HomeMy WebLinkAboutXC2023-0341 - PermitsaEwPoRT City of Newport Beach 111111p11111111111 ll11p1111111111111111111111111111111COMB Permit : XC2023-0341
C� A Community Development Department- Building Division
100 Civic C nter Drive, Newport Beach, CA 92660 Plan Check No: PC2023-2116
S Permit Cou ter Phone: (949) 718-1888
Issued Date : 09/08/2023
f� newportbe chca.gov/civic
c r Final Date:
9�/F00.H� Combinati n Type - Permit Status: Issued
Work Cla - Tenant Improvement Inspection Area : 7
PERMITS EX IRE 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 BIRCI ST Legal Desc : P BK 181 PG 13 PAR 5
Description: COMM TI- EW CEILING SYSTEM/GRID & ACOUSTICAL TILES "CLEARWATER LIVING" 3680 SF
Owner:
JOHN HANCC
USA
Address :
865 S FIGUEF
LOS ANGELE
Phone :
(949) 757-039
Applicant :
JESSICA SMA
Address :
4770 CAMPU:
NEWPORT BE
Phone:
(949)851-308'
Owner/Builder
:
Address :
Phone
Code Edition :
Type of Construction : II-/
Occupancy Groups: B
Bldg Height:
Building Setbacks
Flood Zone : X
Use Zone : /PPCC
PROCESSED BY: I.
SPECIAL CONDITIONS:
LIFE INSURANCE COMPANY Contractor: JLC ASSOCIATES INC
A ST STE3320
CA 90017
DR, STE 100
NCH, CA 92660
Koll Center
Address : 3198 A AIRPORT LOOP DR
COSTA MESA, CA 92626
Phone:
(949)241-4430
Con State Lic
: 645576
Lic Expire :
05/31/2024
Bus Lic:
BT30053881
Bus Lic Expire : 01/31/2024
Workers' Compensation Insurance
Carrier: INS CO OF THE WEST
Policy No: WVE504521604
W. C. Expire : 1/1/2024
Fire Sprinklers :
Fire Hazard Zone
No of Units :
No of Stories
WORK UNDER E2023-0573
Architect: DWYER SUSAN M
Address: 4770 CAMPUS DR NEWPORT BEACH, CA
92660
Phone: (949)851-3080
State Lic :
Engineer: ALI SAFAIAN
Address : 1920 Main St
Irvine, CA 92614
Phone: (317)453-7280
Designer:
Address :
Phone:
YES Construction Valuation :
$85,000.00
NO Added/New/TI sq. ft. Bldg :
0
0 Alteration sq. ft. Bldg :
3,680
Added/New sq. ft. Garage:
0
TOTAL sq. ft. :
0
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable items)
(Section 7031-5. Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
the permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant flora permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($SDO).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_y 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 L'ontmrters' State Urense 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).
❑ 1, 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 properly who builds or improvesthereon; and who contracts for the projects with a licensed Contractor pursuant to the Contractors State License Law).
0 I am exempt from licensure under the Contractors' Stata 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 legali)
sell a structure that I have built as an owner-buildor if it has not been constructed in its entirety by heonsed contractors. I understand that a copy of the applicable law, Section 70144 of the Business a
Professions Code, is available upon request when this application is submitted or at the following Web site:httpitiwww.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 (commending with Section 70 f Div' ion of the Business and Profes ode, a tic full force
and effect. License Class License No Date Contractor Signatu
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 E10 , o), IN ACCITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
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
Imance 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: A
Policy Number
of Agent
certify that, in the performance of the work for whic>08 permit
if I should become subject to th_P workers' dompOvation prove
of Applicant
Date
I shall not. employ any person in any manner so as to become subject fo the workers' compensation laws of California, and agre
7
n 3700 of the Labor Code, I shall forthwith comply with those provisions. Da�
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).
antlers Name Lori Address
ly my signature below, I oetgfy 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 courtly ordinances and stat ws r to b ilding construction.
I authorize representatives of this city or count. to enter;he above Id ' ie ape mspectlon purposes. A n A.
ACTION
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PEPoWIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
or Authorized Apart. x/ L ///% _. _11 Print
5 7ZSl C
REGULATIONS PART 61 OF TITLE 40 AND AQNID RULE
1403
. 15URPITT ED ASBE. 10J NOTle;C.'MC)'1 TO
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PROPOSED
NOTIFICATION 15
FOR OFFICE USE ONLY