HomeMy WebLinkAboutXR2023-1711 - PermitsEWPORT City of Newport Beach D� Community Development Department- Building Division X R 2 0 2 3 1 7 1 1 COMB Permit : XR2023-1711
F My 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No
' T Permit Counter Phone: (949) 718-1888
newportbeachca.gov/civic Issued Date : 06/22/2023
c"srFoaN�° Combination Type - MFP Inspection Area : 1
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 : 4110 SEASHORE DR Legal Desc : N TR 3813 BLK LOT 42
Description: MFR REDECK W/ DEX-O-TEX
Owner: NYMCO DEV LLC
Contractor :
-
Architect
Address : 1935 MARINO TER
Address :
Address
SAN MARINO, CA 91108
Phone: (626) 271-4323
Phone :
Phone:
Con State Lic :
State Lic
Lic Expire:
Applicant: HEBA MATA
Bus Lic :
Engineer
Address : 214 N AVE 57
Bus Lic Expire :
Address
LOS ANGELES, CA 90042
Phone: (323) 472-7550
Workers' Compensation
Insurance
Phone
Carrier :
Owner/Builder : HEBA MATA
Policy No:
Designer:
Address: 214 N AVE 57
W. C. Expire:
Address
LOS ANGELES, CA 90042
Phone: (323)472-7550
Phone:
Code Edition : 2022
Fire Sprinklers :
NO
Construction Valuation :
$1,500.00
Type of Construction : V-B
Fire Hazard Zone :
NO
Added/New/Ti sq. ft. Bldg :
0
Occupancy Groups : U,R-3
No of Units :
2
Alteration sq. ft. Bldg :
Bldg Height :
No of Stories ;
2
Added/New sq. ft. Garage:
0
TOTAL sq. ft. :
0
Building Setbacks : Front: 10, Side: 3, Side: 3, Rear: 0
Flood Zone: X
Use Zone: R-2 - Two -Unit Residential
PROCESSED BY:
SPECIAL CONDITIONS: *NO PLANS REQ PER DRH* OWNER/BLDR AUTH FORM SCANNED
V F\I\r..r\.'aaVrr.Vel� Va.V re�rwrrur.
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s)
iection 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
Fe permit to file a signed statement that he or she islicahsed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
ofessions Code) or that he or she is exemptfrom licensors and the basis for the alleged exemption Any violation of Section 7031 Z by any applicant for a permit subjects the applicant to a civil penalty of
MIT
five hundred dollars IWO), -
I, ar of the property, or my employees with wages as their sole compensation, will do(_) all Of or (_) portions of the work, and the structure is not intended proffered for sale (Section 7044,
usiness and Professions Cone: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
nprovemenls are not intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the Owner -Builder will have the burden ofproving that it was not built or
-nQroved for the purpose of sale).
J I; as owner of the property, am Exclusively contracting with licensed Contractors to construct the project (Section 70", Business and Professions Code: The Contractors' State License Law does not
ly 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: _
y my signature below 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, I cannot legal)
oil a structure that I have built as an owner -bud It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
rofessions Code, is available upon request n mle Epp cation is s Omitted or at the following WOO site:httpJ/www.leginfo.ca.govfcsiaw.html. ..,
,ignatum of Property Owner or Auth gent ate / LZ„�_-
.iCENSED COMTRACTOR'S D ATIO
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prbfassi Code, and my license is in full force
ril edect Licemu ,`.,ass License No Data Contractor Signature
V09KERS' COMPLNSATION DECLARATION
IArtNINr : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (t100,000), Ni ADDITION TO THE
OST OF coMPENSAT11H, U V (AGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hire:y affirm under pen-lbr of perjury one of the folowing declarations:
3 1 hive and will mphltain a certificate OF consent to self -insure tot workers' compensation, Issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
orformanoe of the Sark fir which this permit Is Issued. policy No.
7! hT�r Ind Will 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' compensatioi
IPurance carrier and policy number are:
Poficy Number
Date
^r nf Agent "one e
certify that in the 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 laws or California, and
, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of. Applicant Date
CLARATiON REGARDING CONSTRUCTION LENDING AGENCY
I etty 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).
Idor's Name Lender'sAddress
my signature below, I certify to each of the fodow4ng:
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 an puny ordinances and state laws relating to budding construction.
I authorize representatives of this Pl1 or linty to ante the above -identified property for inspection purposes.
I,9 _ _ /-_ /. _/ Il_f _ A!'.J
ACTION F COMPLIANCE WITH CODE OF FEDER
I GATE I BY DECLARATIONREGULATIONS PARTfi OF TITLE 40 AND AQI RUt€AL I FOR OFFICE
PERMIT
ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO
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