HomeMy WebLinkAboutF2019-0129 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 R 5 Permit Counter Phone (949)644-3288 Job Address: 5000 BIRCH ST NB St: 1 FI: 4 Unit: 4400 Inspector Area: FIRE Owner: JOHN HANCOK.LIFE INS CO Address: 865 S FIGUEROA ST #3320 - LOS ANGELES CA 90017 Phone: Applicant: MORGAN JAKOB Address: 1120 E. FRUIT ST SANATA ANA, CA 92701 Phone: 714-246-1280 Code Edit : 2016 Type of Construction:: V -B -SPR Occupancy Group:. B Added/New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 10 No of Units.: 0 Flood Zone: Bldg Sprinklers: N Construction Valuation: $2,000.00 IIY�FIII ID0 �IILII II���VI0 IITILIII� II W CST- ITV W QF t - FIRE Permit: F2019-0129 Project No: 0504-2019 Inspection Requests Phone (949)644-3255 State Lic: State Lie: Worker's Compensation Insurance Designer: SALORIO MANNY Carrier: Description: COMM FIRE,SPRfNKt@RS' 5 HEARS (X2018-3673) 1120 E. FRUIT ST Policy No: bgvkCEs Legal Description: P SK 181 PG 13 PAR 5 Expire: Contractor: FIRE SAFETY FIRST Architect: Address: 1170 E FRUIT ST Address: SANTA ANA CA 92701 Phone: 714.8364800 X137 Phone: Con State Lie: 599761 Engineer: Lie Expire: 08131/2020 Address: Bus Lie: BT00009906 Lie Exp Date: 06130/2019 Phone: State Lic: State Lie: Worker's Compensation Insurance Designer: SALORIO MANNY Carrier: CYPRESS INS CO Address: 1120 E. FRUIT ST Policy No: BRWC916820 $139.00 SANATA ANA, CA 92701 Expire: 11/01/2019 Phone: 714-248-1280 Issued Date: 0310712019 Special Conditions: Setback- Front: Rear: Left: 1nj` -76-t -33o "G E Right: ,?a? Building PC Fee : $0.00 Building.. Overtime PC Fee:. $0.00 Building Extention Fee : $0.00 Building Investigation Fee: $0.00 Fire Plan Check Fee: $139.00 Fire Permit Fee : $212.00 Building Permit Fee: $0.00 TOTAL FEE : $355.00 PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL: FEES Fire Residential Alarm PC Fee: Planning Counter Review: Planning Zoning PC Fee: Public Works PC Fee: Public Works Traffic Plan Check Fee; Plan Check Fee $0.00 Records Management $0.00 $0.00 $0.00 $0.00 $0.00 Fee Due at Permit Issuance : OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION ••ee e e e . o ee o• eeeo o 0000 e•e o • o om • o e oommoo m oe o ® o 0000 $4.00 $0.00 $0.00 $355.00 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 items) (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). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) 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). 111, 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 property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By my signaturplAI ✓.1 acknowledge 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 legally sell a structure tlfatf ?lave 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 ptgf%%sions 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 Pro@&W.Owner or Authorized Agent Date �tCENySED COIJTRACTOR'S DECLARATION hereby affirm ugcLer penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with S it n 70 0) of Division 3 of the Busipeofes"On' ide, and my I cense' full force Sad effect. . • CyCic2rysg•Class • License No Date I ( Contractor SignXVIKERS'ISOWENSATION DECLARATION gWINOFAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOY R TO CRIMINAL PENALTIES AND CIVIL FINES UP TD THOAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATIIDN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. •. •. '+ir�e$ebyeffirm u.1g r.geralty of perjury one of the following declarations: IIssance DaUand 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 thi a of UA%Wrl�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' compensatior carrier and policy number are: mer Policy Number Expiration Date me of Agent Phone # I certify that, in the pe ma ce of the ork f whit his per issued, I shall not employ any person in any manner so as to become subj ct to the workers' compensation laws of California, and ogre It, if I should become 'e or rs' pen tion provisio sof Section 3700 of the Labor Code, I shall forthwith comply with those ovisio s. (nature of ApplicantA Da / !CLARATION REG IN CONSTRUkTION LENDIf4G AGENCY -reby affirm under enalty of perjury that there is a construction lending agency for the performance of the work for which this permit is h lied (Sec ion 3097, Civil Code). ider's Name Lender's Address my signature below, 1 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 provided is correct. I agree to comply with all applicable city and coun r nes an tate s re mg to bu mg construction. I authorize representatives of this city or county t �,j'��) �,yftp,,'(y�'rl�(r�fentif' pro y for inspe tion purposes. q If l l (G mature of Procertv Owner or Authorized ADent 1 X vll"'l mt ProDertY Owner's or Authorized Agent's Name r V ACTION I DATE V k BY PERTNITCANCE" P€WiTEXTENDED 0 t SUBOTTED ASBESTOS N071FICATION TO: ❑ EPA AQMD ❑ ASBESTOS N037RCAITOMIS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: