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Home My WebLink AboutX2015-3416 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2015-3416 o� A 100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 1 5 3 4 1 5 P Project No : 2558-2015 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-32`15 Combination Type - BLDG Issued Date : 11/1812016 Inspection Area : 4 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. _13 r^k�� Job Address: 12 OLD COURSE DR NB Description: SFR BLOCK WALL 6'-8'MAX HT X 14 LF (INSIDE P/L) cx - Legal Desc.: N TR 15388 LOT 43 Owner: SHARMONCK TRUST Contractor: URBAN LANDSCAPE MAINTENANCE Architect: Address: 12 OLD COURSE DR Address: 895 DOVE ST 3RD FLR Address: NEWPORT BEACH, CA 92660 NEWPORT BEACH CA 92660 Phone: Phone: 949-637-8767 Phone: State Lic: � J Applicant: MCCORKLE DERRICK Con State Lic: 962251 Engineer: COLLINS JEFFERY Address: 15990GRACEELDO LN Lic Expire: 06/30/2017 Address: 1201 N. TUSTIN AVE WHITTER CA 90603 Bus Lic: BT30042651 ANAHEIM CA 92807 Phone: 949-254-5631 Lic Exp Date: 05/31/2016 Phone: 714-630-6114 State Lic:C-080733 Code Edit: 2013 Worker's Compensation Insurance Designer: Type of Construction: Carrier: REPUBLIC UNDERWRITER Address: Occupancy Group: U Policy No: ATWO03386 Added /New sq.ft. Bldg: 0 Expire: 10109/2016 Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: / Special Conditions: No of Units: 0 Front: / Bldg Height: 0 Left: / Bldg Sprinklers: Right: I Building Permit Fee: $114.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $82.08 Additional Fee : $0.00 Plan check Fee : $32.00 Fire Inspection: $0.00 Overtime Plan Ck: $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: $4.00 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 PAN Plan Check: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green as : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $233.08 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $233.08 PROCESSED BY: " " yFXUBLICINOi2KG APPROVAL: ZONING APPROVAL: - -PLAN CHEC0C 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 cl)eckmark(s) I have placed next to the applicable item(s) (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 L) 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). ❑ 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 licensure under the Contractors' State License Law for the following reason: By 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 legally sell a structure that I have 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 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 0) of Division 3 of the Business and Professi Is and my licen of7 rce and effect. License Class License No Date �— t8—) J Contractor Signature WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ,0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under 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 fiance of the work for which this permit is issued. Policy No. have and "II intain 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' compensa rance carri nd olicv number are: Date of certify that, in the performance of the work forwhich this permit is issued, 1 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 rs' com ensation pr of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. t _ nature of Applicant wX/ D CLARATION REGARDING CON CTIO G AGENCY ;reby affirm under penalty of perjury that re 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. 1 authorize representatives of this city or count o e rthe a e-identifi nspe on purposes. 1 nature of Property Owner or Authorized Agent � Print Property Owner's or Authorized Agent's Named \�ff Ck 1)4ACII—� —� ACY"I DATF R DECLARATION OFCOVMPILINCEWITNCODE OF WN UhHEZ[Ak LVKT FEDERAL REGULATIONS PART 61 OF TITLE40 AND 4CUD RIILr 14T? PFRAMT F)rPIRFr) - Q- I SIK)'Lff rTFI J ASWS—!]S KITIrH'ATKIN TO: G LPA PCRIvf1T G4PICELLED _ ❑ I..LIIMD ❑ 5 TOS N07IRCA77OAfIS NOT APPLKABLE TO POSED DEIMOUTION. PERrdrT fXT€NL7€t� PERMIT TINAL 5 S J - 4 /C �`m ✓Jr l K CERZF CATEOF UfGNRl tl!f♦=• OCCUDANCY(SSUED