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Home My WebLink AboutF2021-0339 - Permits+'r City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II 100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 1 0 3 3 9 Permit Counter Phone (949)644-3288 ��AYTYl4�4� Job Address: 2240 UNIVERSITY DR NB Inspector Area: FIRE Owner: NEWPORT JEWISH CENTER INC Address: 2240 UNIVERSITY DR #200 Occupancy Group: NEWPORT BEACH, CA 92660 Phone: 0 Applicant: SCHAFER MICHAEL Address: 23422 PERALTA DR No of Units : LAGUNA HILLS CA 92653 Phone: 949/584-5426 Code Edit : 2019 BERGMAN KPRS LLC Type of Construction: V-A- SPR Occupancy Group: B/A3 Added /New sq.ft. Bldg: 0 Added/New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Flood Zone: Lic Expire: Bldg Sprinklers: Y FIRE Permit: F2021-0339 Project No : 1800-2021 Inspection Requests Phone (949)644-3255 Description: COMM Ti- (2) WAY COMMUNICATION "CHABAD JEWISH CENTER" Legal Description: P M 17642 PAR 3 POR OF PAR Contractor: BERGMAN KPRS LLC Architect: Address: 2850 SATURN AVE Address: State Lic: BREA CA 92821 Phone: 714-672-0800 Phone: Con State Lic: 982577 Engineer: Lic Expire: 04/30/2023 Address: Bus Lic: BT30069323 • o Lic Exp Date: 10/31/2021 Phone: Worker's Compensation Insurance Designer: Carrier: HARTFORD FIRE INS Address: Policy No: 72UEACF2030 ° ° ° Expire: 07/01/2022 Phone: Issued Date: 08/20/2021 Special Conditions: Setback- Front: Building Permit Fee : Rear: - o Left: TOTAL FEE : om m Right: $194.00 Fee Due at Permit Issuance : $225.00 PROCESSED BY: ry E ZONING APPROVAL: FIRE APPROVAL: OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION FEES C Construction Valuation: State Lic: 10 rn••• $0.00 Fire Residential Alarm PC Fee : e $6.00 Building Overtime PC Fee: oeo Planning Counter Review: $0.00 • o State Lic: m m e ° m ° e•eooc • ° Building Investigation Fee : o SCHAFER MICHAEL ®° • o ° c 23422 PERALTA DR • ° ° ° LAGUNA HILLS CA 92553 m 0 0° $219.00 •mmm om o Building Permit Fee : $0.00 - o memoo TOTAL FEE : om m mo••oo $194.00 Fee Due at Permit Issuance : $225.00 ° ° mmm000 cmoo°m ° • omoo° PROCESSED BY: ry E ZONING APPROVAL: FIRE APPROVAL: OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION FEES Construction Valuation: $2,500.00 Building PC Fee : $0.00 Fire Residential Alarm PC Fee : $0.00 Records Management.: $6.00 Building Overtime PC Fee: $0.00 Planning Counter Review: $0.00 Building Extortion Fee : $0.00 Planning Zoning PC Fee : $0.00 Building Investigation Fee : $0.00 $0.00 Fire Plan Check Fee: $194.00 Public Works PC Fee : $0.00 $0.00 Fire Permit Fee : $219.00 Public Works Traffic Plan Check Fee; $0.00 Building Permit Fee : $0.00 TOTAL FEE : $419.00 Plan Check Fee : $194.00 Fee Due at Permit Issuance : $225.00 PROCESSED BY: ry E ZONING APPROVAL: FIRE APPROVAL: OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 L) all of or L) 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). ❑ 1, 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). ❑ I am exempt from licensure under the Contractors' State License Law for the following reason: By 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 Iegalh sell 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw,html. Signature of Property Owner or Authorized Agent Date LICENSED65ATRACTOR'S DECLARATION I hereby affirm unser penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions rode, and my license is in full force ead effect. •••••• y® Si ^- License Class • • • License No Date 6�f Contractor gnatur WORKERS' COMPENSATION DECLARATION NARNING: FAILIJA$P Tq SF••CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001, IN ADDITION TO THE 60•STbf COMP EN§4TION•DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hyeffiby affirm Ig�16Dpenalty of perjury one of the following declarations: : it Tnive and MlPfiaintain 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 th mance of the work for which this permit is issued. Policy No. ie and WIlll rpdi0tain 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' compensatiol nsurance carrief-and policy number are: D••••• Darrler• Policy Number Expiration Date of Agent 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 agree if I should become subject to the worker compensatipp provisio s of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. lature of Applicant ( 4 . Date 9. 0 hereby affirm under penalty of pWjury that there is a n'onstruction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code) ender's Name Lender's Address ly my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners 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/�o(�ter the ove-I entified grope y for inspection purposes. ;ionature of Propertv Owner or Authorized Agent. (o moi. s Print Property Owner's or Authorized Agent's Name ACTION DATE BY DECLARATION OF COMPLIANCE AJITHCODEOF FFOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. PERMITEXPfRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL NO yU CER77RCATEOF SIGNATURE: OCCUPANCYISSUED