HomeMy WebLinkAboutXR2023-1689 - Permitse��WPoRr City of Newport Beach IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit : XR2U23-1689
o @ Community Development Department- Building Division X R 2 0 2 3 1 6 6 9
F 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No : PC2023-0764
i) T Permit Counter Phone: (949) 718-1888 Issued Date : 0612912023
w newportbeachca.gov/civic Inspection Area : 6
CgIrFOPH�r Combination Type - SFP ELEC
Work Class - Alteration
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 : 11 VENETO Legal Desc : N TR 15078 BLK LOT 18
Description: SFR *ADD'L SCOPE* R/R STAIR LANDING GUARDRAIL, R/R GUARDRAIL @ HALL, ADD (9) LIGHTS.
Owner: FIELD RICHARD TR
Address : 11 VENETO
NEWPORT COAST, CA 92657
Phone
Applicant:
DAWN VAUGHT
Address:
1041 W 18TH ST, A106
COSTA MESA, CA 92627
Phone:
(714)488-8003
Owner/Builder:
Address:
Phone
Contractor:
BENJAMIN R MATYSZUK
Address :
2 JARANO ST
RANCHO MISSION VIEJO, CA 92694
Phone:
(949)689-9893
Con State Lic:
1039697
Lic Expire:
05/31/2024
Bus Lic:
BT30081542
Bus Lic Expire
: 05/31/2024
Workers' Compensation Insurance
Carrier: EXEMPT- NO EMPLOYEES
Policy No : EXEMPT
W. C. Expire:
Architect
Address
Phone:
State Lic
Engineer:
GHAZLANIANDY
Address :
4202 ATLANTIC AVE #204
LONG BEACH, CA 90807
Phone:
(562)253-2385
Designer:
NASIMNAD
Address :
181 TRAMONT CIR
FOOTHILL RANCH, CA 92610
Phone:
(714)213-0148
Code Edition :
2022
Fire Sprinklers : NO
Construction Valuation :
Type of Construction :
V-B
Fire Hazard Zone : YES
Added/New/TI sq. ft. Bldg
Occupancy Groups :
U,R-3
No of Units : 1
Alteration sq. ft. Bldg:
Bldg Height:
No of Stories : 2
Added/New sq. ft. Garage:
TOTAL sq. ft.
Building Setbacks:
Front:
10, Side: 5, Side: 5, Rear: 10
Flood Zone :
X
Use Zone:
Coast
PC - Newport Coast
m
PROCESSED Ely:
./
SPECIAL CONDITIONS
$5,000.00
0
0
0
OWNER -BUILDER
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) Indicate
(Section 7031.5. Business and Professions Code.: Any city or county that requires a permit to construct, alter, improve, demolis
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law
Professions Code) or that he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with Wages as their sole compensation, will do C_) all of or (_) portions of the t
Business and Professions Code:. The Contractors' State License Law does not apply to an owner of property who, through emp
Improvements are not Intended or offered for sale. IL however, the building or improvement is sold within one year of compleilk
II roved for the purpose of sate).
L.! I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Bul
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pup
LI I am exempt from licensure under the Contractors' Slate License Law for the fallowing reason: .___.__.__.__�._��_
By my signature helow I acknowledge that, except for my personal residence in which I must have resided for at least one year
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I unden
Professions Code, Is available upon request when this application is submittedor at the follawing Web slte:http:(/www.legmfo.c
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700) j,Dv
and effect. License Class License No Date
WORKERS' COMPENSATION DECLARATION
NARKING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under 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
ormance 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 pe
Trance carder and policy number are:
Fier Policy Number
a of Agent
entity that, in the perform ce of
if I should become su c fo thg
Mure of Anolfca ��
Wow by the checkmark(s) I have placed next to the applicable item(s)
, or repair any structure, prior to its issuance, also requires the applicant for
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
)31.5 by any applicant for a permit subjects the applicant to a civil penalty of
k, and the structure is not intended or offered for sale (Section 7044,
Res' or personal effort, builds or improves the property, provided that the
the Owner -Builder will have the burden of proving that it was not built or
and Professions Code, The Contractors' State License Law does not
to the Contractors' State License Law),
to completion of the improvements covered by this permit, I cannot leg:
that a copy of the applicable law, Section 7044 of the Business and
lealaw,htmi.
3 of the Business and Professions If
Be
full force
Contractor Signature —
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (Sf00,000), IN ADDITION
Relations as provided for by Section 3700 of the Labor Code, for
of the work for which this permit is issued. My workers'
Date
tf
ermit is issued, t shall not employ any person in any manner so apt to become subject to the workers*compensation laws of California, and agre
provisions of Section 3700 of the Labor Code, I shall forthwith DOIply with those previsions. C1,7
`,7 -//z
Dale /
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
ly my signature below, I certify to each of the following:
I am the property owner or authorized to, act on the property owner's be
I have read this application and the Information I have ad is real.
I agree to comply with all applicable city and county or " antes d state I Sting building construction.
I authorize representatives of this city or county t mer e a e_!den ' a propert or inspection purposes.
Sicnature of Prwerly Owner or Authorized A.ae - Print Prnneriv Owner's or Authori ad Anent's Name
DATE BY DECLARATIOKOF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE US] ONLY
REGULATIONS PART 61 OF TITLE, 40 AND AQMD RULE
_ 1403
PERiNl7 EXPIRED'LJ I SUBMITTED ASBESTOS NOT]F]CAT€ON TO
PERMIT EXTENDED
PERMIT,4NALCERTIFICATE OF
ULCOPAPCY ISSUEL)
Date