HomeMy WebLinkAboutXR2023-1231 - Permits�aEWPoR, City of Newport Beach IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit : xR2o23-1231
d Community Development Department -Building Division
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No : 3026-2021
Permit Counter Phone: (949) 718-1888 Issued Date : 05/1112023
U fie,. T newportbeachca.gov/civic Inspection Area : 2
cq«coaN`P Combination Type - SFP
Work Class - Other
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 : 213 TOPAZ AVE Legal Desc : A TR. BALBOA ISLAND RESUB SEC 1 BLK 12 LOT 6
Description: SFR ADD 222 SF & REMODEL 180 SF& REVISE (E) GLASS GUARDRAIL*** CHANGE OF CONTRACTOR TO O/B***
Owner: M & M DOLLANDER HOLDINGS LLC
Address: 213 TOPAZ AVE
NEWPORT BEACH, CA 92662
Phone :
(480) 570-8600
Applicant:
M & M DOLLANDER HOLDINGS LLC
Address:
213 TOPAZ AVE
NEWPORT BEACH, CA 92662
Phone:
(480)570-8600
Owner/Builder : M & M DOLLANDER HOLDINGS LLC
Address : 213 TOPAZ AVE
NEWPORT BEACH, CA 92662
Phone: (480)570-8600
Contractor
Address :
Phone:
Con State Lie
Lie Expire
Bus Lie:
Bus Lie Expire
Workers' Compensation Insurance -
Carrier
Policy No:
W. C. Expire:
Code Edition:
2019
Fire Sprinklers : NO
Type of Construction :
V-B
Fire Hazard Zone : NO
Occupancy Groups :
U,R-3
No of Units : 1
Bldg Height :
No of Stories : 2
Building Setbacks :
Front: 8, Side: 3, Side: 3, Rear: 5
Flood Zone :
X; AO 1
Use Zone :
R-BI - Two -Unit Residential, Balboa
Island
PROCESSED BY:
SPECIAL CONDITIONS: O/B FORM ATTACHED
Architect :
BARRY WALKER
Address :
PO BOX 11658 NEWPORT BEACH, CA
92658
Phone :
(949) 246-4085
State Lie :
Engineer:
Address
Phone:
Designer : :...
Address
Phone:
Construction Valuation
Added/New/TI sq. ft. Bldg: 0
Alteration sq. ft. Bldg : _
Added/New sq. ft. Garage: 0 '
TOTAL sq. ft. : 0
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that (am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(e) I have placed next to the applicable Items)
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
he 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
'rofessions 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
rot 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 L) portions of the work; and the structure is not. Intended or offered for sale (Section 7044,
lusiness and Professions Coda: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or irpreves the property, provided that the
nlprovements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completlon, the Owner -Builder will have the burden of proving that it was not built or
myvroved 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
`pply 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:
_._--.. ._._.
3y my signature boson 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, t cannot legall}
,ell a structure that I have built as an ownor-buildor if it has n t beon constructs. 'n entir by licensed contractors. I understand that a copy of the applicable law, Section 70" of the Business and
'rofessions Code., is available upon request when this soplion is sub: a at B f ing Web site:httpY/www.leginfo.Ga,gov/calaw.fitml.
signature of Property Owner or Authorized Agent __ ___ pate �V//��
-ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am license Lin provisions of Chapter 9 (commencing with Section 7000) df Division 3 of the Business and Professions Code, and my license is In full force
mail effect License Class icense No Date Contractor Signature
PORKERS' COMPENSATION DECLARATION
EARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
:DST OF COMPENSATION: DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES.
hereby affirm under penalty of perjury one of the following declarations:
I 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, forth
erformance of ti io wvrk for which this permit is issued. Policy No. _
lima and Trill 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`
ranee carrier and policy number are:
Policy Number
of Agent
Date
JI certify that, inthe performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation taws of California, and
,M, i, I should bax.t:ic subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Of
Date
hereby affirm gndur {,malty of perjury that there is a construction tending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ood.r's Name Lender's Address
'y ri;, sfgnatuns bglow: I certify to each of tiie 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 ordinal and to laws relating to building construction. p� W c�A.ecRJ
I authorize representatives of this city or county to nter a yr p. ,atified pm arty for inspecuon purposes. -0 _
signature of Property Owner or Authonzed Agent -R C� - CL Print Property Owner's or Authorized Anent's Name X !il ..sCiC..EL.r�IJ� Date -� 1
ACTION DATE I BY DECLAR^CN OF COMPLIANCE WITH CODE OF FECERAL I FOR OFFICE USE ONLY
i REGULATIONS PART 61 OF TITLE 40 AND AQrVID RULE
PfRMREXXPIR£D E ( j�L—.I �I SrURMITTFO ASBESTOS NOTIFICATION TO
PEAMITCANCEtLED -�—��----�— � 1_IEPA
rcmmlt rrEUHL AvI'ASEESTOS NOTIFIC,tA�T'ION IS NOT APPLI AKE T'O
CERT;FICAF£OF I .PROPOSED OEMCUTf I /]�
OCCUPANCY ISSUED SIGNATDREr .GGFK Ox LJJ