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Home My WebLink AboutX2012-0326 - Permits�*mrr o® City of Newport Beach Building Division COMB Permit No: X2012-0326 H PROJECT NUMBER: 0257-2012 u PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requestslrelephone (949)644-3255 Aawoc4`' Combination Type - SFP/ ELEC/ MECH/ PLUM/ Job Address: 105 VIA RAVENNA Description: INTERIOR REMODEL Inspector Area: 1 Legal Desc.: N TR 907 LOT 179 Owner: TRIPPEL PATRICK Contractor: RIMCREST DEVELOPMENT INC Architect: Address: 105 VIA RAVENNA Address: 3419 VIA LIDO SUITE 455 Address: NEWPORT BEACH, CA 92663 NEWPORT BEACH CA 92663 Phone: Phone: 949-466-0900 Phone: State Lic: . Applicant: MICHAEL TERRY Con State Lic: 858893 Engineer: Address: 3419 VIA LIDO, SUITE 455 Lic Expire: 05/31/2013 Address: NEWPORT BEACH CA 92663 Bus Lic: BT30021452 Phone: 949-466-0900 Lic Exp Date: 12/3112012 Phone: State Lic: , Code Edit: 2010 Worker's Compensation Insurance Designer: MICHAEL DAVID .. Type of Construction: V-B Carrier: WIC EXEMPT Address: 712 CENTER ST Occupancy Group: R3/U Policy No: (NO EMPLOYEES) COSTA MESA CA 92627 Added /New sq.ft. Bldg: 0 Expire: Phone: 949-701-9539 Added /New sq. ft. Garage: 0 No of Stories: 2 Building Setbacks Rear: I Special Conditions: No of Units : 1 Front: I ' Bldg Height: 0 Left: I Bldg Sprinklers: Right: I Flood Zone: Use Zone: _ Issued Date: 02114/2012 Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $35.000.00 Building Permit Fee: $545.50 Solar System PC: $0.00 Planning Department - Fire Department Plan Check Fee: $392.76 Excise Tax: $0.00 Plan check Fee : $31.25 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Fair Share: $0.00 Fire Plan Rev $0.00 Investigation Fee: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $3.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department - General Service $0.00 CA Seismic Safety : $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 PAN Plan Check: $0.00 Fee Increase: Fee: $0.00 Electrical %: $38.19 San Dist : $0.00 Additional Fee : $0.00 Mechanical %: $27.28 NMUSD Fee: $0.00 $0.00 Hazardous Mat: $0.00 Plumbing % $54.55 $0.00 Building Green Fee: $2.00 TOTAL FEE : $1,094.53 ; Plan Check Fee : $0.00 Fee Due at Permit Issuance : $1,094.53 PROCESSED BY: /% PUBLIC WORKS APPROVAL: ZONING APPROVAL: ✓� �1`C W PLAN CHECK BY: LG 5in GRADING APPROVAL: APPROVAL TO ISSUE: WL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) 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 the 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 Professions 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 not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U 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 improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner-Builderwill have the burden of proving that it was not built or improved for the purpose of sale). i❑ 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 apply 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). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By 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 legally sell a structure that I have built as an owner -builder if 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 Professions Cede, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date L;CE;43ED CONTRACTOR'S DECLARATION I hereby affirm i panalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof Ions Co , �nd my license is in full force nird effect.-�• JJJjj License Class License No Date Contractor Signature VORWERS' COMPENSATION DECLARATION WARNING: FAIi 7ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRE THOUSAND DOLLARS ($100,000(, IN ADDITION TO THE CCET 3: COMPENSATICN. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I h.s:cby affirm under penalty of perjury one of the following declarations: '� ' nave and MI ma'ntain 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 tht performance of the work forwhich this permit is issued. Policy No. 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' 'ance carrier,nd policy number are: of Agent _ ertify that, in the if I should becor dure of ADolican Policy Number Date 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 of California, and agrer 'kern' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date��C. �y�Z IECLARATION REGARli CON!�TRUCTION LENDING AGENCY hereby affirm under penalty f perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). ender's Name Lender's Address ly my signature below, I certift 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 hav rov ad is correct. I agree to comply with all applicable city and ount "' an s and state laws relating to building construction. - authorize representatives of this city or cou y to nter he bove-identified property for inspection purposes. lignature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name ' kr�L Date i z ACTION DATEBY DECLARATION OF COMPLIANCE WPTHCODE OF FOR OFRCE USE ONLY FEDERAL REGULATIONS PART 61 OF T17LE40AND AQMDRULE 1403. PERMITEXPMED ❑ ISUBMITTED ASBESTOS NORFICATIONTO: ❑ EPA ❑ AQMD ❑ ASBESTOS NOTIFICA770NIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL i L A. Y ac CERTIFICATEOF SIGNATURE: OCCUPANCYISSUED