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Home My WebLink AboutXR2024-0179 - Permits04aEWaoRr City of Newport Beach d Community Development Department - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone: (949) 718-1888 newportbeachca.gov/civic C9</Fp0.N�P Combination Type - MFP ELEC MECH PLUM Work Class -Alteration I��III��III 1111111111111111111111111111111111111�1111 jj COMB Permit : XR2024-0179 Plan Check No: PC2024-0147 ♦, r �"' ^ —• - Issued Date : 01/26/2024 Final Date: Permit Status: Issued Inspection Area : 4 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 : 59 SEA PINE LN Legal Desc : N TR 8445 BILK LOT 1 UN 1 TR 8445 LOT 1 UNIT 1 G1, Description: MFR REMODEL AND WATER DAMAGE REPAIR 103 SF Owner: DOUGLAS BROWNELL Address : 12 VIENNA NEWPORT BEACH, CA 92660 Phone : (949) 293-0544 Applicant: DOSS TIMOTHY Address : 5154 SIERRA ROAD SAN BERNARDINO, CA 92407 Phone: (714)728-7284 Owner/Builder; DOUGLAS BROWNELL Address : 12 VIENNA NEWPORT BEACH, CA 92660 Phone: (949)293-0544 Contractor: OWNER/BUILDER Address : Phone: Con State Lic : OWNERIBUILDER Lic Expire Bus Lic : Bus Lic Expire Workers' Compensation Insurance Carrier : Policy No W. C. Expire: Architect : DOSS TIMOTHY Address : 5154 SIERRA ROAD SAN BERNARDINO, CA 92407 Phone : (714) 728-7284 State Lic Engineer: Address Phone: Designer: Address Phone: Code Edition : 2022 Fire Sprinklers : NO Construction Valuation : $10,880.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/TI sq. ft. Bldg : 0 Occupancy Groups : R-2 No of Units : 1 Alteration sq. ft. Bldg : 103 , Bldg Height: No of Stories : 2 Added/New sq. ft. Garage : 0 TOTAL sq. ft. : 0 Building Setbacks Flood Zone : X Use Zone : PC - Big Canyon PROCESSED BY: SPECIAL CONDITIONS: DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) 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 ee 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 rofessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.E by any applicant for a permit subjects the applicant to a civil penalty of of more than five hundred dollars ($500). 1 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 proffered for sale (Section 7044, usiness and Professions Code, The Contractors' Stale 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 intendedor offered for sale. If, however, the building or improvement is sold withinone year of completion. the Owner -Builder will have the burden of proving that it was not built or n 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' State License Law does not ply to an owner of property wino builds or improves thereon. and who contracts for the projects with a licensed Contractor pursuant to the Contractors' Stale License Law). I am exempt from licensure under the Contractors' Slate License Law for the following reason. q my signature below I 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 legall, ell a structure that I have built as an owner -builder iIf it has been. constructed in Its anti ly by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and 'rofesslons Code, Is available upon request when this a lion is Itted or f lowing web site:http:/Mv y.leginfo.ca.gov/calaw.'htmi. analure of Property Owner or Authorized Agent .__. .._._._.., Date JCENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that € 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 VORKERS' COMPENSATION DECLARATION 'ARNING: FAILURE 10 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 OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I 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 Ih erformanco 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' compensatioi Isurance carrier and policy number are: Number _ _ _ _ _ Expiration Date na of Agent certify that, in the performe of the work for Which this permi s issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,. and agre 1, if should become subje F the worke 4DALGE6N 'pr isions of Section 3700 of the Labor Code. I shall forthwith comply with those provisions. nature of Applicant_ _ Dale___, ��— CLARATION REGARD. CO STR N CY Ireby affirm under penalty of pejury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Ider's Name Lender's Address my signature below, I certify to each of the following: I am the property ow,ier 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 error s aita all applicable city and county ry6i- e above- and seal tin o binding construction. I au]horize representatives of this city or county toe r e above- idled e for inspection purposes. --pp I natu, a of Property Owner or Authorized Acent � Print Property Ovmer's or Authorized AGent's Name 7ioUG .0 4YD !A)12t� / Dato ION I DATE BY DECLARATION OF COMPLIANCE WITH CODE. OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE F'T! PT I IISUFIMITTEDA� FS;;i.,1;T ::. WCELLED EPA F,RM1T E _.._-..I._—__ .._ __ .. .._-._.... TENDELI QgQM p Fdttivt, I FWAL 7��7. ASBESTDS NOl 1 CEi�i 71 l�AiEOF 31✓ PROPOSED DE.MOL OCCUPANCY ISSUED SIGNATURE: