HomeMy WebLinkAboutX2022-0674 - PermitseNro City of Newport Beach - Building Division
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2022-067d
�- 100 Civic Center Drive, Newport Beach, CA 92660
X 2 0 2 2 0 6 7 4 Project No : 0703-2021
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Issued Date : 2022
L iyalY Combination Type - BLDG
Area :
Inspection rea
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST
VALID INSPECTION, PROJECTS MUST BE COMPLETED BY 0310812025 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: 411 EL MODENA AVE INS
Description: SFR BLOCK WALL (ON P/L) 6' X 101' (NORTH SIDE)
Legal Desc.: FIRST ADD TO NEWPORT HEIGHTS BLK 26 LOT 22
Owner: GONZALEZ JOSE Contractor:
OWNER/BLDR
Architect: TEALE MARK
Address: 411 EL MODENA AVE Address:
Address: 2900 BRISTOL ST BLDG A203
NEWPORT BEACH, CA 92663
COSTA MESA CA 92626
Phone: 949-975-0123 Phone:
Phone: 949-975-0123 State Lic:CO22162
Applicant: GONZALEZ JOSE Con State Lic:
O/B
Engineer: HAKIM FADY
Address: 411 EL MODENA AVE Lic Expire:
Address: 124 PEONY
NEWPORT BEACH, CA 92663 Bus Lic:
IRVINE CA 92618
Phone: 949-975-0123 Lic Exp Date:
Phone: 310-422-1536 State Lic:C-075736
Code Edit : 2019 Worker's Compensation Insurance
Designer:
Type of Construction: Carrier:
Address:
Occupancy Group: U Policy No:
Added /New sq.ft. Bldg: 0 Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 0 Building Setbacks
Rear: 5'
Special Conditions: P/L AGREEMENT
No of Units : 1
Front: 20'
ATTACHED TO PERMIT
SS.Jg
Bldg Height: 0
Bldg Sprinklers:
Left: 4'
Right: 4'
goo, t
c `
Flood Zone: Use Zone: Parking
Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $10,000.00
Building Permit Fee: $246.00 Excise Tax:
$0.00
Planning Department - Fire Department
Plan Check Fee: $214.02 Additional Fee :
$0.00
Plan check Fee: $52.00 Fire Inspection: $0.00
Overtime Plan Ck: $0.00 Grading Bonds Fee:
$0.00
Fair Share : $0.00 Fire Plan Rev $0.00
Pee
Investigation Fee: $0.00 Grading PC Consultant :
$0.00
SJH Trans : $0.00 Demolition
Adm $0.00
Record Management : $0.00 Grading Permit Fee:
$0.00
In -lieu Housing Fee : $0.00 Building Dept
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
$0.00
Disabled Access : $0.00
PAN Plan Check : $0.00 Grading Bond:
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 : $513.02
Plan Check Fee :
$0.00 Fee Due at Permit Issuance : $513.02
P'JBLW W.ORK.4 ADPRCYAL:
PROCESSED BY: o2
PLAN CHECK BY:
ZONING APPROVAL:
GRADING APPROVAL:
APPROVAL TO ISSVE:,
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
1e 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 enrj
'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 (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness 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
nprovements 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).
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
Pp
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).
Is
exempt from Iicensure under the Contractors' State Licens aw for the following reason:
my ignature below I acknowledge that, except for my pe al resi an ch I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal
e structure that I have built as an owner -builder if it not be nstructe 'ni entirety y licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Bu mass and
'rofessions Code, is available upon request when this pplicati iu a Poll ng Web site:http://v w .leginfo.ca.gov/calaw.html.
iignature of Property Owner or Authorized AgentOL Dares
.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 Code, and my license is in full force
nd effect. License Class License No Date Contractor Signature
COMPENSATION DECLARATION
EARNING: 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
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:
D 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 thl
erformance of the work for which 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 and policy number are:
Policy Number
of Agent
Date
ertify that, in the performance of the r which this is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
if I should become subject tot - o ion provisi s of Section 3700 of the Labor Code, I shall forthwith comply with those provisions,
nature of Applicant—,%Dat�/
CLARATION REGARDING Old-NISTRUCTITN LEND G AGENCY
areby affirm under penalty of perjury that there is a construction lending agency forthe performance of the work for which this permit is issued (Section 3097, Civil Code).
Ider's Name Lender's Address
By 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.
I have read this application and the information I have I ed is
I agree to comply with all applicable city and cou ordina d s aw relating building construction.
authorize representatives of this city or county o enter ov propert r inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized A
ACTION I DATE I BY DECLARA ON PLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED
'L{ I SURMITTED ASBESTOS NOTIFfCATIO,J TO
PERMITCANCELLED
07PI, ' ' '
PERMIT EXTENDED
LJAQMD
PERMITFINAL
CERTIFICATE OF
OCCUPANCYISSUED
/
1
ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMCUMON -
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