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Home My WebLink AboutXR2023-0055 - PermitsCity of Newport Beach p Community Development Department- Building Division 100 Civic Center Drive, Newport Beach, CA 92660 C Permit Counter Phone: (949) 644-3288 Inspection Requests Phone: (949) 644-3255 cq(P. newportbeachca.gov/inspections Combination Type - MFP Work Class - Other 111111111111111111111111111111111111111111111111111111111JillCOMB Permit : XR2023-0055 Plan Check No : 1419-2022 Issued Date : 01/10/2023 Inspection Area : 4 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 SEA PINE LN Legal Desc : N TR 8445 BILK LOT 1 UN 1 TR 8445 LOT 1 UNIT 1 G1, 2, P OF PR OJECT LOCATED Description: DELTA 1-5 TO ADD SCOPE FOR RESTROOM UPGRADES (REV2022-1744) Owner: JAN ESTERHOIZEN Contractor: WATER SAVERS COMPANY Architect : DOSS TIMOTHY Address : 22982 LA CADENA, 221 Address : 16570 ASTON STREET Address : 5154 SIERRA ROAD SAN BERNARDINO, LAGUNA HILLS, CA 92653 IRVINE, CA 92606 CA 92407 Phone : (949) 305-1166 Phone : (949) 955-1233 Phone : (714) 728-7284 Con State Lic : 561852 State Lic Lic Expire : 11/30/2024 Applicant: DOSS TIMOTHY Bus Lic: BT30079215 Engineer Address : 5154 SIERRA ROAD Bus Lic Expire : 07/31/2023 Address SAN BERNARDINO, CA 92407 Phone: (714) 728-7284 Workers' Compensation Insurance Phone: Carrier: SECURITY NATIONAL INSURANCE,... COMPANY Owner/Builder : Policy No: SNP1383807 Designer: Address : W. C. Expire: 4/1/2023 Address Phone: Phone: Code Edition : 2019 Fire Sprinklers : NO Construction Valuation : $20,000.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/TI sq. ft. Bldg : 0 Occupancy Groups : U,R-2 No of Units : 1 Alteration sq. ft. Bldg: 0 Bldg Height: No of Stories : 0 Added/New sq. ft. Garage: TOTAL sq. ft. : 0 Building Setbacks Flood Zone : X Use Zone : PC - Big Canyon T�j PROCESSED BY: L-/f9�LC Y RJR SPE - SPECIAL CONDITIONS: 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 items) Section 7031.5, Business and Professions Cade; Any city or county that requires a permit to construct, after, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for he permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Stale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Irofessions Code) or that he or she is exempt from licensors,and the basis for the alleged exemption. Any violation of Section 7031.6 by any applicant for a permit subjects the applicant to a civil penalty of of more than five hundred dollars ($500). 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure Is not intended or offered for sale (Section 7044, 3usiness 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 rprovermants 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 rproved for the purpose of sale). ,.t i, as owner of the property, am exclusively contracting with licensed Contractors to constructthe project (Section 7044, Business and Professions Code; The Contractors' State License Law does not Ipply 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 lfcensure under the Contractors' Stale License Law for the following reason: ly my signature below t. acknowledge that, except for my personal residence in which I must have resided for at least one year prior to compiatlon of the improvements covered by this permit, I cannot legall. all 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 copy of the. applicable law, Section 70" of tho Business and „rofessions Code, is available upon request when this application is submitted or at the following Web site;http:tiwww.4eginfo.ca.govtcalaw:htmi. ignamre of Property Owner or Authorized Agent pate -iCENSED CONTRACTOR'S DECLARATION hereby affirm under penalty Of perjury that. I am licensed under provisions of Chapter 9 mmencing with Section 0 If Division 3 of the Business and ProfQss_lga Co a i} y li r�is in full force Ind effect. License Class License No ,�( Datap vo D- � Contractor Signatu �} , YJ , � VORKERS' CONAPENSATION DECLARATION ///�� rARNING: FAIL R. TO AFCURE WORKERS' COMPENSATIO H. COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNORED THOUSAND DOLLARS (St00,000), IN ADDITION TO THE '.DST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3306 OF THE LABOR CODE, INTEREST, AND ATTORNEY'& FEES. I,cruby affirm vrd4, Focally 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 ih ar,0,_,-,,e oe of the work for which this permit Is issued. Policy No. and veil mafnrain 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' compensatiol e carrier and policy number are' "T-rY•• '7' _ Policy Number Expiratiotl�6D Y RTS cf Agent �c� Phone# 7y/�/ -1 r1eruh, that, in 'na pa.Yannance of the work for which this permit is Issued. I shall not employ any person in anymanner so as to become subject to the workers' Compensation laws of California. and agra r.at, if I soould become rubjeet to the workers' compensation provisions ofSection .3700 of the Labor Code; I shall forthwith comply with those provisions. >' 3nature of Applicant �,.� Dat� DECLARATION !1-1011 tbihl,3 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, Civil Code),. _enders Name Lender's Address 3y 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 Ihave 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 cdy ar,Dunl to an r the a ova-ldeniifieo rty for Inspection purposes. / Signature of PropertyOwner or Aulhonzad A ank Print Pro y Owner's or Authorized Agent's Name ACTION DATE BY 1 DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY 1 REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE SUBMITTED ASBESTOS NOTIFICATION TO rcxmrr rrrcat // ZS' rH/t//t =AS8RSTO5 NOTIFICATION 15 NOT APPU BILE TO CERFIffCAY'E OF II{ YT {I{ PROPOSEOD�E�f��qIOLIIj[ONn OGCUPANCYISSUED i 51C.NATlIRID A fL ^ilin