HomeMy WebLinkAboutXR2023-0398 - PermitsagWPORT City of Newport Beach 1111111111111111111111111 11111111� 111 COMB Permit: XR2023-0398
D� A Community Development Department- Building Division X R 2 0 2 3 0 3 9 8
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No:
Permit Counter Phone: (949) 644-3288 Issued Date : 02/10/2023
u c « r r Inspection Requests Phone: (949) 644-3255 Inspection Area : 2
q</FpryN� newportbeachca.gov/inspections
Combination Type - SFP
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 : 1603 BALBOA AVE Legal Desc : A TR BALBOA ISLAND SEC 5 BLK 6 LOT 13 BALBOA ISLAND SEC 5 LOT 13 BILK 3=W 30 FT E 60
FT
Description: SFR DELTA 1, (9) WINDOWS REPLACED, INFILL WATER HEATER, CLOSET DOOR, ELEC. PANEL & FLOOR HEIGHT WINDOWS (REV21-15012) * ;RttV'E!W
EXPIRED PERMIT X2021-1690 * 122-0281
Owner: THERESA FERGUSON
Contractor :
Architect
Address : 1603 BALBOA AVE
Address :
Address:
NEWPORT BEACH, CA
Phone: (949) 310-4716
Phone:
Phone:
, , . *
Con State Lie :
State Lie
Lie Expire
Applicant: THERESA FERGUSON
Bus Lie:
Engineer
Address : 1603 BALBOA AVE
Bus Lie Expire :
Address
NEWPORT BEACH, CA
Phone: (949) 310-4716
Workers' Compensation Insurance
Phone:
Carrier :
Owner/Builder: THERESA FERGUSON
Policy No :
Designer
Address : 1603 BALBOA AVE
W. C. Expire:
Address
NEWPORT BEACH, CA
Phone: (949) 310-4716
Phone:
Code Edition : 2019
Fire Sprinklers :
NO
Construction Valuation :
$4,000.00
Type of Construction : V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg:
0
Occupancy Groups : U,R-3
No of Units :
1
Alteration sq. ft. Bldg:
Bldg Height :
No of Stories :
1
Added/New sq. ft. Garage:
0
TOTAL sq. ft. :
0
Building Setbacks : Front: 20, Side: 3, Side: 3, Rear: 10
Flood Zone : X
Use Zone : R-BI - Two -Unit Residential, Balboa Island
'tits
CONSTRUCTION NOSE
PROCESSED BY: �
SPECIAL CONDITIONS:
c -
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a.P tl 'a
ON THE WEEKEND
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable items)
3eutlon 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
to permit to file a signed statement that he or she is licensed pursuant o the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
ofessions Code) or that he or she is exempt from licensuro 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
of more than five hundred. dollars ($500).
M I, as owner of the property, or my employees with wages as their sole compensation, will do t_) all of or (_) portions of the work; and the structure is not intended or offered for safe (Section 7044,
usiness and Professions Code. 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
nprovements 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 of proving that it was not built or
nproved for the purpose of sale).
3 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Stale License Law does not
poly 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),
3 lain exempt from ecensum 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 'r. Ya built as an ownor-builder if ithas not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable taw, Section 7044 of the Business and
'rofessions Code, i� a,,anabie upon request when th'10pit tion is submitte or t the following Web siteihttp:/Mnvw.leginfo.ca.gov/calaw.html.
,icr e'I - of Property owner or Authorized Agent dYt 2Ak.Srf4i Gir l L) 1) g,,I)
.ICENSE.D CONTRACTOR'S DECLARATION <J
hcIreby 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 Professions Code, and my license is In full force
rid effa..t. License Class License. No Date Contractor Signature
CCUl'E'4SATION DECLARATION
'ARNING. FAILURE TO SECURE WOR%ERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUEJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
7FT O` 4OMPENSATA,i, EAMAGES AS PROVIDED FOR IN SECTION 31Q9 OF THE LABOR COOS, INTEREST, AND ATTORNEY'S FEES.
herehy affirm unda, ,:Lnalty, of perjury one of the following declarations:
I I t.a,.: 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
xformance of the worn for which this permit is issued. Policy No.
nave and 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'
&n-e carrier and policy number are:
Policy Number
of Agent
Date
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 iaws,of Caffennia,. 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.
ignalure of Applicant Date— _
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
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 Cade).
enders Name Lender's Address
y my signature below. I certify to each of the 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 applicablecity and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county toiiiIgter the above-idejtiified property for inspection purposes. _
ACTION DATE BY ' ! DECLARATION OF COMPLIANdE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61'OF TITLE 40 AND AOMD RULE
PERMIT EXPIRED
U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED
EIEPA
PERiMITEXTENDED ----
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PE-RMITFINAL
CERTIFICATE OF
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_ I„_IASHESTOS NOTIFICATION 15 NOT APKICABL£ TO
PROPOSED 0QLITION
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