HomeMy WebLinkAboutF2021-0477 - Permitsy o�� ty of Drive,
Newport Beach BacnBuilding
uisdi og Division
o F �20� �2��� I0� 4��I I7� II
•_ Permit Counter Phone (949)644-3288
Job Address: 1221 BERKSHIRE LN NB
Inspector Area: 3
Owner:
PHAN PHUOC
Address:
3 GRASS VALLEY
IRVINE CA 92602
Phone:
714-478-7334
Applicant:
VU ANTHONY
Address:
9559 NIGHTINGALE AV
FOUNTAIN VALLEY CA 92708
Phone:
714-234-9633
Code Edit : 2019
Type of Construction:
V-B-SPR
Occupancy Group:
R3/1.1
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
1
No of Units:
0
Flood Zone:
X
Bldg Sprinklers:
I r.
Y
Construction Valuation
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee:
Building Investigation Fee
Fire Plan Check Fee:
Fire Permit Fee,
Building Permit Fee
TOTALFEE:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL
$6,100.00
FIRE Permit: F2021-0477
Project No: 2385-2021
Inspection Requests Phone (949)644-3255
Description: SFR FIRE SPRINKLERS (X2020-2588) 32 HEADS
Legal Description: N TR 3031 LOT 18
Contractor:
(FIRE PROTECTION
Architect:
Address:
9559 NIGHTINGALE AVE
Address:
FOUNTAIN VALLEY CA 92708
Phone:
714-234-9633
Phone:
Con State Lic:
1038755
Engineer:
Lic Expire:
04/30/2022
Address:
Bus Lic:
BT30067240
Lic Exp Date:
05/3112022
Phone:
Worker's Compensation
Insurance
Designer:
Carrier:
EXEMPT
Address:
Policy No:
no employees
Expire:
Phone:
Issued Date: 10/11/2021
Special Conditions:
Setback- Front:
Rear:
Left:
Right:
FEES
State Lic:
State Lic:
VU ANTHONY
9559 NIGHTINGALE AV
FOUNTAIN VALLEY.. CA 92708
$222.00
Fire Residential Alarm PC Fee :
$0.00 Records Management
$0.00
Planning Counter Review:
$0.00
$0.00
Planning Zoning PC Fee :
$0.00
$0.00
$0.00
Public Works PC Fee :
$0.00
$0.00
Public Works Traffic Plan Check Fee;
$0.00
$269.00
$495.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance
OTAth 139PrARTM91KITt oo o
a a
PLAIJ43F�OKED Bdt:
APPROVAL TO ISSUE:
4iv0 4' a9
9
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST hoALIDoVNSaECTlO�N
$4.00
$0.00
$0.00
$495.00
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 isheckmark(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 sale 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
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 legalh
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 Sectision 3 of the Business an Pr fessions Code, and my license is in full farce
and effect. Contractor Signature License Class License No Date
WORKERS' COMPENSATION DECLARATION
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 th
oerfRrmance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
Policy Number
of
Date
cehity that, in the pefforance 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 agre
that, if I should beco u j ct to \ eusation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. I I ature of Applicant Date d Z�:>
DECLARATION REGA ONSTRUCTION LENDING AGENCY
I 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).
Lender's Name Lender's Address
By my signature below, I certify to each of the "ordinances
I am the property owner or authorized to aowner's behalf.
I have read this application and the informed is correct.
I agree to comply with all applicable city aces and state laws relating to building construction.
I authorize representatives of this city or cparty for inspection purposes._nSignature of Property Owner or Authorized AgPrint Property Owner's or Authorized Agent's Name AJ1��� Date ) O )
AC77ON
DATE
BY
DECLARATION OF COMPLIANCE MTH CODE OF
FOR OFFICE t SE ONLY
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