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Home My WebLink AboutX2022-0907 - PermitsCity of Newport Beach - Building Division r„aT 100 Civic Center Drive, Newport Beach, CA 92660 f~ Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - CIP MECH ELEC PLUM 11IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 111 COMB Permit: X2022-0907 x 2 0 2 2 0 9 0 7 Project No : 0837-2022 Issued Date : 0610912022 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY OR PERMIT WILL BE INVALID Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 5020 CAMPUS DR NB St: 1 FI: 1 Unit: 200 Description: COMM TI FOR MEDICAL CLINIC 3,251 SF "UNITED MD" , Legal Desc.: N TR 9626 LOT 9 , Owner: NEWPORT CAMPUS LLC Contractor: COLUMN 4 CONSTRUCTION CO. Address: 4701 VON KARMAN AVE STE100 Address: 4701 VON KARMAN AVE STE 100 NEWPORT BEACH, CA 92660 NEWPORT BEACH, CA 92660 Phone: 949-263-1920 Phone: 949-420-1601 Applicant: SCHAFER MICHAEL K Con State Lic: 992770 Address: 23112 ALCALDE DR STE#B Lic Expire: 0513112024 LAGUNA HILLS CA 92653 Bus Lic: BT30067755 Phone: 949-584.5426 Lic Exp Date: 06/30/2022 Code Edit : 2019 Worker's Compensation Insurance Type of Construction: V-B-SPR Carrier: STATE COMP Occupancy Group: B Policy No: 9099527 Added /New sq.ft. Bldg: 0 Expire: 05/14/2023 Added /New sq. ft. Garage: 0 No of Stories: 1 Building Setbacks Rear: I No of Units : 0 Front: / Bldg Height: 0 Left: / Bldg Sprinklers: Y Right: I Flood Zone: X Use Zone: Parking Spaces. 0 11 Construction Valuation: $396,000.00 Building Permit Fee: $3,040.00 Plan Check Fee: $2,644.80 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $62.00 Energy Compliance: $277.20 CA Seismic Safety : $0.00 Disabled Access : $396.00 Hazardous Mat $0.00 Building Green Fee : $16.00 TOTAL FEE: $9,683.83 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Architect: SCHAFER MICHAEL K " Address: 23112 ALCALDE DR STE#13 LAGUNA HILLS CA 92653 Phone: 949-584-5426 State Lic:C013366 Engineer: "' • . Address: Phone: State Lic: Designer: Address: , Phone: Special Conditions: Excise Tax: $0.00 Planning Department - Additional Fee : $357.00 Plan check Fee Grading Bonds Fee: $0.00 Fair Share: Grading PC Consultant : $0.00 SJH Trans : Grading Permit Fee: $0.00 In -lieu Housing Fee Grading PC Fee: $0.00 Public Works Department - WQ Insp. Fee: $0.00 Park Dedication : $0.00 PAN Plan Check: $0.00 Electrical %: $795.87 San Dist: $0.00 Mechanical %: $625.33 NMUSD Fee: $0.00 Plumbing %: $511.63 Plan Fire Department $52.00 Fire Inspection: $0.00 $0.00 Fire Plan Rev $97.00 $0.00 Demolition Fee $0.00 Building Dept Adm $26.00 General Service $219.00 Refund Deposit $564.00 Grading Bond: $0.00 $0.00 $0.00 $4,626.23 Fee Due at Permit Issuance: $5,057.60 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: OWNER -BUILDER DECLARATION 1 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 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 ie 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 'rofessions 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 of more than five hundred dollars (S500). 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 intended or offered for sale (Section 7044, lusiness 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 nprovements 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 nproved for the purpose of sale). I, as owner cf'he property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not pply to an owner of nroperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). I er^. exempt f= licensure under the Contractors' State License Law for the following reason: Iy my signatures 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 legalll III 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 'rofccsions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. ignature of Property Owner or Authorized Agent Date .ICF.N'SED CONTRACTOR'S DECLARATION hereby affirm u, ioer penalty Gf,perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 7 00) of Division 3 of the Business and Prpl�j6sions C CEO, and my license is in full force nd effect. Lice.i.,c Class 1"S License No Q rl �/�7 Jl Date Contractor Signatw�{ea VORKERS' COdIPENSATION DECLARATION �Ta V N FAKNING. FAILURE' O SLLURE 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 DST OF COMPENSATION, nAMAGES 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: I have and WE 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 thI erformance of the work for which this permit is issued. Policy No. 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' of Agent Policy Number Expiration Date Phone # 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 agre :hat, if I should becoEA bject tot a workers' compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with those provisions. /' p Signature of ApplicaCatDECLARATION RE G CONSTRUCTION LENDING AGENCY hereby affirm under nalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Ci I Code). -ender's Name Lender's Address 3y my signature below, I certify 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 county ordinances and state laws relating to building construction. I authorize representatives of this city or Cou n� r)]�, enter h bove-identified property for inspection purposes. ��// Signature of Property Owner or Authorized Agent X-- Print Property Owner's or Authorized Agent's Name+' JS' PT` �V/ADa./7- ACTION DATE BY RATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA PERMIT EMENDED ACM D PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED �7� -�'�/ EST N TIFICATIO IS NOTAPPLICABLE TO PROPOSED OUTDO _ SIGNATURE: