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Home My WebLink AboutXC2022-1982 - Permits04'. City of Newport Beach II IIII I I II I II I III III I I I II Community Development Department- Building DivisionCOMB Permit:XC2U22-1982 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2022-1738 Permit Counter Phone: (949) 644-3288Inspection Requests Phone: (949) 644-3255Issued Date : 10/O6/2022 newportbeachca.gov/inspections Inspection Area : 7 Combination Type - Work Class - Tenant Improvement 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 : 1901 WESTCLIFF DR Legal Desc : N TR 4225 BLK LOT 4 TR 4225 LOT 4(AND SELY 110 FT LOT 3 Description: COMM'MARINERS MEDICAL ARTS REHAB" (N) 110 SF TRASH ENCLOSURE Owner: BUMHAM WARD PROPERTIES LLC Address : 1100 NEWPORT CENTER DR STE200 NEWPORT BEACH, CA 92660 Phone : Applicant: SIEGLINDE PUKKE Address: 414B ANACAPA ST, 101 SANTA BARBARA, CA 93101 Phone: (805)455-0445 Owner/Builder : Address : Phone Code Edition : Type of Construction Occupancy Groups: Bldg Height: Building Setbacks Flood Zone Use Zone : PROCESSED BY: 2019 V-B U X CG - Commercial General 61•lxyr_1111111111101.111Bib Il 163 Contractor: DEMPSEY CONSTRUCTION INC Address : 1835 ASTON AVE - CARLSBAD, CA 92008 Phone : (760) 918-6900 Con State Lie : 945467 Lie Expire : 09/30/2024 Bus Lie: BT30061965 Bus Lie Expire : 01/31/2023 Workers' Compensation Insurance Carrier: NATIONAL UNION FIRE Policy No : 013588226 W. C. Expire; 9/1/2023 Fire Sprinklers : NO Fire Hazard Zone : NO No of Units : 1 No of Stories : 1 Architect : DONALDSON ROBERT STUART Address : 3890 LA CUMBRE PLAZA LN #200 SANTA BARBARA CA 93105, CA 93105 Phone: (805)682-7000 State Lie: Engineer: NELSON WILLIAM MC KEE Address : 8951 RESEARCH DRIVE #200 IRVINE, CA 92618 Phone: (949)752-2070 Designer Address Phone: Construction Valuation : $5,000.00 Added/New/Ti sq. ft. Bldg Alteration sq. ft. Bldg : 110 Added/New sq. ft. Garage : 0 TOTAL sq. ft. Bldg : 110 OWNER -BUILDER DECLARATION Ill 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 checkmadc(s) I have placed next to the applicable Item(. (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 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 '.. not more than five hundred dollars ($500). ❑ 1, 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 cr 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, jr, 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 bull) or improved for the purpose of sale). 0 I, 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 net 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). El 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 must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an ovmor-builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 70" of the siness and Professions Code, is available upon request when this applicator is submitted or at the following Web site:http:lfw .leginto.ca.govlcalaw.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 Secilo 0) of Me n 3 of the Business and Priivsions an41n force land effect License Class License. No Dat i ZOrA. Contractor Signalur WORKERS COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, Me SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AMID ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 7 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 th �r,rav o�r'formance of the work for which this permit is issued. Policy No. L11 e 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' compensatiol isurance carrier and policy number are: :artier o icy N bar Expiration Date lame of Agent Phone # 31 certify that, in the performance t e work for is t ermit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and ogre rat, If I should become subject to I. w,e¢icers' co p provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant Date %�2,�'t yECLARATIpN REG t NSTRUCTIO ING AGENCY' hereby affirm under p alty perjury that re Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097, Civil ode). .ender's Name Lender's Address ly my signature below, I Certify to each of the following: I am the, property owner or authorized to act on the o arty o ier's shelf. I have read this application and the information I h e rovid is tract. I agree to comply with all applicable city an c IT or 'nan state laws relating to building construction. I authorize representatives of this city br c t e th -id ifled property for inspection purposes. �R'L (`p -a (�J o signature of Property Owner or Authorized Ag it Print Property Owner's or Authorized Agent's Name Cate N r ACTIONDATE. BV ; DECLA €D F COMPLIANCE W174 CODE OF FEDERAL FOR OFFICE USE ONLY RFGLA,41ONS PART61 OF TITLF40 AND AGMD RULE 1403 PERM1r EXPIRED I SUBMITTED ASBESTOS NO ICATI TO _ PERILIlr L4rJCF1LED � ' CPA PER NiT EXTENDED MO PERPrirT FINAL 6` ` 2 fL {rjr'L5 ASBEST TIFdC t IS p ABLE TO OCCUPANCY ICERTIFICATE ISSSUED j_SIGNAT'UR i F PROPOSED OUT L