HomeMy WebLinkAboutXR2023-0745 - PermitsaEWPp�T City of Newport Beach III IIIII IIIII 11p11111111111111111111111111111 jj COMB Permit : XR2023-0745
C� s Community Development Department- Building Division X R 2 0 2 3 0 7 4 5
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2022-2168
Permit Counter Phone: (949) 644-3288 Issued Date : 03/21/2023
Inspection Requests Phone: (949) 644-3255 Inspection Area : 4
c4.ico""" newportbeachca.gov/inspections
Combination Type - SFP
Work Class - Other
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 : 2417 BAMBOO ST Legal Desc : N TR 4893 BLK LOT 49
Description: DELTA 1 - ADD SCOPE NEW WINDOWS, MASTER BATH REMODEL 168 SF; BATH #2 FIXTURE R/R, MAIN PNL TO 200A & NEW SKYLIGHT (CHANG OF
CONTRACTOR)
Owner: MICHAEL MUELLERLEILE
Contractor :
Architect
Address : 32 Sunset Cv
Address :
Address1, fir, ^
Newport Beach, CA 92657
� .,
-�' ,_-
Phone! (949) 633-8865
Phone:
Phone: f �; a i�
Con State Lie :
State Lie : tl `�.,f'4^a
Lie Expire :
Applicant: PHIL NIELSEN
Bus Lie:
Engineer : ABARQUEZ JOSE M
Address : 6131 ANACAPA DRIVE
Bus Lie Expire :
Address : 18 EL CORZO
HUNTINGTON BEACH, CA 92647
RANCHO SANTA MARGARITA, CA 92
88
Phone: (714) 717-1418
Workers' Compensation Insurance
Phone: (714) 277-9895
Carrier :
Owner/Builder : MICHAEL MUELLERLEILE
Policy No:
Designer
Address : 32 Sunset Cv
W. C. Expire:
Address
Newport Beach, CA 92657
Phone: (949) 633-8865
Phone:
Code Edition : 2019
Fire Sprinklers : NO
Construction Valuation
Type of Construction : V-B
Fire Hazard Zone : NO
Added/New[TI sq. ft. Bldg : 0
Occupancy Groups : 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: 10, Side: 6, Side: 6, Rear: 6
Flood Zone : X
Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates minimum lot area)
PROCESSED BY: ` W
SPECIAL CONDITIONS: XR2022-2926 & XR2023-0041
4TITH
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State. License Law for the resson(s) indicated below by the checlumark(s) I have placed next to the applicable Rem(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 eippl cent for
the permit to file a signed statement that heor she is licensed pursuant to the provisions of the Contractors' State License Low (Chapter 9 (commencing. with Section 7000)of Dlv@sion 3 of the Business and
Professions Code) or that he or she is exempt from Acensure 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 -Builder will have the burden of proving that it was not built or
CovRnp ed for the purpose of sale).
as owner of the property, am exclusively contracting with tic see 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, an1whojontracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law),
L I am exempt front licensure under the Contractors' State Li nse
By my signature below I acknowledge that, except for my per at re
sell a structure that I have built as an owner -builder if if as a o
Professions Code, is available upon request when I appli ti
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATI
I hereby affirm under penalty of perjury that. I am Iicensad isio
and effect. License Class Lice No
COMPENSATION DECLARATION
the following reason:
In which I must have resided for at least one year prior to completion of the improvements cover
:ted in its entirety by licensed contractors. I understand that a copy of the applicable law, Section
d or at the following Web site:http:llwww.leginfo.ca.gov)calaw.html.
9 (commencing with Section 7000) of Division 3 of the Business and Professions
Date Contractor Signature
his permit, I cannot
of the Business and
my license is In full force
IARNING: 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 (S100.,000), IN ADDITION TO THE
:DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES -
hereby affirm under penalty of perjury one of the following declarations:
3 1 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, forth'
performance of the work for which this permit is.issued. Policy No.
have and will maintain workers' compen;aten insurance, as required by Section 37CO of thee. Labor Code, for the performance of the work for which this permit is issued. My workers'
ranee carrier and policy number are: ��
ne of Agent _
certify that, in. the
, if I should bacon
iature of Applicant
=_reby affirm under penalty of birjlfry that there is a cony
idar's Name
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the pn
I have read this application and the information I have
I agree to comply with all applicable city and county,gqol
N9 4
I authorize representatives of this city of county nt
DATE. P.. BY
PERMIT EXPIRED
1403
Number
Date
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 age
i provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
oats 3 a� ZUZ3
NCY
rction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil ode).
Lender's Address
laws relating to building. construction.
< property for inspection purposes.
OF CONOLIA.NCE WITH CODE OF FEDERAL
PART 51 DF TITLE 40 AND AOIVID RULE
NOTIFICATION TO
PERMITEXTENDfD f LIAVE
PERM17'FlPlAt f/fiq�L,sp 1� `RE`1FI 7t N OT APPCICABLt; TO
CER71 lCATE Of ""iC�7 I r/ PROP OCCUPANCYISSUfO SIGNAT
FOR OFFICE USE ONLY
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