HomeMy WebLinkAboutXR2022-2191 - Permits-wroRT
City of Newport Beach
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Community Development Department - Building Division
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100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone: (949) 644-3288
Inspection Requests Phone: (949) 644-3255
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newportbeachca.gov/inspections
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Combination Type - SFP ELEC MECH PLUM
Work Class - Alteration
I��III��III ��III111111111111111111111111111111111111111COMB Permit : XR2O22-2191
Plan Check No: PC2022-2929 Z706
Issued Date : 01/17/2023
E(..p. ,..r e- Inspection Area : 3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO L/
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS
Job Address : 1226 BLUE GUM LN Legal Dose : N TR.9620 BLgeHT7'
Description: SFR REMODEL OF KITCHEN AND BATHS; REMOVE 171 SF (STUDY/ICWLLIS} AND REPLACE 1TH
Owner: MICHAEL HOBSON
Address : 19050 MT MCLOUGHLIN LN
BEND, OR 97703
Phone :
Applicant: GARRY Michael TRIMM
Address: 26792 CALLE REAL
CAPISTRANO BEACH, CA 92624
Phone: (949)285-6568
Owner/Builder :
Address : 16i
Phone
Code Edition :
Type of Construction
Occupancy Groups:
Bldg Height:
Contractor : J D D CUSTgM%NOjw1ES
Address B RANCA R&Y "tD23
f 1 s aCA 92
6��
Pho VI 7-08, 4f—.
C to Lic 80138
9Ci xpl1032 '3
usLic BT30038 t
x1ptre031/ Bu
® -•-q'
orkers' Compem ti Insurance `y. A
�AIRS FROM ORIGINAL ISSUANCE DATE
ON SUNDAY AND HOLIDAYS IN ALL AREAS
•farrier : INS CO OF THE WEST
Policy No • WPL506566600 = * De ner :
111E C. Emilie :\5/15/2023 R, ess�
0) ' f+, toprinklers
.?'N 3 ''Fire Hazard Zr-WOl` M1 /
\�a'No
Building Setbacks : Front: 20, Side: 5, Side: 5, Rear: 10
Flood Zone : X
Use Zone: PC - Westcliff Grove
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PROCESSED BY:
COS Q i\
SPECIAL CONDITIONS: HAULER: ROBERT'S WASTE
131.
V-B
U,R-
ALT 27 SF
CA 92624
at TRIMM
REAL
BEACH, CA 92624
igKn Valuation :
$775,000.00
ew/TI sq. ft. Bldg :
0
on sq. ft. Bldg :
2,781
4ew sq. ft. Garage:
0
sq. ft. :
0
OWNER -BUILDER DECLARATION
I hereby aHtrm under penally of perjury that t am exempt from the Contractors' State License Law for the reas `(a) indicate.
(Section 7031.5, Business and Professions Code: Arty city or county that requires a permit to construct, alter, I rove, demobs
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' ate license Lew
Professions Code) or that he or she is exempt from licensors and the basis for the alleged exemption. An 'olation ofSeett
not more than five hundred . dollars ($500)•1 t
n.•
J I, as owner of the property, or my employees with wages as their sole compensation, will do L
usiness and Professions Code: The Contractors' Stale License Law does not apply to/awnernprovements are not intended or Offered for sale. If, however, the building or ImpnNeroved for €he purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors toly to an owner of property who builds or improves. thereon; and who contracts for t
Ill am exempt from Itcansure under the Contractors' State License Law for the lot " •ng reason:
iy my signature below I acknowledge that, except for my personal residence in I at have
ell a structure that I have bufft as an owner builder if R has not been construct in its ly by
'rofessions Code, is available upon request when this application is subml or at low ri
ignature of Property Owner or Authorized Agent
.ICENSED CONTRACTOR'S DECLARATION'
hereby affirm under penalty of perjury that I am licensed under pmInns of�C pter q (cornmeal
ad effect, License Class Lice No
COMPENSATION DECLARATION
'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA969 UNLA E "a SHAi SUaJECT AN EMPLOYER TO CRIM94AX
OST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN IrECTIGN. S OF THE OR CODE, MTEaEST. AND AtTORNEY S FEEe.
hereby affirm under penalty of perjury one of the tollo�yAhg decks ens: ;
I have and Will maintain a oartifeate of canson to serf=irysure flit workers' romoensatjnn. Issued jiy the Dire
1ormance of the work for which this permit is Issued_ Po4�ey No.
I have :and will maintain workers' compensation insurance, appequved by Section 3700af the Labor Coda, for
I urance carrier and policy number are:
•ier Policy Number
to of Agent '
certify that, In the performance of the work for which this permit is issu 1�ha I1 t am
If I should become subject t ewar ra. ' Compensation provisions o�Sei(art 0 of
Store of Applicant
L aby affirm under penalty of perjury that there Is a construclion ndRtg agency for the perfo.
ider's Name - Lender's F
my signature below, I certify to each of itree following:
I am the property owner or authorized to act on the property owl's behalf.
I have read this application and the information I have provided Is correct {{{{{
I agree to comply *in all applicable city and county ordinance nd stale latent} iio b
I authorize representatives of this city ar county to a tit the ab a-Idarr iged rroparty for In
nature of Property Owner or At3onzed Agent F
TION DATE RYJ _4�DECLAAATON OF COMPLIANCF WITH COOL
REGULATIONS PART 61 OF TITLE 40 AND A(
EXPIRED
y the. eckmartc(s) I have placed next to the applicable Rem(s)
Ir any cture, prior to its issuance, also requires the applicant for
0 ( m ing with Section 7000) of Division 3_of the Business and
ar applica.. for a j ermitsubjects the applicant to a civil penalty of
work, 9Kd the structure is n ft
)JOY, s' or personal effort, buI
o , the Owner -Builder wig have
lusiness and Professions Code: The Con`
pursuant to the Contractors' State License
one year prior to Can
I. I understand that a
sny pa�9rili airy manner
CERrIFICAEf OF ROPOSEO OEMQ�i%TIO TI N IS NOT APPLICABLE 70
OCCUPANCYISSUED SIGNATURE: A h
of the
law,
offered for sale (Section 7044,
ves the property, provided that the
rrf of proving that It was not built. or
License Law does not
and
license is In full force
J$100,000), IN ADDITION TO THE
Section 3700 of the Labor Code, for
foryvhis,orbils permit is issued. My workers'
to the workerscompensation laws of California, and
n utwut�uiply vru ut�r pt+rnswns.
Date
i
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r Ich th' R is issued (Section 3097,. Civil Code).
FOR OFFICE USE ONLY