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HomeMy WebLinkAboutXR2023-0514 - Permits�E.vaoRT City of Newport Beach IIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: XR2U23-0514 of @ Community Development Department- Building Division X R 2 0 2 3 0 5 1 4 y ty 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2022-2014 Permit Counter Phone: (949) 644-3288 Issued Date : 03/01/2023 U S Inspection Requests Phone: (949) 644-3255 Inspection Area : 3 CgCiFnµN�P newportbeachca.gov/inspections Combination Type - SFP ELEC PLUM Work Class - Alteration 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 Legal Desc : N TR 4710 BILK LOT Description: DELTA 1 REVISION & ADD'L SCOPE-R/R WINDOWS/DOORS. INSTL TANKLESS H2O HEATER Owner: KLOENNE FAMILY TRUST Address : 1100 VIA VERDE SAN DIMAS, CA 91773 Phone Applicant: GABRIELLAGOMEZ 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: 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 : $8,000.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/Ti sq. ft. Bldg : 0 Occupancy Groups : U,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: 20, Side: 6, Side: 6, Rear: 6 Flood Zone : X Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates minimum lot area) PROCESSED BY: SPECIAL CONDITIONS: REV2023-0354 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 itemts) ctlon 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 Seclion.7000) cf 7ivi'.sion 3 of the Business and fessions Code) or that he or she is exempt from ilcensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civii penally of more than five hundred dollars 1$500), 1, as ownerof the property, or my employees with wages as their sole compensation, will do (_) BE of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, iness 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 rovements 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 roved for the purpose of sale). 1, 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 � 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). i m exempt tram licensure under the Contractors' State iy m signature below I acknowledge that, except for my pe structure that I have built as an owner -builder if it has 'rofesslons Code, is available upon request when this a II ,gnature of Property Owner or Authorized Agent .ICENSED CONTRACTOR'S DECLA..RATIO hereby affirm under penalty of penury that I am licensed un nd effect. License Class Lice se Law for the following reason: rson" residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot lege n en constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Saction 7044 of the Busi less and is subm ltetl or at -e following Web site;http:/lwww.leginfo.ca.govlcalavihtmi. © Code,`- d r provisions of Chapter 9 tcommencing with Section 7000) of Division 3of the Business and Professions e3ndm license i In full force License No Date Contractor Signature NORKERS' COMPENSATION DECLARATION YARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND $WALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS t6100,000j, IN ADDITION TO THE .DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTFREST. AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 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, for th )erformance of the work for which this permit is issued. Policy No. -11 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 nsurance carrier and policy number ar 3arrler Policy Number Expiration Date it a of Agent A Phone # e ify that, in the panto t e work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C lifomia, and agree hat, if should become su je t rkers' compensation provision of Section 3700 of the Labor Code, I shall fohhwilh comply with those provisions. Z ure of Applies' Date 0 / DECLARATION RE Di N TRU N LENDI Ei hereby affirm under penalty of per} ry that there construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil ode). -Bader'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 proper inEris behalf. I have read this application and the information I have Ided is correct. I agree to comply with all applicable city and count i ces and state laws relating to building construction. i authorize representatives of this city or county to n above -Identified property for inspection purposes. Signature of Property y Owner or Authorized Agent Print Property Owner's Or Authorized Agent's Nam �U to ACTION DATE BY i DE ATION.OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY C C j REGULATIONS PART 61 OF TITLE 40 AND AONID RULE 1403 PERMIT EXPfREO 3 1 SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED ( EPA -- PERINIT EXTENDED QMD .._. .........._. __ ___ _ -fir-'' _ PERNIITFINALu t_t (� ASSESTOSNOTIFICAlIONISN01'APPLICABLE ToV�— CERTIFlCATEOF \O.6 , PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: ff 3 A {p A m so n d g _ m c nnN yo.�C.: aim— m0_ On C �o 0-90 �Tpp tin�im mm ma y� gF a 7 AN o .m. +' m 0c, m w 3 d m -Q_'' .m o acm on) no � M m o and a co? mmmm �Jm a'i �, ID m A 7'D C m ID w h Qo A�m� m 5,d. 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