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Home My WebLink AboutX2021-3050 - PermitsCity of Newport Beach - Building Division X2021-3,0,5p*"_ , COMB Permit: X2021-3050 ?� 100 Civic Center Drive, Newport Beach, CA 92660 E a a `m Project No : 2650-2021 . 4 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Issued Date : 12/01/2021 "aceva.tiN`s Combination Type - BLDG ELEC Inspection Area : 3 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1210112024 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: 20352 KLINE OR NB Description: SFR NEW 316 SF DECK Legal Desc.: Owner: GOLSON GARY Contractor: OWNER/BLDR Architect: AHN KENNETH Address: 1712 ORCHARD Address: AUTH AGENT: Address: 2040 LOMITA BLVD #104 ' NEWPORT BEACH CA 92660 JASON GOLSON GARDENA CA 90717 Phone: Phone: 714-391-1392 Phone: 310-341-3436 State Lic:C030675 - Applicant: GOLSON JASON Con State Lic: O/B Engineer: Address: 1712 ORCHARD Lic Expire: Address: _ NEWPORT BEACH CA 92660 Bus Lic: > Phone: 562-477-6894 Lic Exp Date: Phone: State Lic: 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: 25 Special Conditions: No of Units : 0 Front: 5 Bldg Height: 0 Left: 5 Bldg Sprinklers: Right: 20 Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $8,400.00 Building Permit Fee: $389.00 Excise Tax: $0.00 Planning Department- Fire Department Plan Check Fee: $267.00 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 Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $0.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 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 Disabled Access : $0.00 P/W Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $27.23 San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $736.23 Plan Check Fee : $319.00 Fee Due at Permit Issuance : $417.23 PROCESSED BY: ZONING APPROVAL: PUBLIC WORKS APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: 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 items '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 he 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 profess' s Code) or that he or xampt from Icansure 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 tot m0 fi hundr ars ("00). I, as property, or my employees with wages as their sole compensation, will do L) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, si rofessions 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 mpro ents 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 mproved 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 apply 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 am exempt from ::censure under the Contractors' State License Law for the following reason: 3y my signature oelow, I acknowledge that, except for my personal residence in wI20 I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot Iegall), ;ell a structure that I have built as an owner-build""applica n construct its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and 'rofess.ons Ccde, is ajailable upon request whenchis sub or at the following Web site:http://www.leginfo.ca.gov/calaw.html.5'gna'ore of Property Uwner or Authorized Agent Date_ICENSED CONTRACTOR'S DECLARATIherehy affirm anuer penalty of perjury that I am lovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force anu effect. Lice,I..L Class License No Date Contractor Signature unRKERS' ('1)MPliNSATION DECLARATION 'ARNING: 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 (5100,000), IN ADDITION TO THE OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under o^nalty of perjury one of the following declarations: I have and vA, 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 in erform.3nce of Vie wok for which this permit is issued. Policy No. I 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 Isurance carrier and policy number are: :arrier Policy Number Expiration Date lame of Agent Phone # I certify that, in the performance f the work for which this pe ' ' I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre iat, if I should become subject tD a workers' compe provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 1 Iignature of Applica� nt Dat �^ IECLARATION REG RD STRU ION LENDING AGENCY hereby affirm under penalty 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 ly 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 co�un/��" ordinan es and state laws relating to building construction. I authorize representatives of this city or countN enter th vejtlentified property for inspection purposes. -}.� S Owner's or Authorized Acent's Name 'i ACTION DATE BY I CGULOCOMPLIANCE CODE OF FEDERAL RAT ONS PART OF TITLE 0 AND RULE PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA PERMIT EXTENDED AQM D PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED -'L 'Z`� BESTOS NOTIFICATIOpN IS NOT PROPOSED MO TIt7 ' SIGNATURE: I FOR OFFICE USE ONLY