HomeMy WebLinkAboutF2019-0271 - Permitsr City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
h € Permit Counter Phone (949)644-3288
Job Address: 20360 BIRCH ST NB St: 1 FI: 2 Unit: 220
Inspector Area: FIRE
Owner:. NEWPORT HEIGHTS VENTURES
Address: 4100 MACARTHUR BLVD #120
NEWPORT BEACH CA 92660
Phone
Applicant:
MENDOZA LUIS
Address:
4100 BIRCH #500
Address:
NEWPORT BEACH CA 92660
Phone:
949-333-7000
Code Edit: 2016
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units
Flood Zone:
Bldg Sprinklers:
Construction Valuation
II -B -SPR
B
0
0
II II I� II� I III II� I /III TNI 0�� � ILII I71 III
FIRE Permit: F2019-0271
Project No: 2597-2018
Inspection Requests Phone (949)644-3255
Description: COMM TI MEDICAL GASES "'EDEN FERTILITY CENTER" (X2018-3342)
Legal Description:
BT30061263
Contractor:
MORRIS INC
Address:
4100 BIRCH ST #600
EMPLOYEE SERV
NEWPORT BEACH CA 92660
Phone:
949-333-7015
Con State Lic: 959349
Lic Expire: 11130/2020
Bus Lic:
BT30061263
Lic Exp Date:
04130/2020
Worker's Compensation Insurance
Carrier:
EMPLOYEE SERV
Policy No:
WC093379003
Expire:
0410112020
2 Issued Date: 05/0812019
0 Setback- Front:
X Rear:
Y Left:
Right:
Building PC Fee:
Building Overtime PC Fee:
Building Extention Fee:
Building Investigation Fee
Fire Plan Check Fee:
Fire Permit Fee:
Building Permit Fee
TOTALFEE
$100,000.00
FEES
$0.00
Fire Residential Alarm PC Fee:
$0.00
Planning Counter Review:
$0.00
Planning Zoning PC Fee:
$0.00
$0.00
Public Works PC Fee
$209.00
Public Works Traffic Plan Check Fee;
$0.00
$209.00
Plan Check Fee:
Architect: SAUNDERS NIALL F
Address: 2700 W COAST HWY #200
NEWPORT BEACH CA 92663
Phone: 949.721-0730 State Lie: CO26955
Engineer
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
$0.00
$0.00
$0.00
$0.00
$0.00
State Lic:
Records Management
$0.00 Fee Due at Permit Issuance
PROCESSED BY: `, ' E. °„ ° ° ° :' OTHER DEPARTMENT:
6 4 6 6
p 4i i 1 4 O°O
ZONING APPROVAL: =�_ d " d ° e PLAN CHECKED BY::
FIRE APPROVAL: �S APPROVAL TO ISSUE:
W O PI• •Y
PERMIT EXPIRES 680 DAYS AFTSa? IGSUANGE OR LAST VALID INSP9CTION
6 C
B4♦ V° �°Y 0 m 000 YO°
$0.00
$0.00
$0.00
$209.00
IWNER-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) 1 have placed next to the applicable item(s)
lection 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
is 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
'rofessions 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
of more than five hundred dollars ($500).
1, as owner of the property, or my employees with wages as their sole compensation, will do U 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
nprovements 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
n roved 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
only 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).
I am exempt from licensure under the Contractors' State License Law for the following reason:
ly my signature below I 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
ell a structure that I have 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
'rofessions 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
.ICENSED CONTRACTOR'S DECLARATION
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 Professi s Code, and my license is in full force
nd effect.
icense Class License No Date' 8 Contractor Signature, �C
VORKERS' COMPENSATION DECLARATION
'ARNING: 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
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
] 1 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 thl
ie rmance of the work for which this permit is issued. Policy No.
I have and will mai I/E�N 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
Isurance carrier and oli number are4) � "')
Date
is of Agent
v ly.p r rliullen
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,fhe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
laturepfApplicant AC
ICVLXRX 11 V IY RG VXR V IIY V W I\J 1 M1 V V 11 V I\ L
hereby 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).
ender's Name Lender's Address
y 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.
1 agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or count to e/nter theobove-identified property for inspection purposes. Fr.�
'innatiim of Pronertv Owner or Authorized ADent x f1— Print Property Owner's or Authorized Agent's Namlli LL)3'' M(Fwl
ACTION DATE BY DECLARATION OF COMPLIANCE MTN CODEOF I FOR OFFICE USEONLY
P€RMITEXPIRED _- nttnHArwLt= W. • • • . •
❑ f �ugMtrr�Das�sTps,�uortFJ�TIp,w,To:-
P€RMITCANCELLED ❑ • EPA
P€RMIT EXT€NDED ❑ AQMD
_ ❑ ASBESTOS NORFICAHOMIS NOT APPLICABLE TO
PERM1TFtNAi
., i PROPOVIE(3.DNOI. I VIVj • . . • . • :.
CERTIFICATE OF • • • • . • •
SIONATLIM: •
OCCUPANCYISSUED