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Please print 3 copies
Worksheet for Building Combo Perri �EW�Re
City of Newport Beach - Building Departae& MUCH
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CITY OF NEWPORT BR"P
�Buiiding ; Grading rDrainage Elec Mec!) D `Pl�rr�
1. Project Address (Not
iling address)
Suite No
Dfz
y# Units (if Residential)
Tenant Name(if Applicable)�%
2. Description of Work
Use 0�ne H014-
.. ...... ........ ....... .. ... ..........
Extg Building SF F77 Demo Building SF
F777
.........................................................
Valuation $ 3� �a
Add/Reconstruct Bldg SF
......... - ...................._._....................i
Extg Gar sf Demo Garage sf
.................................................:
Add/Reconstruct Garage sf
# Stories
New 7 Ad Alter
Demo
TOTAL BLDG SF
Cu Yd Cut
F77
f�Af�F
N!�!/..................
TOTAL GARAGE SF
........ ..........
Cu Yd Fill
F77
Check ADDror,riate Box for ADDlicant
�1 /
F_ 3. Owner's Name Last
First
Owner's Address Owner's E-mail Address
..................................................................
.. ................................
City, � State- Zip Telephone
J ..... .
4. Architect/Designer's Name
Architect/Designer's Address
City
Last First
.........................................................................................................
Lic. No.
Architect/Designer's E-mail Address
...........
State Zip TelephoneF7777 ............
5. Engineer's Name LastFirst Lic. No.
c..... ........ .... ........................................................... .....:............. .............................................. ._
Engineer's Address
� .............................................. U: .._.... . ...........................
Engineer's E-mail Address
...................................................
City � State Zip Telephone
.........................�.��......
f....G....`....`.....................................................................-
6. Contractor's Name Last First Lica No. -'Class ....
Contractor's Address
City State Zip
....ii--=.....: ..
Contractor's E-mail Address
�`7� Telephone............ .........................
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO. t / t t /
GRADING P/C FEE $
FIRE P/C FEE $
PLAN CHECK NO
CITY PORT BEACH MARSOR APPLICATION
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are 7'g"5 5ec/1017 of NewPo,- -mor
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HARBOR RESOURCES f,. - -�♦r
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CITY OF' h "ORT BEACH FIRE MARINE Dr VENT.
HARBOPERMIT APPLICATION (Please print a(r nformation) A)i
117�4111_z_ i21Z . -
1: Applicant (Property Owner) Address Telephone
571111�1" e7 Zc��— 57 �
2. project Address (Street Address) Harbor Permit Number
3. New Construction Ilevision Maintenance k"e Dredging
4. Fee ��� ®� Check No. Date
5. Brief Description of Proposed Work: 57,;,A16- 6�1'�' �� 411�_�4�7�
6. Submit 8 1/2" x 11" Drawings (3), Include: �������./��/�� v -' %�✓�'
1). Location and dimension of proposed structure including piles and location of existing structures.
on adjacent properties.
2). Location of bulkhead, pierhead andprojectlines.
3). Location of property lines.
4). Location of channel markers within 200 feet.
5). Lot sizes and lot numbers, if available.
6). Existing ground profile beneath proposed structure.
7). Elevation of top and bottom of bulkheads and piles with respect to M.L.L.W.
8). Area and profile of any proposed dredging with elevations showing depths with respect of M.L.L.W.
9). Any special conditions affecting the construction or affecting boating operations.
.,10).Complete all information required in information block, bottom of sheet. Note that the OWNER.
of the property is the applicant.
11).Drawing size shall be 8 -1/2" x 11".
12).Scale shallbe adequate to clearly show the above information.
13).Existing structures shall be shown in light dashes. New work shall be shown in heavy solid lines.
7. Owner -Builder Declaration must be completed (on reverse side of this sheet)
1 � �
8. Applicant's/Agent's Signature: Date: Y'
Joint Permittee Signature (if appl ble): Date:
9. Work can begin once the City has received evidence of the following additional approvals and you have
been notified to proceed. If you begin prior to the notice you will be in violation of the Newport Beach
Municipal Code and subject to penalties.
10. Your permit will not be final until we have conducted an on site inspection once construction is
completed as per Municipal Code, Section 17.24, if we have not been contacted for a final inspection.
OFFICE USE ONLY
Approval in Concept.
Approval of the City of Newport Beach Council.
Approval of the Army Corps of Engineers
_ Approval of the California Coastal Commission.
__ Approval of the City's Public Works Department
Approval of the City's Building Department.
_ Approval of County of Orange.
Electrical and/or plumbing permit (Building Department)
'✓Issued. (Permit is stamped drawing)
V Site Inspection. (call 644-3043 for appointment)
Site Re -Inspection
Conditions:
Date
Date
Date
Date
Date
Date
Date
Date,
Date
Date f�
Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the contractor's license law for the following reasons:
(Sec. 7031d.5, Business and professions Code). Any City or County which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires
the applicant for such permit to file a signed statement that he is licensed pursuant to the
provision of the Contractors License Law (Chapter 9, commencing with Section 7000, of
Division 3 of the Business and Professions Code) or that he is exempt therefrom 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 for not more than five hundred dollars ($500).
/. I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who does such work himself or .through his own employees,
provided that such 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 he did not build or improve for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business_ and Professions Code: The Contractor's License Law
.does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects who builds or improves thereon, and who contracts for such projects with a
Contractor(s) License pursuant to the Contractor's License Law). .
I am exempt under Sec.
11 wner's Signature: J
Contractor:
,r Address:
License class: State Board No.
License Contractor's Declaration
of Business and Professional Code for this reason: . .
Date: OAC( C,
Telephone:
City License
I hereby affirm 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 and
effect.
Contractor's Signature Date:
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DEPARMNUNT OF THE P"""'
COUPS OF uGG
NOTICE OF AUTHORIZATION
17 September 19 75
A PERMIT TO instail a new slip float, ramp and cant levered
dock, at 524 Harbor Island Drive, Lot 37, Tract 3867
Ar Newport Bay, Pacific Ocean, City of Newport Beach,
cogni of Orange Ca I I f orn I a
il A i�Elsl iSSUE TO Mr. Jack Bransford ON 17 September19 75
ADDRESS OF PERMITTEE 12700 Knott Avenue, Suite B
Garden Grove, CA 92645
PERMIT NUMBER 75-129 JOHN V. FOLEY, COL, CE
District Engineer
EN^orm F 4336
'2 THIS NOTICE MUST BE CO'NSPICUOUSLY 01140"aVED Al Tl'�E SITE OF
Jul 70 * GPO: 1971 0-415-598
STATUS SHEET
HARBOR PERMITS
LOCATIONcr New
Revision
Dredging
/ uv
Date Rec'v Fee Amt. ! �� Fee Processed
Date Reviewed by M.S.D.
Approved Denied
Correction Req'd. - Desc.
City Council: Approved Denied
Remarks
DATE MATERIAL SENT/APPROVED
C.O.E. SCRZCC SARWQCD J.H.C. Or.Co. T.I.C.
1. Application�'
�9�� x,20
2. Consent Letter q 'r
3. "Waste" Letter ep
4. Drawings r ��
it
5 Staff Report
6.
7
8.
REMARKS
r "TIFIE - RETUm RECEIPT RE'3 - i
DEPARTMENT OF THE ARMY
LOS ANGELES DISTRICT, CORPS OF ENGINEERS
P. O. BOX 2711
LOS ANGELES, CALIFORNIA 90053
9 Septenber 1975
Nr,, 4ad Brans -ford
2806 Lafayette Avenue
Ne"ort Beath, CA 926,60
Pear Mr. sfor ::
1 locl (dam)
As stat
C Fu:
Cir,ty Qf' Newp rt Beach
Slotorely your;:
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CITY'--OF HEWPOR--._- �BrEACH HARBOR APPLi . 'lON HO..�....., ._
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PERMISSION IS HEREBY GRANTED TO CONSTRUCT AND
MAINTAIN THE FACILITY SHOWN ON THE REVERSE HEREOF,
AT THE SITE INDICATED, SUBJECT TO THE PROVISIONS OF
THE HARBOR PERMIT POLICIES OF NEWPORT BEACH ANIS
ANY SPECIAL CONDITIONS LISTED HEREON. THIS PERMIT
IS NOT TRANSFERABLE WITHOUTTHE WRITTEN CONSENT OF
THE CITY HARBOR COORDINATOR OR COUNCIL. THE
RIGHTS GIVEN UNDER THIS PERMIT E PERMISSIVE ONLY
AND THIS PERMIT ACCORDANCE AY BE REVOK F BY E CITY COIJWILIN Y
17 MA C E.
Cl ",H OR COORDI ATIDR..
PERMIT NO. DATE
Z
DEPARTMENT OF THE ARMY
LOS ANGELES DISTRICT, CORPS OF ENGINEERS
P. Q. BOX 2711
LOS ANGELES. CALIFORNIA 90053
Public Notice No. 75-129
25 June 1975
YOU ARE INVITED TO COMMENT ON THIS APPLICATION FOR A PERMIT
APPLICANT.: Mr. Jack Bransford
12700 Knott Avenue, Suite B
Garden Grove, California 92645
.ACTIVITY: Install new slip float, ramp and cantilevered deck at 524 Harbor
Island Drive, Lot 37, Tract 3867, in Newport Bay, City of Newport Beach,
Orange County,.-C.al-ifornia,.. as -shown on the drawing accompanying this.notice.
PURPOSE AND USE: To provide private boat docking facilities.
FEDERAL, STATE AND LOCAL AUTHORIZATIONS.- Approved by the Santa Ana Regional
Water Quality Control Board. Approval will be required prior to issuance of
permit from the City of Newport Beach, and the South Coast Region California
Coastal Zone Conservation Commission.
ENVIRONMENTAL IMPACT: This office does not intend to prepare an Environ-
mental Impact Statement on this activity unless significant detrimental
effects are brought to our attention.
CRITERIA: Your written comments or objections should include the number and
date of this notice and must reach this office within thirty (30) calendar
days. The decision whether to issue a permit will be based on an evaluation
of the probable impact of the activity on the public interest. That'decision
will reflect the national concern for both protection and utilization of
important resources. The benefit which reasonably may be expected to accrue
from the activity must be balanced against its reasonably foreseeable.detriments.
All factors which may be relevant to the activity will be considered; among
those are conservation, economics-.,aes-thetics, general environmental
concerns, historic values, fish and wildlife values, flood damage prevention I
land use classification, navigation, recreation, water supply, water quality,
and, in general, the needs and welfare of the people. Details of changed
conditions on the final permit action will be provided upon request.
FOR THE DISTRICT ENGINEER:
ROBERT H. REINEN
LTC, CE
Deputy District Engineer
HARBOR�;
CITY OF NEWPORT 13EACH
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