HomeMy WebLinkAboutS2021-0185 - Permitsgwt'nk City of Newport Beach - Building Division JJJ11�III 11111111111111111111111111111111p111111111 Jill
100 4 Permit Counter Phone (949)644-ic Center Drive, Newport 288 Beach, CA 92660
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Job Address: 1422 HIGH BLUFF DR Floor: Suite:
Bldg: 1
Description of Work:SFR SPA DEMO 100 SF CITY STANDARD
* STOP WORK 121-2390—
Inspector Area: 4
Legal Description: N TR 15243 LOT 61
Owner: KHIEM NGUYEN
Contractor:
OWNER/BLDR
Address: 1422 HIGH BLUFF DR
Address:
NGUYEN KHIEM
NEWPORT BEACH, CA 92660
O/B AUTH ATT
Phone: 949-800-9837
Phone:
949-800-9837
Applicant: KHIEM NGUYEN
Con State Lie:
O/B
Address: 1422 HIGH BLUFF DR
Lie Expire:
NEWPORT BEACH, CA 92660
Bus Lie:
Phone: 949-800-9837
Lie Exp Date:
Building Rear:
Setbacks: Front:
Left:
Right:
Construction Tvoe :
Construction Valuation: $4,000.00
Building Permit Fee :
$147.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$147.00
Building Green Fee:
$1.00
Plan Dept Plan Check:
$52.00
Building Dep Plan Check:
$127.89
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE:
PROCESSED BY:
ZONING APPROb
Worker's Compensation Insurance
Carrier:
Policy No:
Expiration:
POOLPermit: S2021-0185
Project No:1867-2021
Inspection Requests Phone (949)644-3255
Plan Check No: 1867-2021
Code Edit: 2019
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Special Conditions:
Issued Date: 08/16/2021
FEES
M
State Lie:
1..�
State Lie: CfL
�
�d
6
Record Management:
$2.00
Water Quality- --
Building Dept Inspection Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Drainage Plan Check:
$0.00
Building Dept WQ Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Additional Fee :
$0.00
$0.00
Plan Check Fee : $0.00
PLAN CHECKED BY::
APPROVAL TO ISSUE
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at Permit Issuance :
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 checkmark(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
th,t 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
ovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner-Builderwill have the burden of proving that it was not built or
mp, v for the purpose of sale).
s 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
ly 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).
❑ 1 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 st have resided for at least one year priorto 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 construct s 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 Is application . subaitte or at the following Web site:http://w .leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent r Date/ 0if 1 j 6 (y% 21
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed uncle Isions of Chapter 9 (commencing with Section 70f Division 3 of the Business and Profe*ions Code, and my license is in full force
0 o
and effect. License Class License No Date b � 7Contractor Signature
WORKERS' COMPENSATION DECLARATION
(WARNING: FAILURE TO FECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$100,0001, IN ADDITION TO THE
II COST 0' COMPE'ISt TION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
II hereby affirm under penalty of perjury one of the following declarations:
I�'ili I nave 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 thl
carfo,mance of ih_7 crk for which this permit is issued. Policy No.
have and VI! 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'
.-ante carrier and policy number are:
Policy Number
Date
le of Agent Htlone 8
certify that, i.1 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
if' should tscom3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
ignature of Applicant Date_
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
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
ender's Name Lender's Address
y 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 providedis correct.
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 cou�Jty to enter a ov tiled property for inspection purposes.
ionature of Prooertv Owner or Authorized AaerJY Print Property Owner's or Authorized Agent's NameJ_"_LFA
ACTION
DATE
BY
DECLAIffikfE11TOF COMPLIANCE WITH CODE OF FEDEI
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE
1403
PERMIT EXPIRED
U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
EIEPA
PERMIT EXTENDED
OMD
POOLALARMS
ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
INSTALLED
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
Civil Code).
Date
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