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X2021-1743 - Permits
City of Newport Beach - Building Division I�(IIIII�III�IIIIIIIIIIIIIIIIIIIIIII�IIIIII[�IIIIII[II COMB Permit: X2021-1743 .� z 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 t 7 4 3 Project No Permit Counter Phone (949)644-3288 3 Inspection Requests Phone (949)644-3255 Type BLDG PLUM Issued Date: 07/07/2021 NO CONT OISE Combination - , Inspection Area: 5 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0710712024 OR PERMIT WILL BE INVALID Construction Hours: Monday - Friday 7.00 a.m, to 6:30 p.m. and Saturday from 8.00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 611 BEGONIA AVE NB ERS G S I l YiS CITY STD BLOCK WALL 45 LF (INSIDE P/L, MARKERS ON SITE) W/(3) PILAST Description: SFR PM 265-7 PAR 1 OF PROJECT 938-01 LOCATED ON AP 459-085-23 TOGETHER Legal Desc.: Owner. FOLLEYIHUMMELBERG Contractor: SMITHLIN DEAN COMPANY INC Architect: Address: 611 BEGONIA AVE Address: 32565 B GOLDEN LANTERN #104 Address: NEWPORT BEACH CA 92625 DANA POINT CA 92629 Phone: State Lic: Phone: Phone: 949-689-7228 Applicant: SMITHLIN DEAN COMPANY INC Con State Lic: 896691 Engineer: Address: Address: 32565 B GOLDEN LANTERN #104 Lic Expire: 05/31/2023 DANA POINT CA 92629 Bus Lic: Lic Exp Date: BT30048091 0813112021 Phone: State Lic: Phone: 949-689-7228 Code Edit: 2019 Worker's Compensation Insurance Designer: SMITHLIN DEAN Address: 32565 B GOLDEN LANTERN #104 Type of Construction: VB Carrier: Policy No: EVEREST INS 76000010189 DANA POINT CA 92629 Occupancy Group: U Expire: 11/01/2021 Phone: 949-689-7228 Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 Building Setbacks Special Conditions: Rear: / P No of Stories: 0 Front: No of Units : 0 Left: 3' Bldg Height: 0 Right: 3' Bldg Sprinklers: X Use Zone: Parkin Spaces: 0 Fire Hazard Zone: N Flood Zone: Construction Valuation: $8,000.00 Building Permit Fee: $212.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Fee: $52.00 Fire Inspection: 0.00 Plan Check Fee: $184.44 Additional Fee: : Grading Bonds Fee: $0.00 check $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Overtime Plan $0.00 Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans: $0.00 Demolition Fee $0.00 Building Deptce $0.00 Record Management: $2.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: $0.00 Public Works Department - General Service $0.00 Energy Compliance: $0.00 Grading PC Fee: WQ insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 $0.00 CA Seismic Safety: $0.00 Grading Bond: P/W Plan Check: $0.00 9 Disabled Access: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 $0.00 $0.00 Building Green Fee: $1.00 Mechanical $0.00 NMUSD Fee: $0.00 Plumbing %: $19.08 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $470.52 TOTAL FEE : $470.52 PUBLIC WORK ©®PPROVAL: PROCESSED BY: m o mo o© o 0 0 0 © o � ©o o © f�'!=AN �BY: ZONING APPROVAL: o 0HE'C p o a ® ® ® ® ®® -1 4/'1 000 O 00 © © i V APPROVAL TO ISSUE: GRADING APPROVAL: n n 0 11 <) U O U OWNER -BUILDER DECLARATION 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) (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 jor 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 prope or my employees with wages as their sole compensation, will do U 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 intendedor 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 improved for the purpose of sale). ❑ 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 property1who 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 legall; sell a structure that I ha� ei bui�It 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 Code, 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 Agent D AC LICENSED CONTR!TO'R'S DECLARATION hereby affirm under penalty lof perjury that I am licensed under provisions of Chapter 9 (commencing with Section 00 v o the Business and Pr fessio e, and my license is in full force and effect. License Class License No Date Contractor Signat WORKERS' COMPENSATION DECLARATION i NARNING: 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penaltyof perjury one of the following declarations: ?1chave 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 th rmance of the work for which this permit is issued. Policy No. and will m htaih workers' co ation insurance, as re nsurance carrier and olicy, number are: wired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatior 3arrier P� rl Expiration Date Vame of Agent Ph- iE JI certify that, in the perforrha5pe6f the work or whi this permit iAissued, I shall not employ any person in any manner so as to become subject to the workers' co pensation laws of California, and agre rat, if I should become ub' to' the workers' o� nsation of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ignature of Applicant date V �f �i;7_/ ,ECLARATION REGARDING CONSTItUCTIQW6ENDING AGENCY hereby affirm under pe II 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). ender's 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. 1 have read this application and the information I have provided is c rect. I agree to comply withl,'all applicable city and coup ordinances a state laws relating to building construction. I authorize representatiives, of this city or cow enter the a e-identified property for inspection purposes. ignature of Property Owner or Arthorized Agent Print Property Owner's or Authorized AAent's Na .Oar sn � _ a / / - n P % ACTION DATE BY ( l DECLA ION 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 LJEPA o o n c o 0 PERMITEXTENDED ❑AQMD �--- —� ❑ASBESTOS NOTIFICATr, 1 IS NOT �APPLIC-ABLE ;O PERMITFINAL Q � CERTIFICATE OF tJ PROPOSED DEMOLITION OCCUPANCY ISSUED SIGNATURE: