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Worksheet tor 8ui Id ing (;om-bo Permit Appl - icat ion
City of Newport Beach - Building DepartmeHARBOR RESOURC
uilding F- Grading [7:Drainage fu NEWPORT
17., Elec I—, Me c
ra
1. Project Address (Not mailing address)
F_-1, 2-t�
Tenant Name(if Applicable)
z. Liescription ot work
J
L. .. .......
Exist House SF Demo House SF
Add/Reconstruct House SF
............ ... .. .. ...... ..
..........
Add/Reconstruct Garage SF
Exist Gar SF Demo Garage SF
F
TOTAL HOUSE SF
New Add Alter
[7.Demo
GARAGESF
Check Appro2riate Box for Applicant
3. Owner's Name Last F
irst
..... . .......
Owner's Address Owner's E-mail Address
"n
...................
...... .... .. .... . .. ..... . .. .... ... ..... . .. . ....... .. .. .... ... ......
Ly State Zip Telep
hon e
# Units (if Residential)
. .... .. . ............. .......
Use r
Valuation JJ
Cu Yd Cut
Cu Yd Fill
# Stories
4. Arch itect/Des ig ner's N
arne Last First Lic, No.
... ....... ............
Architect/Designer's Address Arch itect/Designer's E-mail Address
. .. ... ....... . . . ............ .................................................... ........
State
5 E -
ngineer's Name
Engineer's Address
Last
Telephone
............. .......... . . ..... .
First
.... ... . ..
....... .......
,::ngineer's E-mail Address
... . ......... .. ... ........
.ty i State Zip Telephone
.. . ... .. .... . .... ... ......... .... ..... . ... .......... ..... . . . ... ....... .... ........... . ................
Lic. No.
_P7
7 6. Contractor's Name ast
First Lic. No: :,ss
Contractor's Address
Contra`616r's Xail Address
.............................. .......... .....
..... . ......... . ...........
"Ity Telephone
State zip
(;FF,'—'—E USE ONLY ENERGYP/CFEE$
GRADING P/C FIEE $
Rev 1118107 ELEC/IV1E0H/PLUI%A P/C
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $
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RALPH N. HIGHSMITH
ATTORNEY AT LAW
GENEVA 1-3842 SEAL BEACH
322 MAIN STREET CALIFORNIA
C ITY OF NEWPORT BEACH PUBLIC WORKS DEPARTMENT
P!ERPERMIT TRANSFER FORM DATE
APPLiCATION HEREBY MADE T�IIRANSFER ALL MY RiGHT3 TITLE AND I NTEREST IN
�17 ER AND FLOAT
PERMIT NO. FOR
210 south Ba ',r
Y VOUt Balboa ISI#md
LOCATED BAYWARD 016 PROPERTY AT'
IF
(ADDRES�
BEING LOT BLOCK
SECTION OF TRACT
IT IS AGRE.ED Tt4AT ALL COND�TIONS CONTAINED IN THE ORIGINAL PIER PERMIT AND ANY SPECAAL
PROVISIONS SHOWN HEREON SHALL APPLY, AND THAT THE TRANSFEREE HAS ACQUIRED OR IS IN THE
PROCE83 OF ACQUIRING THE ABUTTING UPLAND PROPERTY. IN THE EVENT THAT THE ACQUISITION
DOES NOT BECOME FINAL, THIS TRANSFER IS NULL AND VOID. BEFORE FINAL ISSUANCE OF TRANSFE I R
A LETTER FRTU Mj R 0*, A R 1
--A-(i_�NT WILL BE -REQUIRED STATING THAT TRANSFER OF
TITLE HAS EdfN L E
DeceaSed 1700 brooklyns Los Aqp
TRANSFEROR Calif
Co 8, I't Jr., ELIZABETH MAILgNG-ADDRESS
�LABAUOH and MARY P. 0. 30 300$ Fullerton-* Calif,
TRANSFEREE T
(BUYER) X MA I L I
x Tw J* -or, T -mat"
SIGNATUR . E OF TRANSFEROR
x
�bW4. "�C'IaCb�'
E LmRn
IGNATURE F TRAN IGNATURE OF TRANSFERORI
x
TRANSFER AP VED
ENlIED BY THE C.ITY CIL
UN DATEJ/-��C�
SPECIAL P ROV ION 3MPO 3 BY CITY COUNC
-7�
-p&;j vv -
PERMIT NO. 2/7
GENERAL PROVISIONS FOR HARBOR PERMITS
ACCEPTANCE OF PROVISIONS: IT IS UNDERSTOOD AND AGREED BY THE PERMITTEE THAT,
THE DOING OF ANY WORK UNIJERTHIS PERMIT SHALL CONSTITUTE AN ACCEPTANCE OF ALL OF THE
PROVISIONS -
2. PERMIT FROM OTHER AGENCIES: THE PARTY OR PARTIES TO WHOM THIS PERMIT IS
ISSUED,,SHALLj WHENEVER THE SAME IS REQUIRED BY LAW,, SECURE THE WRITTEN ORDER OR CONSENT
TO -ANY WORK-,...HE/REUNDER FROM THE U. S. CORPS 0,F ENGINEERS OR ANY OTHER PUBLIC BODY HAVING
JUR-ISDICTI9..'Nv.AND THIS PERMIT SHALL BE SUSPENDED IN OPERATION UNLESS AND UNTIL SUCH
ORDER OR CONI�ENT IS OBTAINED.
TRANSFERRING PERMIT: THIS PERMIT IS NOT TRANSFERABLE WITHOUT THE WRITTEN
CO'N'stw-T OF THE PUBLIC WORKS DEPARTMENT OR OF THE CITY COUNCIL OF THE CITY NEWPORT
OF
BEACH IF .1 COUNCIL AP PROVAL IS REQUIRED.
4. INSPECTION. THE WORK SHALL BE SUBJECT TO . THE: SUPERV IS ION AND APPROVAL OF THE
PUBLIC WORKS DEPARTMENT. THE PERMITTEE SHALL NOTIFY'THE PUBLIC WORKS DEPARTMENT AT LEAST
3 DAYS IN ADVANCE OF THE DATE WORK IS TO BEGIN AND BEFORE ITS COMPLETION.
5-' PROTECTION OF TRAFFIC. ADEQUATE PROVISIONS SHALL BE MADE'FOR THE PROTECTION
OF THE -TRAVELING PUBLIC. BARRICADES SHALL BE PLACED ON STREET$, WITH LIGHTS AT NIGHT,
ALSO FLA'GMEN".- EMPLOYED.9 ALL AS MAY BE REQUIRED BY THE PARTICULAR WORK IN PROGRESS.'
THE PERMITTEE SHALL NOT ATTEMPT TO FORBID THE FULL AND FREE USE BY THE PUBLIC
OF ALL NAVIGABLE WATERS AT OR ADJACENT TO THE WORK OR STRUCTURE. IF THE DISPLAY OF
LIGHTS AND SIGNALS ON ANY WORK HEREBY AUTHORIZED IS NOT OTHERWISE PROVIDED BY LAWly SUCH
LIGHTS AND SIGNALS, AS MAY BE PRESCRIBED BY BUREAU OF LIGHT HOUSES, DEPARTMENT OF COM-
MERCE, SHALL BE INSTALLED AND MAINTAINED AT THE EXPENSE OF THE PERMITTEE.
STRUCTURES SHALL BE SO CONSTRUCTED AS NOT TO OBSTRUCT, INTERFERE -WITH OR PRE-
VENT THE FREE USE OR PASSAGE OF ANY SIDEWALKS STREET, ALLE _Y, PUBLIC WAY OR NAVIGABLE
z
..OHANNEL.
-'FOR DAMAGES-. THE PERMITTEE IS RESPONSIBLE FOR ALL LIABILITY FOR
6. LI AB,I� L 1. T Y
PERSONAL INJURY OR PROPERTY DAMAGE WHICH MAY ARISE.OUT OF WORK HEREIN PERMITTED) OR
WHICH MAY ARISE OUT OF THE USE OR POSSESS.ION OF SAID WORKS, AND IN THE EVENT ANY CLAIM
IS MADE AGAINST THE CITY OF NEwPORT-BEACH OR ANY DEPARTMENT, OFFICER OR EMPLOYEE
THEREOF, THROUGHi BY REASON OF, OR IN CONNECTION WI-TH SUCH WORK, PERMITTEE SHALL DEFEND,
INDEMNIFY AND HOLD THEM, AND EACH OF THEM,, HARMLESS FROM SUCH CLAIM.
-REVOCAT10N OF PERMIT: THE RIGHTS GIVEN UNDER THIS PERMIT ARE PERMISSIVE ONLY,
7.
AND THE CITY OF NEWPORT BEACH RESERVES FULL RIGHT, POWER, AND AUTHORITY TO REVOKE THIS
PERMIT AT ANY TIME. IN THE.EVENT THE PERMITTEE FAILS TO REMOVE SAID WORKS WITHIN THE
TIME SPECIFIED.9 THEN THE CItY ENGINEER SHALL HAVE THE RIGHTJO IMMEDIATELY REMOVE SAME�
A -,T THE COST AND EXPENSE OF THE PERMITTEE�
REPAIRS TRE PERMITTEE SHALL KEEP THE STRUCTURES IN GOOD REPAIR AT A LL
TIMES. FAILURE TO REPAIR.9 WHEN WRITTEN NOTICE HAS BEEN GIVEN BY THE.CIJY�TNGIN,�-,El
SHALL
BE CAUSE FOR THE REVOCATION OF THE PERMIT.
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CITY OF NEWPORT BEACH - PUBLIC WORKS DEPARTMENT
PIER TRANSFER INSPECTION REPORT FORM
TRANSFEREE
(NEW OWNER)
ADDRESS
42
x /e
LOCATION-, DATE OF INSPECTION
INSPECTED
By*
RESULTS SATISFACTORY
UNSATISFACTORY
F-1
REMARKS
STRUCTURAL: DATE OF INSPECTION
INSPECTED BY:
RESULTS SATISFACTORY
UNSATISFACTORY
El
REMARKS
PLUMBING: INSPECTION REQUIRED YES No
DATE OF INSPECTION INSPECTED BY.'
RESULTS SAT13FACTORY UNSATISFACTORY
N
REMARKS "2 zL d -10 -ell
Z/
ELECTRICAL: INSPECTION REQUIRED YES NO
DATE OF, INSPECTION INSPECTED By:
RESULTS SATISFACTORY UNSATISFACTOR'Y
REMARKS
PIER PERMIT No. 112/7
D_-ALPH n. HIGHSMITH
ATTORNEY AT LAW
322 MAIN STREET
SEP L B -E49 C H, GR LlfoQniq
GENzvA 1-3842
October 11, 1967
Mr. Glenn Weldon
City Attorney, New -port Beach
3300 West Newport Boulevard
Newport Beach., California
Re: 210 South Bay Front, Balboa Island
Lot 6 of Block 3 of Resubdivision of
Section 1 of Balboa island, as shown
on a Map recorded in Book 6. Page 30,
Miscellaneous Maps, records of Orange
County, California
Dear Mr. Weldon:
The above -captioned property is owned by the
Estate of John A. Wahlen, deceased, and is being
sold to Mr. C. Stanley Chapman. The property
has a boat dock attached to it and floatin- on
the waters of the bay. I have been advised that
it is necessary to clear with your offices in
order that the purchaser -may acquire the full
rights of the seller in this property and dock-
age. Would you please advise what, if anything,
is necessary for the Wahlen Estate to do in order
to accomplish this purpose.
Very truly yours,
RALP N. 1111G�
RUN -H - f S
RJU
E C fl-vf D
UqLPH n. HIGHSMITH
ATTO R N EY AT LAW
322 MAIN STREET
5E41L BEACH, C-ALWOMIq
GENEVA 1-3842
November 15) 1967 dot,
OF C F I Yr'U
NOV
FUMC, W DEpt,
4
Mr. Glen E. Welden
Senior Engineering Aide
City of Newport Beach
3300 Newport Boulevard
Newport Beach, California 92660
Re: Harbor Permit #217
(210 South Bayfront, Balboa Island)
Dear Mr. Welden:
Confirming our telephone conversation of November
143% 1967, 1 am enclosing my report from Gill -s
Plumbing Service wherein he deletes the'necessity
of anti -syphon device on this particular property.
Also enclosed are the executed Pier Permit Trans-
fer Forms and a check in the sum of $25.00 to
cover the costs thereof.
The escrow in this matter will close as soon as
this permit is granted. It is being handled
through the Orange County Title Company in Santa
Ana.
Thank you for your cooperation.
Very truly yours,
J,
SMI,
RA&LF N. H12
RNH: f s
Enclosures: 6