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HomeMy WebLinkAboutF2022-0190 - Permits,wi�r3 City of Newport Beach - Building Division *F2022-0190" 100 Civic Center Drive, Newport Beach, CA 92660 '. Permit Counter Phone (949)644-3288 si r't+totn.. WSZAI,5 r FIRE Permit: F2022-0190 Project No : 2851-2021 Inspection Requests Phone (949)644-3255 NeV0Por2:-r Job Address: 1220 BISON AVE NB St: A FI: 1 Unit: A-7 Description: COMM - MEDICAL GAS i X;Loa i -3,AA) Inspector Area: FIRE Legal Description: N TR 12309 LOT 6 Owner: IRVINE CO/MCKENNA ELIZABETH Contractor: THE TQS CONSTRUCTION,= Architect: SAUNDERS NIALLF °°°• 00000s Address: 110 INNOVATION OR Address: 5041 HORSE CHESTNUT ST Address: 2700 W COAST HWY #200 IRVINE, CA 92617 JURUPA VALLEY CA 91752 NEWPORT BEACH CA 92663 Phone: 949-720-3156 Phone: 949-689-6786 Phone: 949-721-0730 State Lie: CO26955 °. •° ° Applicant: GARHWAL RAJATDEEP/CHRIS Can State Lie: 1009447 Engineer: NOURMOHAMMADI KHOSROW� °••• •° °°• Address: 210 CORAL ROSE Lie Expire: 01/3112023 Address: 2515 BAMBOO IRVINE, CA 92603 Bus Lie: BT30078563 NEWPORT BEACH CA 92660 Phone: 5206-856-8471 Lie Exp Date: 04/30/2023 Phone: 949-822-8700 State Lie: C-07114J 000000 Code Edit : 2019 Worker's Compensation Insurance Designer: ; °, • v ° Type of Construction: V-B-SPR Carrier: STATE COMPENSATION INS FUND Address: • ° •• Occupancy Group: B Policy No: 9261919 Added /New sq.ft. Bldg: 0 Expire: 08/11/2022 Phone: Added /New sq. ft. Garage: 0 No of Stories: - 1 Issued Date: 04/22/2022 Special Conditions: TI PERMIT: X2021-3292 No of Units : 0 Setback- Front: Flood Zone: X Rear: Bldg Sprinklers: Y Left: Right: ' �6-� L49- t� FEES Construction Valuation: $1,000.00 Building PC Fee : $0.00 Fire Residential Alarm PC Fee : $0.00 Records Management: $0.00 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: $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 : $413.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $413.00 PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL: 131 LAW OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Y T OD OWNER -BUILDER DECLARATION - I hereby affirm under penalty of perjury that 1 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 Iicensure 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 o{tile 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 town owner E18Ilroperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ®eI anaexempi frol}I Iicensure under the Contractors' State License Law for the following reason: By my signature b@IGX1 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 legal) SeIFa structure tha! 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. SigaatLte of PrEgerry (twner or Authorized Agent Date LICEIIISED CO,NTIjACTOR'S DECLARATION T I"911y�affirm an der 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, nd my lic r(se is in full force and eXect. Liceesi%class License No Date ?h2 Contractor Signature WORKERS' G6W9NSATI0N DECLARATION .. ARIMIN3e FAILURE To TI SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN ED THOUSAND DOLLARS b766,600), IN ADDITION TO THE S1J �OPCOMPENS 0.TI ON;MANAGES AS PROVIDED FOR IN SECTION 3766 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES. I hereby affirm under penalty of perjury one of the following 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, fort performance of the work for which this permit is issued. Policy No. 11 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 ie of Agent Phone # certify that, in the performance of the work f r which this permit is' sued, 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 worker ' ompe ation�provissi/�}n�s of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. j iature of Applicant X , = / Date � I hereby affirm under penalty of perjuryXat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name / Lender's Address By 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 ordinan es and state ws relating to building construction. I authorize representatives of this city or county to enter t ab Iden d property for inspection purposes. [� Signature of Property Owner or Authorized Agent Print Property Owners or Authorized Agent's Name ' `-� ' C \ Date "Z Z ACTION DATE BY DECLARATION OF COMPLIANCE MTH CODE OF FOR OFFICE USE ONLY FEDERAL REGUL.ATIONSPART61 OF TITLE4©AND AQMD RULE 1403. PERMiTEXPIRED ❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMITEXTE,MDED ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PR POSED DEMOLITIO PERMIT FINAL a' CERTIFICATED€ SIGNATURE: OCCUPANCYISSUED