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Home My WebLink AboutF2023-0223 - PermitsaEWPo�r City of Newport Beach II II I IIIII I IIIIIII IIIIIIIIIII IIIIIIIIIIIII II COMB Permit: F2023-0223 o� Community Development Department- Building Division F 2 0 2 3 0 2 2 3 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2023-1116 D Y4 S Permit Counter Phone: (949) 718-1888 Issued Date : 05115/?�023 newportbeachca.gov/civic ,� cgCtFORN�P Combination Type - Inspection Area /^[Z Work Class - Other i(l l� PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS Job Address: 393 HOSPITAL RD, NORTH Legal Desc : A TR IRVINE SUB BLK 2 LOT 169 IRVINE SUB LOT 169 BLK 2 FOR O F LOT AS DESC IN Description: COMM TWO WAY COMMUNICATION SYSTEM "ATRIA" Owner: NEWPORT BEACH PROPCO LP Address: PHOENIX, AZ 85050 Phone: (916) 5DB-9801 Applicant: SAM AMICAY Address: 15531 Container Lane Huntington Beach, CA 92649 Phone: (714)902-8000 Owner/Builder : Address: Phone Code Edition : 2022 Type of Construction Occupancy Groups: Bldg Height: Building Setbacks: Flood Zone : X Use Zone : PI - Private Institutions j PROCESSED BY: SPECIAL CONDITIONS: Contractor: SAM AMICAY Address : 15531 Container Lane Huntington Beach, CA 92649 Phone : (714) 902-8000 Con State Lic : 612153 Lic Expire : 02/28/2025 Bus Lic: BT30066217 Bus Lic Expire : 02/28/2024 Workers' Compensation Insurance Carrier: INS CO OF THE WEST Policy No : WSD500658012 W. C. Expire : 7/1/2023 Fire Sprinklers : NO Fire Hazard Zone : NO No of Units : 0 No of Stories Architect Address Phone: State Lic Engineer: Address : Phone Designer: SAM AMICAY Address : 15531 Container Lane Huntington Beach, CA 92649 —...� Phone: (714)902-8000 Construction Valuation : $5,700.00 Added/New/TI sq. ft. Bldg: 0_j Alteration sq. ft. Bldg : 6^� Added/New sq. ft. Garage: 0 TOTAL sq. ft.: 0 0p,� ^^ Di OWNER -BUILDER DECLARATION I hereby affirm under penally of perjurythat 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 Items) (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 Low (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 (S500). 111, 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. Ir, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was nor 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' Stale License Law does not apply to an owner of property who builds or Improvesthereon, 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 most have resided for at least one year prior to completion of the improvements covered by this permit, I cannot logalh sell a structure that I have builtas an owner -builder if It has not been constructed in its entirety by licensed contractors. 1 understand that a copy of the applicable I w action 7044 of the Business and Professions Code, is available upon request when this application is submitted orat the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property owner or Authorized Agent oat LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (Commencing with Section { 3 of the Business and Pro , n y license it In full force and effect. License Class License No Date l Contractor Signa re WORKERS' COMPENSATION DECLARATION WARNING: 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 (E100,000).114 ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1N SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to solf-insure for workers' compensation, Issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Cade, forth p ormance of the work for which this permit is issued. Policy No.. a and will maintain workers' compensation insurance, as required by $action 3700 of the Labor Code. for the performance of the work for which this permit is issued. My workers' componsatioi insurance carder and policy number are: Carrier Policy Number Expiration Date Name of Agent _ Phone # ❑I certify that, in the pawn nee of the rk for w is 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 agm that, if I should becom sub rkers' p anon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Appliva Dal DECLARATION RE R _ TION LTOING AGENCY .�. I hereby affirm under Beatty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 CI II 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 1�nronarty Owner's behalf. I have read this application and the i anon I have vided Is .ct. I agree to comply withal[ appkcab city and coumy or aI a state laws relating to building construction. I authorize representatives of this city or count a-ide Ified pro Fly for Inspection purposes. Signature of Property Owner or Authorzed A t Print Property Owner's or Authorized A en ' am ACTION DATE BY C: CLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 DF TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED (SUBMITTED ASBESTOS NOTI WATION 1 O PERMIT FX 5'1OEO _ TI'LJAQMD PERMIT fINA1 �. (V��YL12{� t,,,r ASBESTOS NOT7EICA1 ION 15 NOT APPLICA8L£ TO CERTIFICATE OF PROPOSED DEMOLITION OCCUPANCY ISSUED I SIGNATURE: