HomeMy WebLinkAboutF2022-0260 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIII II FIRE permit: F2022-0260
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 2 0 2 6 0 Project No : 1333-2022
l; _�,. n Permit Counter Phone (949)644-3288
v
Inspection Requests Phone (949)644-3255
Job Address: 30 BAFFIN BAY NB
Description: SFR FIRE SPRINKLER SYSTSEM 10 HEADS (X2021-1428)
Inspector Area: 5
Legal Description:
N TR 15851 LOT 23
- -
Owner: - HSIEH LEAH M
Contractor:
KELLY FIRE PROT INC Architect:
Address: 30 BAFFIN BAY
Address:
10141 THESEUS DR Address:
,
NEWPORT COAST, CA 92657
HUNTINGTON BCH CA 92646
Phone:
Phone:
714-907-7586 Phone: State Lic:
Applicant: KELLY FIRE PROT INC
Con State Lic:
878823 Engineer:
'
Address: 10141 THESEUS DR
Lic Expire:
08/31/2023 Address:
'
- HUNTINGTON BCH CA 92646
Bus Lic:
BT30070761
Phone: 714-907-7586
Lic Exp Date:
01/31/2023 Phone: State Lic:
Code Edit : 2019
Worker's Compensation Insurance Designer: KELLY SEAN
Type of Construction: V-B-SPR
Carrier:
AMERICAN FAM HOM INS Address: 10141 THESEUS DR
�-
Occupancy Group: R31U
Policy No:
2EA5WC000024603 HUNINGTON BEACH, CA 9264&
Added /New sq.ft. Bldg: 0
Expire:
0411112023 Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2
Issued Date: 0512312022 Special Conditions:
No of Units : 0
Setback- Front:
Flood Zone:
Rear:
Bldg Sprinklers: N
Left:
Right:
FEES
Construction Valuation: $2,200.00
Building PC Fee :
$222.00
Fire Residential Alarm PC Fee : $0.00 Records Management :
$2.00
Building Overtime PC Fee:
$0.00
Planning Counter Review: $0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee : $0.00
$0.00
Building Investigation Fee:
$0.00
$0.00
$0.00
Fire Plan Check Fee:
$0.00
Public Works PC Fee:
Fire Permit Fee :
$0.00
Public Works Traffic Plan Check Fee; $0.00
Building Permit Fee :
$269.00
TOTAL FEE :
$493.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance :
$493.00
PROCESSED BY:
OTHER DEPARTMENT:
ZONING APPROVAL:
PLAN CHECKED BY::
FIRE APPROVAL:
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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 checkmark(s) I have placed nextto 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 L) all of or L) 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 th? PurpoPe of sale).
I, as owner or 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
Lppry to an owner ,f 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 exempr from licensure under the Contractors' State License Law for the following reason:
Gy r,iy 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 dtructure thit I haae 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, 's available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Prooerty Owner or Authorized Agent Date
1_2EXSED CONTRACTOR'S DECLARATION
Iti,rs 7; 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 dff^rt.
L.ce❑se -;lass _ License No Date 3 Z Contractor Signatur -
ViIQRxFRS' COMPENSATION DECLARATION
WARNINCi FAILURE.TO S,=RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA LARS ($100,000), IN ADDITION TO THE
COST OF COMPENSAI ION, DAMAGES AS PROVIDED FOR IN SECTION 3700 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, for the
performance 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 Agent
Date
I certify that, in the performance 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
it, if I should become subject tolhe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prpv)sions.
nature of Applicant Date -7-L
CLARATION REGARDING NSTRU ON L IN AGENCY
areby affirm under penalty of perjury that the s a co truction lending agency for the performance of the work for which this permit is issued (Se lion 3097, Civil Code).
ider's Name Lender's Address
my signature below, I certify to each of o owing:
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 ordi antes and state laws relating to building construction.
I authorize representatives of this city or couN }/d an the abov�lemified property for inspection purposes.
nature of Property Owner or Authorized Agent X /N✓//4� ' Print Property Owner's or Authorized Agent's Name —L
ACTION
DATE V
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USEONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMIT EXTENDED
❑ ASBESTOS N07IACATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
Z
CERTIFFCATEOF
SIGNATURE:
OCCUPANCYISSUED