HomeMy WebLinkAboutXR2023-0009 - Permits4�EW �T City of Newport Beach jji111111111111111111111111111111111111111111111111111111 1 COMB Permit : XR2023-0009
dcnCommunity Development Department- Building Division X R 2 2 3 0 0 0 9
d� Y 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No:
Permit Counter Phone: (949) 644-3288 Issued Date: 01/0312023
h Inspection Requests Phone: (949) 644-3255 Inspection Area : 6
newportbeachca.gov/inspections
Combination Type - SFP a
Work Class - Water Re -pipe Cam•'
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAS ALID INSP L ON, B NO LA YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR NDAY IN H? DENSI AREAS AN WC h«ON SUNDAY AND HOLIDAYS IN ALL AREAS
Gm O y
Job Address : 21 VIA PALLADIO egal *c : N0'R 1407 LK LOT 91 ,
Description : PLUMB PEX REPIPE WHOLE HOUSE (24) T k.
\R O"°
IRk
Owner: TRIDER ALAN TR A D Cont*a�rr : P INE RESTORATION PLUI Architect ,
Address : 3230 E IMPERIAL HWY STE208 Address : 91 KENSINGSTON DR /'y Addres
BREA, CA 92821 4AGUNA NIGUEL, CA 9267 'N<
Phone : (949) 306-2526 P 60-4250 Ph a:
n 1c : 965965054 ' ya S to Li "
1 x 1OB'704
023 ` t\
Applicant : BEN MEDINA s 100 /'(f rD EAddress : 31225 LA BAYA DR 1c Ex '223 \A C
WESTLAKE VILLAGE, C 1362 All,' "d �� �C
Phone : (818) 735-7876 orker%pration In P ne
Carr!+INSURA CQ$ANY+I
Ow dress: lder: Po SWC1 \� esigner: „
Address : ZN1re : 5/1312 3 Address
P
�b Phone:
Phone:
Code Edition : 2022 Sprinklers NO Construction Valuation : - $16,508.00
Type of Construct! V- . e Hazard Zo e.. YES Added/New/TI sq. ft. Bldg: 0
Occupancy Grou o of Uru s (�. 1 Alteration sq. ft. Bldg
Bldg Height: Cj No of St Added/New sq. ft. Garage: 0
TOTAL sq. ft. 0
Building Set ks � Qua
Flood
Use Zones J �\
PROCESSED BY:
SPECIAL CONDITIONS:
INS-117*111-
4,CCTOR
thereby affirm under penalty of perjury that I am exempt from the Contractors State License Law far the ra r
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct. alte
the permit to file a signed statement that fie. or she is licensed pursuant to the previsions of the Contra, S at
Professions Code) or that ha or she is exempt from lieens ire and the basis for the alleged exomptiolo y latren
not more than five hundred dollars ($500),
0 I, as owner of the property„ or my employees with wages as theirsolecompensation, will d ) of or on
Business and Professions Code: The Contractors' State License Law does not apply to an or prope who, t
Improvements are not Intended or offered for sale. If, however, the buHdiIn or imprimve is .old with! one year
Improved for the purpose of Sala},
El I, as owner of the property, am exclusively contracting with licensed Contract to nstruct a project (S lid
apply to an owner of property who builds or improvesthereon, and who contra #or a prate with a lioer cc.
i am exempt from licensors under the Contractors' State License Law In oIlaw7n as in
By my signature below I acknowledge that, except for my personal rest ce which I ust have Ne9jup r a
sail a structure that I have butlf as an owno-r-builder if it has not bee n clad in ' onhrety by iiGensod tract
Professions Code,. is available upon request when this applicatio a itted o t the following INeti .Ifs,
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Inane n r provlsi a of Chapter 9 (eommen wit}i Section
and effect. License Class Licens o Datq
NORKERS' COMPENSATION DEC RA N k
NARNING: FAILURE TO SECURe WORKERS' COMPEN IN
G UNLAWFU{.f1Ne S 4 GT AN EMPLOYE > lyr
nO$T dF COMPENSAT,rN ^AMAGes As moviaE OR I ION b OF THE LAR� DOE. EREST a ATTORNEY y 0'
hereby affirm unc'---innaity of perjury \ folio It dec€arate_ppp
of the
and
to tt
checkmark(s) I have placed next to the applicable items)
struc�kure, prior to its Issuance, also requires the applicant for
encing with Section 7000) of Division 3 of the Business and
'Dent for a permit subjects the applicant to a civil penalty of
PENALTIES AND cIUIL FP,E6 UP 70 ONE
i
and wif, maintain a oa cat on t fin selt•irt�a fdr Og rs mpansatiory tested by the ❑IrPatrN of Industrial
and will rhi
carrier a,tu
by Section 3700 of the Labor Cade, for the performance
me of Agent'-
+r _
I CS'i that ln_, e rmance of the work i his permit is is a not employ soy person in
I If I should bee .sd to the workers' she lens of Section 3700 of the Thor rode.
mature of Applicant
C..;'4:,TI0N REGAR N LENDING AGENCY.
?nPhy affirm urde par. r that there is a construction lending agency f perfarrpd" of the work for
rdere Name
my signature , I certify eh the following:
I am the pia erty owner cr autti6)f6eTtt act on the property
I have read this application and thito thin I ha�v .�W '
I agree to comply with all appllcable8n ount}rbctlipf�n�
I authorize representatives df this city Dun to enterth0,
ACTION 1 DATE
PERMf7EXPIRED
PERMITCANCEtLSD
PERMhi EXTENDED
CERT0CAYE O€ PROPOSED
OCCUPANCY ISSUED I I ssrnr atnn,
tended or offered for sale (Section 7044,
s or improves the property, provided that the
the burden of proving that It was not built or
Law).
State License Law does not
this permit, I cannot
of the Business and
license is In full force
00.000), IN ADDITION TO THE
by Section 3700 of the Labor Code, for
this permit is issued. My workers'
q as to Ira a subject to the workers' compansation laws of California, and agre
,ompi h those provisions.
Datetz I `3 2
this permit is issued (Section 3097, Civil Cade),
stair to TWfithng ,alluding c traction.
ton tifrt� loperp.�inspec' purposes.
y ra t 0 wner's or Authorized A
! k7PLIANCE WITHC OF FEDERAL I FOR OFFICE USE ONLY
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!IESTOS,UOFFICATIONTO
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