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Home My WebLink AboutX2018-2932 - Permits$ 1r0 City of Newport Beach -Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit: X2018-2932 100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 1 8 2 9 3 2 Project No : 2332-2018 .� Permit Counter Phone(949)644-3288.. v Inspection Requests Phone (949)644-3255 Combination Type BLDG Issued Date: Inspection Area: 7 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. 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: 520 SUPERIOR AVE NB Description: COMM NON ILLUM DOOR SIGN "GEORGIA AND ROBERT ROTH PAVILION" Legal Desc.: FIRST ADD TO NEWPORT MESA TR LOT 614 POR OF LOT Owner: NEWPORT HEALTHCARE Contractor: SIGN SPECIALISTS Architect: / /(v• Address: PO BOX 6100 Address: 111 W DYER RD #F Address: T� NEWPORT BEACH CA 92658 SANTA ANA CA 92707 Phone: - Phone: 714-641-0064 Phone: State Lie: - Applicant: TANNAYA ALLAN Con State Lie: 988048. Engineer. Address: 111 W DYER RD #F Lie Expire: 10131/2019 Address: SANTA ANA CA 92707 Bus Lie: BT30042506 Phone: 562-254-1623 - Lie Exp bate: 03/31/2019. Phone: .State Lie: Code Edit: 2016 Worker's Compensation Insurance Designer: TANNAYA ALLAN Type. of Construction: - Carrier: CYPRESS INS CO Address: 111 W DYER RD #F Occupancy Group: -U Policy No: SIWC927363 SANTA ANA CA 92707 Added /New sq.ft. Bldg: 0 Expire: 08/2512018 Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: I Special Conditions: No of Units: 0 Front: Bldg Height: 0 Left: Bldg Sprinklers: Right:. Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $1.000.00 Building Permit Feer $104.00 Excise Tax: $0.00 Planning Department Fire Department Plan Check Fee: $90.48 Additional Fee.: $0.00 Plan check Fee : $40.00 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $12.00 Grading Permit Fee: $0.00 In-lieu Housing Fee: $0.00 Building Dept Adm $0.00 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department- General Service $0.00 CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 PAN Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 - San Dist : $0.00 Building Green Fee.:. $1.00 Mechanical %: $0.00 Ni-Fee: $0.00 - $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $247.48 Plan Check Fee $247.48 Fee Due at Permit Issuance : $0.00 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: 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 the 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). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) 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 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 it was not built or improved for the purpose of sale). ❑ I, as 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 apply to an owner of plgpErty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempffrom licensure under the Contractors' State License Law for the following reason: By my signature below J,pcknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legalll sell a structure thald Nave built as an owner -builder if it has not been constructed in its 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 this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. License Class License No Date Contractor Signature COMPENSATION DECLARATION IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the fallowing declarations: I have 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 the erformance of the work for which this permit is issued. Policy No. have and will 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' rance carrier and policy number are: Policy Number Date 1e of Agent Phone # 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, and if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. of Date ueby 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, Civil Code). Ider's Name Lender's Address 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 provided is 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 county to enter the above -identified property for inspection purposes. nature of Pronertv Owner or Authorized A❑ent Print Prooertv Owner's or Authorized AGent's Name ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED I LJ I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT PERMITFINAL 1�C C U ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATEOF 1 PROPOSED DEMOLITION OCCUPANCY ISSUED SIGNATURE: