HomeMy WebLinkAboutXC2023-0250 - PermitsEwPo City of Newport Beach
Community Development Department -Building Division
eT Y P x c z 0 z 3 9 z 6 9 COMB Permit : XC2023-U250
� e
? Ong 100 Civic Center Drive, Newport Beach, CA 92660 c'a 1 s^�..-«: P• „-� Plan Check No: PC2023-1645
u �? Permit Counter Phone: (949) 718-1888
Issued Date : 89/21/2923
o- newportbeachca.gov/civic Final Date:
c9�/F00.��p Combination Type - ELEC MECH PLUM Permit Status: Issued
Work Class - Tenant Improvement Inspection Area : 7
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 : 5000 BIRCH ST (EAST TOWER), 405
Legal Desc : P BK 181 PG 13 PAR 5
Description
: COMM TI - SPEC SUITE 2107 SF
Owner :
JOHN HANCOCK LIFE INSURANCE COMPANY
Contractor: CREW BUILDERS INC
Architect : DWYER SUSAN M
USA
Address :
865 S FIGUEROA ST STE3320
Address : 6191 CORNERSTONE STE 101
Address : 4770 CAMPUS DR NEWPORT BEACH, CA
LOS ANGELES, CA 90017
SAN DIEGO, CA 92121
92660
Phone :
(949) 757-0397
Phone : (619) 587-2033
Phone: (949) 851-3080
Con State Lic : 753428
State Lic
Lic Expire : 04/30/2025
Applicant :
JESSICA SMARKER
Bus Lic : BT30082651
Engineer
Address :
4770 CAMPUS DR, STE 100
Bus Lic Expire : 09/30/2024
Address
NEWPORT BEACH, CA 92660
Phone:
(949) 851-3081
Workers' Compensation Insurance
Phone:
Carrier: ZURICH AMERICAN INSURANCE COMPANY
Owner/Builder
:
Policy No : WC380497501
Designer:
Address :
W. C. Expire : 10/1/2023
Address:
Phone:
Phone:
Code Edition :
2022
Fire Sprinklers :
YES
Construction Valuation :
$147,490.00
Type of Construction :
I -A
Fire Hazard Zone :
NO
Added/New/Ti sq. ft. Bldg ;
0
Occupancy Groups :
B
No of Units;
0
Alteration sq. ft. Bldg
Bldg Height :
No of Stories :
6
Added/New sq. ft. Garage:
0 .
TOTAL sq. ft.
0 -
Building Setbacks
Flood Zone :
X
•... , , , , - ,
Use Zone :
PC - Koll Center
PROCESSED BY:
"
SPECIAL CONDITIONS:
OWNER -BUILDER DECLARATION
I hereby allirm 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
:he permit to file a signed statement thathe or she is licensed pursuant to the provisions of the Contractors' Slate 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 licensors 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
rot more than five hundred dollars ($500).
1 I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intendedor 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. IL 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
unproved for the purpose of sale),
I, as owner of the properly„ am exclusively contracting with licensed Contractors to construct the project (Section 7D44, 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 ContractorsSlate 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 legallt
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:llwww.legnfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Delta
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 0) of Division 3 of the Business and Prate o d my license is in full force
and effect. License Class License No Date r contractor Slgnatur
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AD CIVIL FINES UP TO ONE HUNDRED TNOU RS (f100,0001, IN ADDOION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION V06 OF THE LABOR CODE, INTEREST, ANO ATTORNEYS 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, for lb
PP�pp�K�Trmance of the work for which this permit is issued. Policy No.
ll/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' componsatioi
m rance carrier and policy number are:
is of Agent _
certify that, in
. if I should be
of
Policy Number
Date
this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calf mia, and agrai
rovtalons of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. J / /
Date
Cl ARATION REG RDING CONSTRUCTION L DING AGENCY
:reby affirm under p alty of perjury that (here ' construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
.der s Name Lender's Address
my signature below, I certify to each of the following:
I am the prope-hj ),vner or authorized to acton the property owner's behalf.
I have read thisannlication and the information I have provided Is correct,
6 se fir 1, r�
Sre to ecmOly with all applicable city and unty ordinan relating to building construction.
I au-thorize repasen atives of this city or county a -identified p erty for inspection purposes. <
. , . „f or. r.., ,.r A th rl,ad Anent Print Prooertv Owner's or Authorized Agent's Name
DATE By r DECLARATION OF C PLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
T 61 OF TITLE 40 AND AOMD RULE
_,1Eh;N1, �XP/RED' _ I I I L.1I SUBMITTED A53ESTOS WTIFICATION TO
__—__ _
'.Y1 _- ENDE!` frID
P .,7:L 1 fNAL iZ, `Z ' ESTOS NOTIFICATION IS NOT APPLICABLE TO
ERTIFIC'dE OF P OPOSED DE
OCCUAMICYf550FG _--1- ��,^.IG"IA_F.,_.._
Dat!�z/�