HomeMy WebLinkAboutF2022-0208 - Permitsa
City of Newport Beach - Building Division JJJIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII it FIRE Permit: F2022-0208
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 2 0 2 0 8 Project No : 1047-2022
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 840 NEWPORT CENTER DR NB St: 1 FI: 2 Unit: 200 Description: COMM SPRINKLER MONITORING SYSTEM (X2021-2869)
Inspector Area: FIRE
Legal Description:
P BK 136 PG 22 PAR 1
Owner: CSHV PACIFIC FINANCIAL
Contractor:
H C I SYSTEMS INC
Architect:
Address: 515 S FLOWER ST #6TH
Address:
1354 S PARKSIDE PL
Address:
LOS ANGELES, CA
ONTARIO CA 91761
Phone:
Phone:
909-628-7773
Phone:
State Lic:
Applicant: WILLIAMS DOMINIQUE
Con State Lic:
905493
Engineer:
Address: 1354 S PARKSIDE PL
Lic Expire:
0212912024
Address:
ONTARIO CA 91761
Bus Lic:
BT30042287
Phone: 909-957-5200
Lic Exp Date:
02128/2023
Phone:
State Lic:
Code Edit: 2019
Worker's Compensation
Insurance
Designer:
JEROME BRION
Type of Construction: V-B-SPR
Carrier:
FEDERAL INSURANCE CO
Address:
1354 S PARKSIDE PL
Occupancy Group: B
Policy No:
54309498
ONTARIO CA 91761
Added /New sq.ft. Bldg: 0
Expire:
03/0212023
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 7
Issued
Date: 04120/2022
Special Conditions:
No of Units : 0
Setback- Front:
Flood Zone: X
Rear:
Bldg Sprinklers: Y
Left
FEES
Construction Valuation:
$711.25
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 Extention Fee :
$0.00
Planning Zoning PC Fee :
$0.00
Building Investigation Fee :
$0.00
$0.00
Fire Plan Check Fee:
$145.00
Public Works PC Fee :
$0.00
$0.00
Fire Permit Fee :
$283.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$434.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance :
$434.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL: AtA
OTHER DEPARTMENT:
PLAN CHECKED
APPROVAL TO ISSUE:
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PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID IX-SPE&ION
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LDER 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).
❑ I, 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 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 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
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
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 Code, and my license is in full force
and effect. �/ ( /,., /
License Class License No Da -1 / C.0 / ZZ- Contractor Signat f4 �y � -
INORKERS' COMPENSATION DECLARATION o
NARNING: 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
COST 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 the
foa ante of the work for which this permit is issued. Policy No.
JwPave 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
ns n 5.ca-rrfe^r and policy number are:
..arner_}e(/R:YinS CZ. Policy Number OCt L4Ct R Expiration Date
Vame of Agent Phone #
❑1 certify that, in the performance of the work forwhich 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
:hat, if 1 should become su�t to the orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Ll
Signature of Applicant Date
CLARATION REGARDING CONSTRUCTION LENDING AGENCY V
areby 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 enl rtheaove-identified property for inspection purposes.
AC7I0IY
DATE
BY
DECLARATION OF COMPLIANCE INITN CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART BF OF TITLE40 AND
AQMD RULE 1403
PERMIT EXPIRED
... • •
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❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
PERMIT CANCELLED
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❑ AQMD
PERMITEXTENDED
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❑ ASBESTOS NORFICA RON IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMITFINAL
CERTIFICATE OF
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SIGNATURE:
OCCUPANCYLSSUED
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