HomeMy WebLinkAboutM2019-0035 - Permitst+`LCjkT City of Newport Beach - Building Division Illlllllllll ll�llilllllll 111 II
400 Civic Center Drive, Newport Beach, CA 92660 M 2 0 1 9 0 0 3 5
I- Permit Counter Phone (949)644-3288
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HARBOR Permit: M2019-0035
Project No : 1056-2019
Inspection Requests Phone (949)644-3255
Job Address: 515 36TH ST Floor: Suite: Bldg: 0
Description of Work: RE -IN FORCE (E) SEAWALL -UTILIZING DYWIDAG TIE -BACKS TO NEW CONCRETE DEADMEN
Inspector Area: 1
Legal Description: CANAL SECTION LOT 8 BILK 536(AND NELY1/2 LO.T�17 BILK 6
Owner: GUO JACK � � ` E-RIB B ^ngineer!f aWFt01/ NMEN
Address: 50 W LEMON AV #23 Address G O JACK Address: ?@ 1 CA$!�A
MONROVIA CA 91016 El 8a 1X t�L 0Xc9j0pnd
Phone: 909-319-6868 h�, e: 9ii9-319 �8�b�p �`�1�1one: 714-717-7542
State Lic: 694 is_ `. y
i6Pto Whom:
Applicant: HUDGINS SCOTT Con State Lic:O/B esigner:
Address: 1107 S COAST HWY xpire� £" ass:
LAGUNA BEACH CA 92651 Bu is +'t a r; (• -
L x,
Phone: 949-322-7922 �;— Licr . p P ' "$5 c$ hont
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Special Cond: N® Longshoremen's and Harbor Workers' Compensation De ration -
EWEEKE Carrier: �1 qsg
Issued Date 12/05/2019 k I 3 "ttAAioP iiii (� i 0�
_s i .-
Valuation: $10,000.00 Fire Inspec4,,Wp�j? started) FEES $0.00 (no wol k started) $0.00
Inspection Fee: $297.00 Fire Plan Check Fee: $0.00 Plan Dep -Counter Review: $0.00
Plan Check Fee $312.00 pprds Mangement: $4.00 Plan Dep - Zoning Plan Check: $0.00
OT Plan Check Fee: $0.00 N r0 an ep - ver Ime an eck : _ .00
Investigation Fee: $0.00 ii S3. ia�itials:
Building Green Fee : $1.00
-
TOTAL FEE : $677.00 Plan Check Fee : $302.00 Fee Due at permit Issuance: $375.00
PROCESSED BY: JA PUBLIC WORKS:
PLAN CHECK BY: M� +1 APPROVAL TO ISSUE: _ T
OTHER DEPARTMENTS: CG
FINAL INSPECTION: _
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION_
ER -BUILDER
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;
:tion 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 fo
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 anc
'essions 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
more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U 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 thi
•ovements 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 o
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
y 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).
am exempt from licensu rlde�tMe--�isultraetersl:r "
signature below I ackno ledge that, except for my s n r e'n hich must have resided for at least one year prior tocomp a ion o e Im
structure that I have buil as a��pw er-builder if 1 s n b co cted in its entirety by licensed contractors. I understand that a copy of the
sions Code, is availablet.upontrdI w "s c n " ad or at the following Web site: http:4fTp.Epbydcalaw, html.
ure of Property Owner or Authorized Agent,--
V � v
.ICENSED CONTRACTOR'S DE'' N '!^ = ❑ 80% or ❑ 100% refund
hereby affirm under penalty of perjury I a.- licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof(
nd effect. License Class �jliiense No Date Contractor Signature
.ONGSHOREMEN'S & HARB V119RKERS' COMPENSATION DECLARATION :_a to W orn-
IARNING: FAILURE TO SECURE LONGSHOREMEN'S a HARBOR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm ur
eclarations: - -
I have and will malt
My workers'
I certify that, in the p,
that, if I should become
Iture of Applicant:
and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
insurance carrier and policy number are:
covered by this permit, I cannot legall
law, Section 7044 of the Business an
oat' QO_ C,
as Code, and my license is in full fort
S UP TO ONE HUNDRED THOUSAND DOLLARS
penalty of perjury one of the following
of the work for which this permit is
Expiration
Tone #
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 California,
rjpg�nSaUon pf ull o action 3700 o or 4 shall forthwith com y with t se provisions.
'"' eeca
,.�
)ECLARATION REGARDING COP0TRaCTI (9WTPP'[AM)NCY (no work started) '
I hereby affirm underpenaltyof perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name-, s _,'- . Lender'sAddress
By my signature below, I certify to bacfirof-the-ficit ina
I am the property owner or authorized to act an the property owners behalf.
I have read this application and theinformaMon-have-proNidad is correct Ins- sa"Y.. initials:
1 agree to comply with all appli bl ity and county ordinanCaSAO,¢„at4e.Jaws-LPlar'p ...}c b Tlirjg_r;_p ruction. I
I authorize representatives for county to enter -above-identified property for inspection purposes. n
signature: i� / Print Name: \ �i� u U Dater
7�/
ACTil
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
---
----
FEDERAL REGULATIONS PART 61 OF TITLE 40AND
AQMD RULE 1403.
-
PERMIT EXPIRED
_ _
See
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMTCANCELLED
PERMIT EXTENDED
L
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYISSUED
SIGNATURE:
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