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Home My WebLink AboutX2021-3187 - Permits, aka City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 . y I Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 q:�� Combination Type - SFP III�IIIIIIIIIIIIIIIII �IIIIIIII�I1111IIIIII�IIilIill COMB Permit: X2021-3187 Project NO : 0490-2021 Issued Date: 11/23/2021 Inspection Area : 5 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1112312024 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 SJBJEMTO EKMR Job Address: 250 HAZEL DR NB Description: DELTA 3, CHANGE TO ARCHITECT TO ENGINEER (REV21-1851) DRIVE) W,}DME Eic OM o, Legal Desc.: TRACT NO 673 BLK A LOT 44 AND POR ABAND STR (GLEN NBW 15.a4.OW �y MiNtt UANCE REQUHW C Owner. KAN STEPHEN WAYLAND Contractor: OWNER/BLDR Architect: Address: 25.0 HAZEL DR Address: KAN STEPHEN WAYLAND Address: ., CORONA DEL MAR, CA 92625 Phone: Phone: State Lie: Phone: 8181919-5678 Applicant: KAN STEPHEN WAYLAND Con State Lie: O/B Engineer: PATEL JAGDISH ST Address: 250 HAZEL DR Lie Expire: Bus Lie: Address: 1761 N PARTRIDGE ANAHEIM CA 92806 CORONA DEL MAR, CA 92625 Lie Exp Date: Phone: 714-528-2402 State Lic:C-049546 Phone: 8181919-5678 Code Edit: 2019 Worker's Compensation Insurance Designer: Type of Construction: VB Carrier: Address: Occupancy Group: R3IU Policy No: Phone: Added /New sq_ft. Bldg: 0 Expire: Added /New sq. ft. Garage: 0 Building Setbacks Rear: / Special Conditions: LANSDSLIDE &FUEL MOD. No of Stories: 3 Front: I REDUCTION AREA No of Units : 1 Left: / Bldg Height: 0 Right: / Bldg Sprinklers: X Use Zone: Parking Spaces: 0 Fire Hazard Zone: Y Flood Zone: Construction Valuation: $2,000.00 Building Permit Fee: $110.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Fee: $52.00 Fire Inspection: $0.00 Plan Check Fee: $95.70 Additional Fee: $0.00 $0.00 Grading Bonds Fee: $0.00 check Fair Share : $0.00 Fire Plan Rev $0.00 Overtime Plan Ck: Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Trans: $0.00 Demolition Fee $0.00 Building Dept Adm $0.00 Record Management: $26.00 Grading Permit Fee: $0.00 $0.00 In -lieu Housing Fee: Public Works Department - General Service $0.00Refund Energy Compliance: $0.00 Grading PC Fee: $0.00 WQ Insp. Fee: $0.00 Deposit $0.00 Park Dedication : $0.00 p CA Seismic Safety: P/W Plan Check: $0.00 Grading Bond: $0.00 Disabled Access: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 $0.00 Building Green Fee: $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0-00 Plumbing %: $0.00 TOTAL FEE : $284.70 Plan Check Fee: 6 $0.00 Fee Due at Permit Issuance : $284.70 l PUBLIC WORKS APPROVAL: PROCESSED BY: PLAN CHECK BY: ZONING APPROVAL: APPROVAL TO ISSUE: GRADING APPROVAL: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) 1 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 fhe applicant for the permit to file a signedstatement 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 Buainess and Professions Code) or that heror 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). ❑ 1, as owner of the groperiy, 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 j5ve rents 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 imor d for the Duroosei of sale). I, i, owner of the properrty, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not eapp o 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). am exempt from licensure Linder 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 Iegali, sell a structure that I have built as an owner -builder if it has not been constructed in it entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Busine s and Professions Code, is available upon request wh 2 is applicatio itted of the following Web site_:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent ` T-- - O Dat LICENSED CONTRACTOR'S DECLARAT I hereby affirm under penalty of perjury that I A licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions C de, and my license is in full force and effect. License Clads, ': License No Date Contractor Signature WORKERS' COMPENiSATION DECLARATION WARNING: 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 ATTORNEYS FEES. 1 hereby affirm under penalty, of perjury one of the following declarations: ❑ 1 have and will maintain la 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 performance of the work for ..which this permit is issued. Policy No. ❑1 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' compensation insurance carrier and policy num1 ber are: Carrier Policy Number Expiration Date Na of Agent Phone # 1 certify that, in the performance of the work for which this ermit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree if I should become 5,ubject to the workers' compe a n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature ofApplica A - DECLARATION REYRMONG CONOMUCTION LENDING AGENCY f hereby affirm und,4r 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). -ender's Name Lender's Address 3y my signature below,:I certifyto each of the following: I am the property ownler or authorized to act on the property owner's behalf. I have read this application land the information I have provided is correct. agree to comply with all; applicable city and county ordinances and stat laws relating to building construction. I authorize representatives of this city or goun;y to enter the above-i ified propert f r inspection purposes. Signature of Property Owner or'Authorized AM�` Print Property Owner's or Authorized Agent's Na ACTION DATE D 'LAI�TION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REG TIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED I SUB ITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED LJEPA _ PERMIT EXTENDED Q D PERMITFINAL ASBESTOS NOTIFICATION IS NOTAPP ICABLE TO CERTIFICATE OF PROPOSEp DEMOTION OCCUPANCY ISSUED c it Na7