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Home My WebLink AboutXR2022-2176 - Permits��EWPORT City of Newport Beach C 6 Community Development Department- Building Division 100 Civic Center Drive, Newport Beach, CA 92660 rt Permit Counter Phone: (049) 644-3288 O Inspection Requests Phone: (949) 644-3255 °q<.rFoae`P newportbeachca.gov/inspections Combination Type - SFP Work Class - Addition/Alteration III I I I I I II I II II I IIII II COMB Permit Plan heck No I Inspection Area : 3 : XR2022-2176 PC2022-2014 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 : 1945 SANTIAGO DR Description: SFR ADD 191 SF REMODEL 2894 SF Owner: KLOENNE FAMILY TRUST Address : 1100 VIA VERDE SAN DIMAS, CA 91773 Phone Applicant: GABRIELLA GOMEZ Address : 1100 VIA VERDE SAN DIMAS, CA 91773 Phone : (909) 592-8500 Owner/Builder: KLOENNE FAMILY TRUST Address : 1100 VIA VERDE SAN DIMAS, CA 91773 Phone: Legal Desc : N TR 4710 BLK LOT 5 Contractor Address : Phone: Con State Lic: Lic Expire: Bus Lic: Bus Lic Expire Workers' Compensation Insurance Carrier: Policy No: W. C. Expire: Architect Address Phone: State Lic Engineer: SHANT PIERRE SHAHBAZ Address : 15445 VENTURA BLVD, 63 SHERMAN OAKS, CA 91403 Phone : (818) 747-7269 Designer: Address Phone : Code Edition : 2019 Fire Sprinklers : NO Construction Valuation : $180,000.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/TI sq. ft. Bldg : 191 Occupancy Groups : R-3 No of Units : 1 Alteration sq. ft. Bldg : Bldg Height: No of Stories : 1 Added/New sq. ft. Garage: 0 Building Setbacks : Front: 20, Side: 6, Side: 6, Rear: 6® Flood Zone : X PEa Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates minimum lot area) ' 1�`S PROCESSED BY: 4,x% SPECIAL CONDITIONS: ATHENS SERVICES TO HALL DEBRIS OWNER -BUILDER DECLARATION t 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 items) clion 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 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 fessions 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 /hare than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_, all of or (_) portions of the work; and the structure is not intended or offered for sale (Section 7044, ;tress and Professions Code: The Contrarlors' State License Law doe, not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the Movements 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 bullt or ,roved 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' Stale License Law does not kly to an owner of property who builds or Improvesthereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' Slate License Law), J am exempt from licensure under the Contractors' State License Law for the following reason: _ 3y rljy signature below f 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 lagalh �M�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 tho. applicable law, Section 7044 oft. a Business and 'rofessions Code, Is available upon request when this a lice ion I bmitt or at following Web siteihttp:liwww.leginfo.ca.gov/calaw.html. q Signature of Property Owner or Authorized Agent Dot 1 LICENSED CONTRACTOR'S DECLARATIt�� hereby affirm under penalty of perury that I am licensed under provisions of hapter commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is In full force and effect. License Class License No Date Contractor Signature NORKERS' COMPENSATION DECLARATION YARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAR.D DOLLARS ($100,000), IN ADDITION TO THE ]DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: -1 I have and will maintain a cerliffcate 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 )erforma.nce of the work for which this permit is issued. Policy No. -1I 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' compensatiol nsurance carder and policy number are: �arrler Policy Number Expiration Date 5N a of Agent Phone # ertify that, in the performance of the work for which thispermit is issued; I shall not employ any person in any manner so as to become subject to Ina workers' compensation laws of California, and ogre If I should become sub rt to the workers' compereatif provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /� Signature of Applica - _ _ Data._/._. '"I �Z �zez )ECLARATIGN R RDILi' STRU G LENDt AGENCY TT''�G hereby affirm under penalty of perjury that there is a cons etion lending agency for the performance of the work for which this permit Is issued (Section 3097, Civil Code). .andar s Name Lender's Address 3y 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 provided is correct. I agree to comply with all applicable city and county ordinances and state taws relating to building construction. I authorize representatives of this city or county to Iter th a ove-id ntifie rcperty for inspection purposes. Signature of Proper, Owner or Authorized Agel Pont Property Owner's or Authorized Agent's Name \yt (}Vt'1 eZDate tY 1 L.''LC9� ACTION DATE 9Y N, %IIICLARATIONOF tQMPLICN317 WITH CODE OF FEDERAL FOR OFFICE USE ONLY 1 REGULATIONS PART 51 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED —-IrSUBMITTED -ASBESTOS NOTIFICATION TO L,-,! _—_ PERMIT CANCELLED_ EPA PER+bfIT Ea TENDED QM p ' PERMIT FINAL lO�/ q� I `BES705 NOT IF HON 15 NOT APPLICABLE TO CERTIFICATE OF b L PROPOSED OEM C OCCUPANCY ISSUED SIGNATURE- O IT