HomeMy WebLinkAboutXR2023-1566 - PermitsCity of Newport Beach
Community Development Department - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
n Permit Counter Phone: (949) 718-1888
newportbeachca.gov/civic
°7u�onN`r Combination Type - SFP ELEC MECH PLUM
Work Class - Alteration
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COMB Permit : XR2O23-1566
Plan Check No:
Issued Date: 06/0812023
Inspection Area: 6
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 : 1224 PEMBROKE LN Legal Desc : N TR 3607 BILK LOT 5
Description: SFR REMODEL KITCHEN AND BATHROOMS PER CITY STANDARD PLANS. 359 SF "STOP WORK 123-1757"
Owner : BRIAN LOYOLA
Contractor :
Architect
Address : 555 ANTON BLVD, 150
Address':
': Address
COSTA MESA, CA 92626
Phone: (714) 235-3572
Phone ;
Phone
Con State Lic :
State Lic:
Lic Expire
Applicant: BRIAN LOYOLA
Bus Lic:
Engineer:
Address: 555 ANTON BLVD, 150
Bus Lic Expire :
Address
COSTA MESA, CA 92626
Phone : (714) 235-3572
Workers' Compensation insurance
Phone:
Carrier
Owner/Builder : BRIAN LOYOLA
Policy No:
Designer: BRIAN LOYOLA
Address: 555 ANTON BLVD, 150
W. C. Expire:
Address: 555 ANTON BLVD, 150
COSTA MESA, CA 92626
COSTA MESA, CA 92626
Phone: (714)235-3572
Phone: (714)235-3572
Code Edition : 2022
Fire Sprinklers :
NO
Construction Valuation : $12,000.00
Type of Construction : V-B
Fire Hazard Zone :
NO
Added/NBW/TI sq. ft. Bldg : 0
Occupancy Groups : U,R-3
No of Units :
1
Alteration sq. ft. Bldg : 359
Bldg Height :
No of Stories ;:
1
Added/New sq. ft. Garage: 0
TOTAL sq. ft.: 0
Building Setbacks : Front: 20, Side: 4, Side: 4, Rear: 10
Flood Zone: - X
Use Zone: R-1 - Single -Unit Residential
PROCESSED BY:
SPECIAL CONDITIONS: STOPWORK 123-1757
affirm
rovemento are not intended or offered for sale. if, however, the building or Improvement is sold within one year of Completion, (he 0
roved for the: purpose of sale). '
b as owner ofthe property, am exclusively contracting with licensed Contractors to construct the project($action 7044, Business or
ty to an owner of property who builds or improvee,therson, and who contracts for the projects with a licensed Contractor pursuant to
1 am exempt from licensure under the. Contractors' State License Law for the following reason:
of
have .the burden
Item(s)
led the! the
not built or
he.Contractors' StateLicense Law does not
License Law).
Araby affirm under penalty of perjury that am9lconsed under prolion f ChoptsK (co r riNmoing with Section 7000) of Division 3:of the Business and professions Code, and my license is In full Woe:
effect. License Class. Licana -. / Date. Contractor Signature
IRKERW COMPENSATION DECLARATION
:NINW. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FIRED UP TO ONE HUNDRED THOUSAND DOLLARS (0f00,000), IN ADDITION TO THE
T OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION $706 OF THE LABOR GODTL INTEREST, AND ATTORNers FEES.
reby affirm under penalty of perjury one of the following daclerauons:
I have and will maintain a certificate of Consent to selfdnspre for workers' compensation, issued by the Director of industrial .Relations as provided for by Section 37QO of the Labor Code, for th
ormance of the work for which this permit Is Issued. Policy No.
have and will maintain workers' compensation Insurance. asrequired by Section 3700 of the Labor Code, for the performance of the work: for which this permit is issued. My worker$' rompansetiol
Trance carder and policy number are:
Nor Policy Number. Expiration [late
ne'of Agent. Phone #
/certify that. in the performance o for which this permit Is Issued, 1 shall not employ any person in any manner so as to become subject to the workers`compensa ion laws of California. and ogre
If I should become subject to t rk rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Comply with those provisions. /
M.1- ^6 OV Zoe Z
rreby affirm under penalty at erjurytii there too construction lending agency for the performance of the. work for which this permit to Issued (Section 3097,: Civil Code),
wder's Name _LenderraAddress
my signature below, rl to sac f the following:
I am the property owner of orized to act on the property ownef's behalf.
I have road thti application. and the information I have provided In correct.
f agree to comy'y rilh all applicable city and cDmay.. ens and slate laws;relauhg to building construction,
1 PL00rize rep'Pve•ltativas of this city Dr oounry to 1 th bove•idantlffed property for Inspection purposes;
f.LT:�N I GATE Lt Vic
I By I IN 2TION5 PART 51 OF ATIUN UP TITLE 40
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