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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the ContractorsState License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable Remits)
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
ie permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Slate 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
of more than five hundred dollars ($500).
1, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business 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
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 of proving that it was not built or
nproved for the purpose of sale).
11, 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).
7 1 am exempt from licensure under the Contractors' Slate License Law for the following reason: ._
ly 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)
ell a structure that I have built as an owner -builder if it hasA been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 oft Business and
rofessions Code, is available upon request when `thiT�a llc Ion is subrna eHewing-bYsti site:hftp://wv,N✓.leginfo.ca.gov/calaw.htmi.
signature of Property Owner or Authorized Agent y� Date ��"3
.ICENSED CONTRACTOR'S DECLARATION
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 Professions Cogel, and my license is in full force
nd effect. License Class License No Date Contractor Signature
COMPENSATION DECLARATION
'ARNING: 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 rfc00.000t, IN ADDITION 10 THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations: II
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, For if,
erfcrmance of the work for which this permit is issued. Policy No. u
have 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'
ranee carrier and policy number are:
Policy Number
Date
ie of Agent Phone #
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 oeCali`-T:ia, and ag.
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
ignature of Applicant _ Date
IECLARATION 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 Lenders Address _
y my signature below, I certify to each of the following:
1 am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have proved is correct.
I agree to comply with all applicable city and county ordig6ricles and slate laws relating to buildin construction.
I authorize representatives of this city or county I me the bove-identified nspection purposes. r
signature of Property Owner or Authorzed ADent % Print Property Owner's or Authorized Agent's Name Dat)
ACTION
DATE
BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED
LJ I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
EPA
PERMITEXTENDED
LJAQMD
PERMIT FINAL
a
'y p ❑ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATE OF
tJt� PROPOSED DEMOLITION
OCCUPANCY ISSUED
SIGNATURE:
City of Newport Beach X 2��r��u���d����►�������►q��� COMB Permit : XC2U23-0164
b Community Development Department - Building Division
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: 2849-2017
Permit Counter Phone: (949) 710-1e88 Issued Data: 0511712023
u ems. newportbeachca.gov/civic Inspection Area: 1
°M.rcoP�`' Combination Type -
Work Class - New
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 : 412 29TH ST Legal Dose: N TR 18108 ELK LOT:2,
Description: RESIDENTIAL UNITS A. B, AND C (3) CONDOS 6,7131792 LIVING/P.IARAGE -UNIT A 3 BEDROOMS, UNIT B 3 BEDROOMS, UNIT C 3 BEDROOMS
Owner:
410 TWENTY NINTH STREET LLC
Contractor:
Architect:
BRANDON LINSDAY
Address :
5933 MCCONNIE AVE
Address :
Address :
151 KALMUS DR, G-1 COSTA MESA, CA
WOODLAND HILLS, CA 91367
92626
Phone:
Rhone:
': Phone:
(714)754-4040
Con State Lie:
State Lie:
Lie Expire s
Applicant:
BRANDON LINSDAY
Bus Lie:
Engineer:
DEIHIMI AMIR HOSSEIN
Address:
151 KALMUS DR, G-1
Buff Lie Expire :
Address :
23172 PLAZA POINTE DR STE 145
LAGUNA HILLS CA 92653
COSTA MESA, CA 92626
Phone: (714)7544040
Owner/Builder: 410 TWENTY NINTH STREET LLC
Address: 5933 MCCONNIE AVE
WOODLAND HILLS, CA 91367
Phone:
Code Edition: 2016
Type of Construction : V-B
Occupancy Groups: S-2,M,R-3
Bldg Height:
Building Setbacks:
Flood Zone:
Use Zone:
Workers' Compensation Insurance
Carrier;
• Policy No:
W. C. Expire:
Fire Sprinklers :
NO
Fire Haxard Zone i
NO
No of Units:
1
Noof'Stories;
3
X
MU-CV/15TH ST - Mixed -Use Cannery Village and 15th Street
PROCESSED BY:
SPECIAL CONDITIONS: CHANGE OF CONTRACTOR TO OWNER/BUILDER (X2017-4043)
phone: (949)954-7244
Designer:
Address
Phone:
Construction Valuation:
Added/Newrrl sq. ft. Bldg : 0
Alteration sq. ft. Bldg :
Added/New sq. ft. Garage: 0 "
TOTAL sq. ft.: 0 ,
NO OONSTRi t--" iOf\l ;\1(.;)i- -
ON THE i tr)
I have
'rofeA4lone Cbdb: The.Codtr0ders' State License Law does not apply to an aNnor of property who, through amployooW nr paroonal effort, builds or Improves. the property,. provided [het the
are not intended or othood for sale. If, however, the building: or improvement Is sold withinone-year of compistfon :the owner-BuIldef Will have the burden of proving that it was not built or
I, as ownarof the property, am exclusively contracting with licensed Contractors to construct the project .(Section 7044, Business and Profession$ Code;: The Contractors' State License Law does not.
dyto an owner of property, who builds or Improveadhereon, and who contracts for the projects with dlicensed Contractor pursuant to the Contreelers' Slate License. Law).
t am exempt from libensure under the Contfactors'$lals License Law for the following reason:
my signature below 1 acknowledge that, axcept for In eMoneI residance In which I must resided for at feast ogre year prior to completion of the Improvementa covered by this permit, I cannot leg
eetruoture lhot I have built as an owner -builder lilt hot boars conatructod in its entirety by licensed conlradtors. Iuhdorefand that a copy of the appltcOblo, law, Section 7044 of the Buatnose and
fesslohs Code, is evellobietupcn request whoa thle " Ileetion is submitted or at the following Web site;tillp:llwww:fagintd.ea.govlcalaw.html.-
nature of Property Owner or Authorized Agent l% __ _. _. Date f� 1 Z—
COMPENSATION DECLAiii1lTION
license'It In full force
CIVIL FarEa UP TO ONE HUNDRED THOUSAND DOLLARS IS100,0001, IN ADDITION TO THE
areby Affirm Under penalty of perjuly.dne of the following declanibons:
I have and :will maintain a certificate of consent: to self lnstite for workers' compensation, Issued p.y the Director of Industrial) Relationsas provided for by Section 3700 of the Labor Code,: Foe th
formance of :the work for which this parmll is issued. PollcyNm
I have and Will maintain workers' -compensation brounmoo, as required by Section 3700 of the Labor Code, for the performance of the Work for which this permit Is Issued.. My workers' componaptioi
uranca carder:And 0011py numbet are;
filer Policy Number. Expiration Dale
me of Agent Phone At
I certify that, in the perfor ce of the work for which this permit Is Issued, I shah not employany. person In any manner so as to become subject to the workers` compensation laws of Celifomle, end ogre
I, If I should become ad ec to the workers' compensation provisions of Sectfoh 3700.of the Labor Code, I shall fof fhwllh comply With those provisions.
nature of Applicant Dale_ Id-Z
NO
CY
LARauDANa�lrrebYipAffirm nderPeneltyof perjury Inallhere is ab8Mr61nendfnG AgINIcy for the mence of t@e work forwhlc[his Is Issued (Section oh 8087, Civil Cadq .
ides s Name. Lendat'tl'Addres9.
my signature below, I Certify to each of the following::
1 am the plc,T_l-y owner of authorized10 act On the property owher's behalf.
I have read: fft.'e cppllcalion and the Information i:have prov d6dis correct.
I qnroo tocrt^ fl;'with all applicable: city and county,p(dinsnces and AtataIowa foisting to building construction.
ACTION I DATE I ey I RE ULATION& OAi1T 61 OF TITLE 40 AND