HomeMy WebLinkAboutX2022-1318 - Permitsr.ar4r City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2022-1318
100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 2 2 1 3 1 8 Project No
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - MFP Issued Date :
Inspection Arearea :2022
4
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 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: 2621 VISTA ORNADA NB
Description: MFR REMOVE PATIO COVER
Legal Desc.: N TR 7082 LOT 23 "
Owner:
SEYMOUR TULLY H
Contractor:
Address:
2621 VISTA ORNADA
Address:
NEWPORT BEACH, CA 92660
Phone:
Phone:
Applicant:
SEYMOUR TULLY H
Con State Lic:
Address:
2621 VISTA ORNADA
Lic Expire:
NEWPORT BEACH, CA 92660
Bus Lic:
Phone:
949-644-5502
Lic Exp Date:
Code Edit : 2019
Type of Construction: V-B
Occupancy Group: R2/U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 2
No of Units : 4
Bldg Height: 0
Bldg Sprinklers:
Flood Zone:
Construction Valuation
Building Permit Fee: $110.00
Plan Check Fee: $0.00
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management :
$0.00
Energy Compliance:
$0.00
CA Seismic Safety :
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $111.00
PROCESSED BY:
ZONING APPROVAL:
OWNER/BLDR Architect:
.., .
Address:
wg4 Y..
1 N � L__C 1 3.i
Phone:
State Lic:•- -
O/B Engineer:
Address:
Phone:
State Lic:
Worker's Compensation Insurance
Carrier:
Policy No:
Expire:
Building Setbacks
Use
Excise Tax:
Additional Fee
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical W
Plumbing %:
Rear: /
Front: /
Left: /
Right: /
kin S a
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Designer:
Address:
Phone:
Special Conditions: OWNER/BLDR ATTACHED
0
Planning Department -
Plan check Fee:
Fair Share
SJH Trans:
In -lieu Housing Fee
Public Works Department -
Park Dedication :
$0.00
PAN Plan Check:
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee: $0.00 Fee Due at Permit Issuance : $111.00
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL: APPROVAL TO ISSUE:
OWNER -BUILDER DECLARA
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
the 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
Professions 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
not 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,
Business 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
Improvements 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
improved for the purpose of sale).
Ias 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
p to an owner dr pronedy 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 licensure under the Contractors' State License Law for the following reason:
B,, rry sihnature'oe,ow` I acknowledge that, except for my personal residence in which 1 must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legall)
sell a structure t15at I ;lave built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7 44 of the B tees and
P:of:;ssicns Code, is available upon request wh Is appIi,GaSen-f9-sVbFi r atth lowing Web site:http://www. leginfo. ca.gov/calaw. html.
Signature of Property nwner or Authorized Age t Date l
LICENSED CONTR4i.TOR'S DECLARA ON
I lereuy affirm under penalty of perjury that I 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
a,Id affect. Lice.ise lass License No Date Contractor Signature
COMPENSATION DECLARATION
WAkNING:rAILURE TO 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
CnST OF COMPENSM Ki OnMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I her=nv affirm upper penalty of perjury one of the following declarations:
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 th
iperformance of the work 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'
urance carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the performance of the 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 California, and agre
t, if I should become subject to the worlserss:commp�p/iensaationTvisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Jt�!y��/' -I o�
(nature of Applicant- ! `�"""" dT A "^ Ds �l �L��z
CLARATION REG DING CONSTRUCTION VNDINGAGEVY
=reby affirm under penalty of perjury 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 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 laws relating to building construction. C
I authorize representatives of this city or countXrktnter 1per�9v9-#entifiei gropqa for inspection purposes. �� / —f , � "
Signature of Property Owner or Authorized Agent -J t PropertyOwner's or Authorized Agent's Name l d Daffi J
ACTION DATE BY DECLARATION OF OMPLIANCE WI CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
140B
PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED EPA
PERMIT EXTENDED .AQMD
PERMITFINAL VAkBESTOSNOTIFICATION IS NOTAPPLICABLE TO
CERTFICATE OFOCCUI PANCYISSUED �// �� 5 GNAOTURE: I�q�LTl01�� a p, `
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