HomeMy WebLinkAboutF2018-0130 - Permitsv.
nv� City of Newport Beach - Building Division
a 100 Civic Center Drive, Newport Beach, CA 92660
F ail Permit Counter Phone (949)644-3288
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v
Job Address: 4301 JAMBOREE RD NB
Inspector Area: FIRE
Owner: THE PICERNE GROUP
Address: 5000 BIRCH ST, STE 600
NEWPORT BEACH CA 92660
Phone: 949.487-6262
Applicant:
SUNDANCE FIRE PROT
Address:
3225 E POST RD
LAS VEGAS CA NV 89120
Phone:
702-458-8600
Code Edit: 2016
Type of Construction:
Occupancy Group: U
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 0
No of Units : 0
Flood Zone:
Bldg Sprinklers: N
Construction Valuation:
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee:
Fire Plan Check Fee:
Fire Permit Fee :
Building Permit Fee:
TOTALFEE:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
0
0
$751,300.00
FIIIILIIII IILIIIII II ISII VIII �I0 II
FIRE Permit: F2018-0130
Project No : 0509-2018
Inspection Requests Phone (949)644-3255
$0.00 Fire Residential Alarm PC Fee : $0.00 Records Management: $2.00
$0.00 Planning Counter Review: $0.00
$0.00 Planning Zoning PC Fee: $0.00
$0.00 $0.00
$355.00 Public Works PC Fee : $0.00 $0.00
$362.00 Public Works Traffic Plan Check Fee; $0.00
$0.00
$719.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $719.00
OTHER DEPARTMENT:
PLAN CHECKED BY::
r ✓ 7 APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Description: COMM - FIRE WATER SERVICE LINE FROM BACKFLOW TO Su
F i
Legal Description:
N TR 7953 LOT 2�',
k x+
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Contractor:
Address:
SUNDANCE FIRE PROT
3225 E POST RD
Architect:
Address:
V
�' r
_
LAS VEGAS CA NV 89120
4t.
Phone:
702-456-8600
Phone:
State Lie:
� „
Con State Lie:
805026
Engineer:
Lie Expire:
07/3112018 -
Address:
Bus Lie:
BT30060139
Lie Exp Date:
08/3112018
Phone:
State Lie:
Worker's Compensation
Insurance
Designer:
SUNDANCE FIRE
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°
Carrier:
TRAVELERS PROP
Address:
1060 N BATAVIA ST, STE D
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Policy No:
UBOK418002
ORANGE CA 92867
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Expire:
11/1212018
Phone:
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Issued Date: 03/0212018
Special Conditions:
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Rear:
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Right:
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$0.00 Fire Residential Alarm PC Fee : $0.00 Records Management: $2.00
$0.00 Planning Counter Review: $0.00
$0.00 Planning Zoning PC Fee: $0.00
$0.00 $0.00
$355.00 Public Works PC Fee : $0.00 $0.00
$362.00 Public Works Traffic Plan Check Fee; $0.00
$0.00
$719.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $719.00
OTHER DEPARTMENT:
PLAN CHECKED BY::
r ✓ 7 APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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 next to the applicable item(s)
lection 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
m 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 ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
',usiness 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
n roved for the purpose of sale).
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 not
pply 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 Contractors' State License Law for the following reason:
,y 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
ell 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
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.ieginfo.ca.gov/calaw.html.
ignature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby 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 P fe a' ns Code, and my liq �Se is in full force
nd effect. � W//�/�_�.
icense Class License No Date ,C� G / , _ _ Contractor Signature /ii,%% a
✓ORKERS' COMPENSATION DECLARATION
...
ISRNING: FAILURFF�� TQQ$$E�CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HONORED THOUSAND DOLLARS (E100,000), IN ADDITION TO THE
OST OF COMPEUATT0 , DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
....
LIlave and•wil.redintain 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
ante of the work for which this permit is issued. Policy No.
Ile and d✓iW ji'laidtain 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' compensation
mace carrier and policy number are:
ursiec . Policy Number Expiration Date
Phone #
2Rify that, in.the pgrforman��ee of the work for which 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
e t should tPepome subbieftopofhe workers' compeptobn provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions/
nature of Applicant /b' Date
CLARATION REG DING CO TION LENDING AGENCY.
:reby 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
ider's Name Lenders Address
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 co ordinances and stat s relating to building construction.
I authorize representatives of this city or co y l� en the abo�v�e1-ide led property for inspection purposes.
nature of ProDertv Owner or Authorized n ///.Ale%/r/ �9ir� Print Property Owner's or Authorized Agent's Name
ACTION DATE BY
UtLLAKA ftVN Ur wAvrUAPn.0 VVIIn wuc Vr
FEDERAL REGULATIONSPART 67 OFTIILE40AND
AQMD RULE 1403.
PERMIT EXPIRED
I SUBMITTEDASSESTOS M071FICATION TO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMITEXTENDED
-
❑ ASBESTOS U071FICATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMITFINAL
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED
Civil Code).
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