Loading...
HomeMy WebLinkAboutM2011-0068Worksheet for Building Combo Permit Application W P P City of Newport Beach - Building Departme MA Please print 1 3 copies RBORRESOURCE '"EWPORTEACH F—Building F Grading F.Drainage Elec F MecCl"Fua 1. Project Address (Not mailing address) Tenant Name(if Applicable) 2. Description of Work .... ......... . ....... . Extg Building SF Demo Building SF Add/Reconstruct Bldg SF Extg Gar sf F Demo Garage sf F Add/Reconstruct Garage sf F7777 TOTAL BLDG SF -New Add Alter f—;Demo TOTAL GARAGE SF IFS # Units (if Residential) 177 Use Valuation $ Cu Yd Cut r Cu Yd Fill # Stories �\6. Contractor's Name Last FirsLic. No. Class Contractor's Address Contractor's E-mail Address &7 .......... State Telephone ..................F�7 zip F COS.& _M Psi.... City OFFICE USE ONLY ENERGY P/C FEE $ GRADING P/C FEE $ Rev 4116109 ELEC/MECH/PLUM P/C FEE$ FIRE P/C FEE $ PERMIT NO. PLAN CHECK NO. o PLAN CHECK FEE $ 1`ZE W PCS o� ` CITY OF NEWPORT BEACH 829 Harbor island Drive, Newport Beach, CA 92659 949-644-3034/Fax 949-723-0589 9�IFOR�h,r July 7, 2004 s Freedom Escrow Fax 949-644-3938 Re: Pier Permit #800-200 200 Grand Canal, Balboa Island Escrow # 41423-M Dear Sirs: The pier has been found to meet City standard and the permit will be transferred into the buyer's name. Thanks for your help. If you require further assistance in this matter, please call 644-3034. Sincerely, Lorne Aroese Lorrie Arcese Harbor Resources Division TRANSFER APPLICATION zx o Date of Applicaton. Permit Number. Property Address: a00 ad- CA N A L 1--J 6 , 014- fZ(-&-2-- Buyer's Names: d N a ,,T,> L A,5 a #4 wLc Billing Address: 4 i 6 as Vis, c - Ca- Telephone No.: q `f 9- 6 7 Bu er's Signatures: y 9 Seller's Names! Seller's Signatures: Joint Owner Signature: Escrow Company: Escrow Number: `-H�-a - M Fax #: Inspection Date: Reinspection Date: Fee Amount: 9 ,? CXD Date Paid: Check,Number: JLXJ Application Approved: Harbor SignaturelDete Special Conditions: This permit is revocable by the City Council in accordance with Title 17 of the Newport Beach Municipal Code. .: W -Pp;. c�Lrorz�a HARBOR PERART IrR"SFER APPLICATION Date of Applicaton: Permit Number: Property Address: Buyer's Names: Bitting Address: Telephone No.: Buyer's Signatures: Seller's Name- Seder's Signature Joint towner Signature: Escrow Company: Escrow Number: Inspection Date: Fee Amount: Date Paid: Application Approved: ReinspectionDate: Check Number: k Harbor Resources SignatureMete PLEASE SIGs Special Conditions: This permit is revocable by the City Council 'tiiii in accordance with Title 17 of the Newport Beach Municipal Code. PLEASE SIGN AND RETURN Date: Inspection Requested By: INSPECTION FORM Harbor Resources Department -716 Id `7l Z-1 Inspector: Don Duffy Pier Address: �'"� l Pier Transfer Reinspection GFI Present Yes Need None Neeq!ad Yes Need � 1—I F -- Anti-Siphon / Backflow Present Other Comments Eelgrass / Yes No Present Pump Out Pier Location Yes No Operational I I Recommended Action Encroachmenet Address of Complaining Party Boat Description CF Number Location on Dock Comments / Observations Other Request Date 16i 1 HARBOR PERMIT NO. CITY ©F NEWPORT BEACH MARINE DEPARTMENT APPLICATION FOR HARBOR PERMIT Site address Occ &r4"d, Owner � C e2k1,t?. \b y �_t 2 i /Z+— Telephone Owner Mailing Address City Description of work: New Revision -='' Maintenance 1/ Other Work to be done: o� & Zip OWNER -.BUILDER DECLARATION I hereby affirm that I am exept from the contractor's license law for the following reason: (Sec.7031.5, 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 re- quires the`-appl-icant for such permit to file a signed statement that he is licensed pursuant to the provision of the Contractors License Law (Chaper 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 sub- jects 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 coothe 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, pro- vided 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 onstruct 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 with a Contractor'(s) License pursuant to the Contractor's License Law). I am exempt under Sec.—Pf Business and Professions Code for this reason: 1-n Date - Owner Signature Contractor i � C i . fi<<e � � J Yn V►`vyn ma_,t1Ar Telephone 4a_g?t-p Address *9(a City & zip _A� &= o��f License Class State License No. & / &,o 4. City License No. l l 1p LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busin and Professions Code, and my license is in full force and effect. Contractor signature Date INSURANCE INFORMATION Workers' Compensation Declaration I hereby affirm that I have a Certificate of Consent to self -insure, or a Certificate of Workers' Compensation Insurance, or a Certified Copy thereof. (Sec. 3800 LAB.C.- Policy No. Company Certified Copy is hereby furnished: Date Applicant Certified Copy is filed with Marine Dept. Federal Longshoremen & Harbor Workers' Insurance Declaration I hereby affirm that I have a Certificate of Insurance for Longshoreman & Harbor Workers' Insurance as required by Federal Law. Date Applicant Certificate of Exemption from Workers' Compensation Insurance/Federal Longshoremen and Harbor Workers' Insurance I 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' Compensation Laws of California or Federal Longshoreman & rbor Wo kers' Insurance. Date / 13 Applicant __Note to Applicant: If, _after maki';ng this certificate of exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, or the Federal Longshoremen and Harbor Workers' Act, you must for,'thwith comply with such provisions or this permit shall be deemed revoked. I certify that I have re -a `: 3tion and state that the above information is correct. I agree to comply with all !nty ordinances and State laws relating to. building construction, and hereby aut..- - - -�sentatives of this City to enter upon -the above- mentioned property for Signature of permittee date NAME ADDRESS OF PROPOSED FACILITY PERMIT a �%"�� ACX✓ �iti�/,� G��%/�r���� ..r="/��= .��°"- � ,��- MAILING ADDRESS TELEPHONE NO. FEE �' CHECK NO. DATE APPROVED BY: DATE APPLICATION �S HEREBY MADE FOR A HARBOR PERA1IT TO ❑ �.P!'dS nU7^ CT/gEViSE A / j-✓ OCHD AT THE ABOVE LOCATION IN ACCORDANCE WITH THE CITY OF ENGR -1B'! NEWPORTBcA/r/ujP�ERMIT POLICIES AND DRAWING F �f �/>�i9L._,lr`'Ii' .nE 1ATTACHED COUNCIL PUBLIC WORKS ❑ DATED DEPT. EscaoW F] DATE INSPECTION ❑ SIGNATURE 1-1 SPECIAL CONDITIONS: CITY OF NEWPORT BEACH, CALIF. WX FORM 68-1010 r4" EW Pp�T ° CITY OF NEWPORT BEACH V _ P.O. BOX 1768, NEWPORT BEACH, CA 92659-1768 V4 -'Y" LI Fp12 November 5, 1989 Neport Center Escrow Atn: Jane 2430 W. Coast Highway Newport Beach, CA 92773 Sirs: The City of Newport Beach has received an application to transfer Pier Permit 0801-200 for the property located at 200 Grand Canal, Newport Beach. The structure was inspected on November 1, 1989, at which time it was determined that it conforms to City standards. When we have received the pier transfer card, signed by both the previous owner and the new owner, and the $275 transfer fee, we will transfer the pier permit. Sincerely, Tony Melum Tidelands Administrator 3300 Newport Boulevard, Newport Beach S 'A I TN SHEET HARBOR PEPAITS L TRANSFER sel I er Buyer Da te kq? P1 i cation a.Rec ve. Date Fee Loci v: Oral Request for Inspection Escrm�Ca iYate Es craw Officer -Escrow I Date Inspection Made 31— Dai Deficiency Letter Sent, (if applicable) Date Deficiency Corrected (if applicable) Date Orange County Notified (if applicable) Date Transfer Completed 1. Location: 2. PlLmbing: 3. Electrical: 4. Structural: inspector's initials-, Sll' �yr r r r r . //VA , .r r JJ February 19, 1991 City of Newport Beach Marine Department 3300 Newport Boulevard Newport Beach, CA 92660 Re: 200 Grand Canal/attached Gentlemen: Enclosed is your statement of February 4, 1991 and my payment of $55.00 pier permit fee for 1991. I requested correction of your records last year and am pleased to do so again: The phrasing "West Coast Accc modator" was terminology used during the 1989 transfer of ownership of this property and is no longer relevant. Please adjust your records to show the billing name and address for this property to be: Ms. Lee Dutwiler 608 Macadamia Lane Placentia, CA 92670 Thank you for your consideration of this request. Sincerely, t l?� V Lee Dutwiler