HomeMy WebLinkAboutXR2022-1883 - Permits04"'.
City of Newport Beach ���COMB Perm:t : XR2022-1883
Community Development Department - Building Division X R 2 0 2 2 1 8 8 3100 Civic Center Drive, Newport Beach, CA 92660 Fian (;h?Ck No,: PC2022-1743
Permit Counter Phone: (949) 718-1888 issueu Date C1211212023
newportbeachca.gowcivic Final Date:
Combination Type - MFP ELEC MECH PLUM Permit Status: Reissued
Work Class - Alteration ins?ection Area : 6
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BU i 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 : 14 DAUPHINE Legal Desc : TRACT 14588, LOT 9 OF PROJECT 936-46 LOCATED ON AP 461-201-6 1 TOGETHER WITH AN
UND. 1/24 INT. IN LOTS 8 & 9.
Description: MFR BATHROOM AND KITCHEN REMODEL 231 SF
Owner: CLARK CHUKA
Address : 14 DAUPHINE
NEWPORT COAST, CA 92657
Phone: (949)795-8095
Applicant: CLARK CHUKA
Address : 14 DAUPHINE
NEWPORT COAST, CA 92657
Phone: (949)795-8095
Owner/Builder: CLARK CHUKA
Address : 14 DAUPHINE
NEWPORT COAST, CA 92657
Phone: (949)795-8095
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: CHU TIEN MANH
Address : 9542 PACIFIC AVE
ANAHEIM, CA 92804
Phone: (714)829-5053
Designer
Address
Phone:
Code Edition : 2019
Fire Sprinklers :
NO
Construction Valuation :
$125,000.00
0
Type of Construction : V-B
Fire Hazard Zone
: NO
Added/New/T1 sq. ft. Bldg :
Occupancy Groups : R-2
No of Units :
6
Alteration sq. ft. Bldg :
Added/New sq. ft. Garage :
0
Bldg Height :
No of Stories :
2
TOTAL sq. ft.
0
Building Setbacks
Flood Zone : X
Use Zone : PC - Newport Ridge
PROCESSED BY:
SPECIAL CONDITIONS:
OWNER -BUILDER DECLARATION
€ hereby afflmn under penalty of perjury that I am exempt `rom !Le !'okrac'ors' Skate Lroense Law for the reasen(s) indicated below by the checkmark(s) I have placed next to the applicable Items)
(Section 7031.5. Buslncss and Professions Code: Any cfb, o, courvy Ihatrebuires a perrei, to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
the permit to file a signed statoment that he or she is licensed pw suant to theprovisions cf :ho 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 Iicensure 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 (5500),
0 I, as owner of the property, or my employees with wages as fleir sale Tom^ensation,'vill no C) all of or i_) portions of the work, and the structure is not Intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State Lirensn Law does not apply to an ow, er of property who, through employees' or personal effort, builds or improves the property, provided that the
improvements are not Intended or offered for sale. Ir, however, ti,e buildinq or;mprovement 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).
El 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 improvesthereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
am exempt from licensure under the Contractors' State License Law for the following reason
By y signature beiova acknowledge that, except for my parse I residence in which must have resided for at least ono ,+ear prior tG completion of the improvements covered by this permit, i cannot legali;
loll a structure that I have built as an owner -builder if it has n (bee Gonstructod in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Businoss and
Professors Coda, is available upon request when this applicati,- Ittei or at the following Web site:httpliwnsv.leginfo.ca.gotdcalaw.html.
Signature of Property Owner or Authorized Agent _ .Date CD )Z:�,-,�
LICENSED CONTRACTOR'S DECLARATION
I hereby 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, andmy license is In full force
and effect. License Class License No Date Contractor Signature
NORKERS' COMPENSATION DECLARATION
KARNING: 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 (6100,000)., IN ADDITION TO THE
]DST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1N SECTION 370E OF THE LABOR CODE, INTEREST, 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
)erformanco of the work for which this permit is issued. Policy No.
UI 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' compLir io
insurance carrier and policy number. are:
Carrier Policy Number Expiration Date
Name of Agent Phone N
131 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 ogre
that, if I should become subject e v ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions,
Signature of Applicant._ _ _ __ _ _ _ _.
DECLARATION REGARDING CO RUCTION LENDING AGk.NCY Data
hereby 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).
Lenders Name Lenders Address
3y 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 andthe information I have provided is correct. eC yaSK C liter (�/�
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county t -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent Print Pro p e y Owner's or Authorized A ent's Name Data
ACTION DATE BY DECLARATION OF COMPLIANCE W17H CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITL£ 40 AND AQNID RULE
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