HomeMy WebLinkAboutX2020-2193 - Permits�8w na City of Newport Beach - Building Division
c� 100 Civic Center Drive, Newport Beach, CA 92660
tr+ Permit gaunter Phone (949)644-3288
Inspecti m Requests Phone (949)644-3255
n'�4rsiNY�� Combination Type - BLDG PLUM
COMB Permit: X2020-2193
III�IIIIIII�IIIIIIIIIIIIIIII�IIIIIIIIIIIII II
Project No : 2795-2019
Issued Date : 09/2912020
inspection Area: 5
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0913012023 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: 4515 ORRINGTON RD NB
Description: DEMO SFRIG4R 3353 SF.4 BEDROOMS. SEWER CAP INCLUDED
Legal Desc.: N TR 3357 LO r 76
Owner:
ZIEMBA FAMILY TRUST
Contractor:
S C HOMES INC
Architect:
TEALE MARK
Address:
520 FIINTDALE RD
Address:
3050 PULLMAN ST
Address:
2900 BRISTOL ST BLDG A203
HOUSTON, TX 77024
COSTA MESA CA 92626
COSTA MESA CA 92626
Phone:
Phone:
949-723-4243
Phone:
949-975-0123 State Uc:CO22162
Applicant:
S C HOMES INC
Con State Lic:
828216
Engineer:
HAKIM FADY
Address:
3050 PULLMAN ST
Lic Expire:
12131/2021
Address:
124 PEONY
COSTA MESA CA 92626
Bus Lic:
BT30002421
IRVINE CA 92618
Phone:
949-723-4243
Lic Exp Date:
02128/2021
Phone:
310-422-1536 State Lic:C-075736
Code Edit: 2019
Worker's Compensation Insurance
Type of Construction: V .B
Carrier:
STATE FUND
Occupancy Group: R3/U
Policy No:
1763760
Added /New sq.ft. Bldg: 0
Expire:
01/07/2021
Added /New sq. ft. Garage: 0
No of Stories: 1
Building Setbacks
Rear. I
No of Units: 1
Front: I
Bldg Height: 0
Left: I
Bldg Sprinklers:
Right: I
Flood Zone:
Use Zone:
Parkino Spaces:
Construction Valuation: $24.300.00
Building Permit Fee: $-' 20.00
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: $2,165.80
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Designer:
Address:
Phone:
Special Conditions: GREENLEAF TO
HAUL DEBRIS
Fires Hazard 7nneN INSP UI
Excise Tax:
$0.00
Planning Department -
Fire Department
Additional Fee :
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
Grading Bonds Fee:
$0.00
Fair Share :
$0.00
Fire Plan Rev
$0.00
Grading PC Consultant:
$0.00
SJH Trans :
$0.00
Demolition Fee
Grading Permit Fee:
$0.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
$26.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$316.00
WQ Insp. Fee:
$0.00
Park Dedication : $0.00
Refund Deposit
$1,692.00
PAN Plan Check: $0.00
Grading Bond:
$0.00
Electrical %:
$0.00
San Dist: $0.00
Mechanical%:
$0.00
NMUSD Fee: $0.00
$0.00
Plumbing %:
$10.80
$0.00
Plan Check Fee:
$0.00 Fee Due at Permit Issuance :
$2,165.80
PPBL IC WORKS APPROVAL:
PLAN CHECK BY:
P PPPOVAL TO ISSUE:
DocuSign Envelope ID: 146OCC23-6942-4B4A-8DOF-D8EB7AC6FB2E
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated belay by the checkmark(s) I have placed ne 3 to the applicable Items),
(Section 7031.5, Business and Professions Code: Any city or county that requlres a permit to construct, alter, Improve, demolish, or repairany structure, prior to Bs issuance also requires the applicant for
the permit to file a signed staterlam that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter g (commencing with Section 700D) f 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 he 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 offe ad 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 is 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 :roving that it was not built or
roveci for the purpose of sale).
LJ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 70", Business and Professions Code: The Contractor - State License Law does not
apply to an owner of property who builds or Improves thereon, and who contracts forthe projects with a licensed Contractor pursuant to the Contractors' State Ucense Law).
111 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 priorto completion of the improvements cove ed by this permit, I cannot legally
sell a structure that I have built as an owner -builder 0 It has not been constructed in its entirety by licensed contractors. € understand that a copy of the applicable law, Sectfc 17044 of the Business and
Professions Code, Is available upon request when this application is submitted or at the following Web she:hOpY/Www.leglnfo.ca.govicalaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed udder provisions of Chapter 9 (commencing with Section 7, §),PJ�np qt_"U0W16#d Prole ns Cod and my license is in full force
antl effect License Class License No Dat 'Contractor Ignatur
WORKERS' COMPENSATION DECLARATION
APNING: FAILURE TO SECURE WORKERT COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND O LLARS ($100,000), IN ADDITION TO THE
LI
F COMPENSATIO MAGES AS PROVI€IEDFOR IN SECTION 37C6 OF THE LABOR CODE INTEREST, ANDATTORNEY'SFEES.
y affirm ER&IA"4 of perjury one of the following declarations:
�{i4P'. Intain a certificate of consent to self -Insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Factor 3700 of the Labor Cotle, for th a work for which this permit is issued. Policy No.
ve and wilt maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is isued. M/ workers' compensatfo
insurance earner and policy number are:
CarriwSTATE COMPENSATION INSURANCE FUNS foy Number 1763760 expiration Date 01/07/2021
None of Agent Phone # 877405-4545
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' compem Alon laws of California, and agre
that, if I should become sub ct to the workers' compensation provisions of Section 2700 of the Labor Code, I shall forthwith comply With those provisions. ,,,,�28/0 2' 03 PM PDT
Signature of AppllcanG C RDa
GA DECLARATION RERbiNUCTION LENDING AGENCY
I 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 8097, CIWI Cade).
Lender's Name Lender's Addrass
By my signature below, I Canny to each of the foll➢wing:
I am the property owner or authorized to act on the property owner's behalf.
1 have read this application and the information 1 have provided is correct
I agree to comply with all applicable city, and County ordinances and state taws relating to building construction.
l authodze representafives of this city or Gun to e r the above-ideni fiad property for inspection purposes. }(,5Cott Cross S 118/20
11
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Na e D
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE
1403
PERMIT EXPIRED LJ I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED LIEPA
PERMIT EXTENDED LIAQmD
PERMIT FINAL 'L'L_21 aV.� A,(A5gE5TO5 Nil',-iFIEATICN�ES NOT AP�L1 AB?E TO�
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