee: $127.00
Plan Check Fee: $110.49
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$2.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $306.46
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Con State Lic:
925939
Lic Expire:
02/28/2023
Bus Lic:
BT30075231
Lic Exp Date:
05/31/2022
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9049015
Expire: 03/19/2022
Building Setbacks
Excise Tax:
Additional Fee
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Engineer: WILSON KALEN
Address: 23152 VERDUGO DR#102
LAGUNA HILLS CA 92653
Phone: 714-576-6524 State Li¢C-083753
Designer: �.
Address:
Phone
Rear: / Special Conditions:
Front: /
Left: I
Right: I
n Fire Hazard Zone : N
$0.00
Planning Department -
Fire Department
$0.00
Plan check Fee : $52.00
Fire Inspection:
$0.00
$0.00
Fair Share : $0.00
Fire Plan Rev
$o.00
$0.00
SJH Trans : $0.00
Demolition Fee
$0.00
In -lieu Housing Fee : $0.00
Building Dept Adm
$0.00
$0.00
Public Works Department -
General Service
$0.00
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
P/W Plan Check: $0.00
Grading Bond:
$0.00
$8.B9
San Dist: $0.00
$5.08
NMUSD Fee: $0.00
$0.00
$0.00
$0.00
Plan Check Fee
: $0.00 Fee Due at Permit Issuance :
$306.46
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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
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 `) 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).
❑ I 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://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 of Division 3 of the Business and Professi Cod nd lie Is In full force
and effect. License Class License No Date i-Z-2.1 Contractor Signature _
NORKERS' COMPENSATION DECLARATION
P'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
CO3: JP bOMPENSATIO4, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm u,tder 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 the
3erformance of the work for which this permit is issued. Policy No.
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'
carrier and o0ev number are:
Ts cf Agent _
I certify that, in 'he performance of the work for
;/if °should become )&ject to the/w/gq/jjkers'cc
(nature of Applicant/
Policy Number
Date
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
ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
✓I^ Date
GLAKA I IUN EU=OAKUIINU UUINJ 1 KLIU I IUIN LtNUINIi AUtNUY
oreby 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
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 gate laws relating to building construction.
I authorize representatives of this city or county�° anteh abo/Je d tified property for inspection purposes. ,t
nature of Prooertv Owner or Authorized ADent/ l Print Prooertv Owner's or Authorized Aoent's Nnme/( I LLG
ACTION
DATE
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
1-7112
OCCUPANCYISSUED
4
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
I SUBMITTED ASBESTOS NOTIFICATION TO
NOTIFICATION IS NOT APPLICABLE TO
FOR OFFICE USE ONLY
Civil Code).
SL QMjIvM Date