HomeMy WebLinkAboutF2018-0129 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
H Permit Counter Phone (949)644-3288
Job Address: 4201 JAMBOREE RD NB
Inspector Area: FIRE
Owner:
THE PICERNE GROUP
Address:
5000 BIRCH ST, STE 600
N TR 7953 LOT 2
NEWPORT BEACH CA 92660
Phone:
949487-6262
Applicant:
SUNDANCE FIRE PROT
Address:
3225 E POST RD
$355.00
LAS VEGAS CA NV 89120
Phone:
702458-8600
Code Edit : 2016
Type of Construction
Occupancy Group: U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
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:
$0.00
FIRE Permit: F2018-0129
Project No: 0508-2018
Inspection Requests Phone (949)644-3255
FEES
$0.00
Description: COMM -
FIRE WATER SERVICE LINE FROM BACKFLOW TO SUPPLY
Legal Description:
N TR 7953 LOT 2
$0.00
Contractor:
SUNDANCE FIRE PROT
Architect:
Address:
3225 E POST RD
Address:
$355.00
LAS VEGAS CA NV 89120
$0.00
Phone:
702458.8600
Phone: State Lie:
Con State Lie:
805026
Engineer:
Lie Expire:
07/31/2018
Address:
Bus Lie:
BT30060139
Lie Exp Date:
08/31/2018
Phone: State Lie:
Worker's Compensation Insurance
Designer: SUNDANCE FIRE
Carrier:
TRAVELERS PROP
Address: 1060 N BATAVIA ST, STE D
Policy No:
UBOK418002
ORANGE CA 92667
Expire:
11112/2018
Phone:
Issued Date: 03102/2018
Special Conditions:
Setback- Front:
Rear:
Left:
Right:
FEES
$0.00
Fire Residential Alarm PC Fee:
$0.00
$0.00
Planning Counter Review:
$0.00
$0.00
Planning Zoning PC Fee:
$0.00
$0.00
$355.00
Public Works PC Fee :
$0.00
$362.00
Public Works Traffic Plan Check Fee;
$0.00
$0.00
$719.00
Plan Check Fee:
$0.00
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
Records Management
Fee Due at Permit Issuance
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
0 0
meoemo
0 0
$0.00
$0.00
$719.00
)WNER-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 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
is 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
Irofessions 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).
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 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 intendedror 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).
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
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:
ly 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 coveted 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.leginfo.ca.gov/calaw.htmi.
signature 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 tion 7000) of Division 3 of the Business and Prof lns Code, and my licen ' in full force
nd effect. ....
icense Class • License No Date — Contractor Signature r
GQMEIRS' CSMP€NSATION DECLARATION
ARNING:•FAILURE�•r�•SECLIRE 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
OGT ORCOMPENSATIO11,UAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm undLr penalty of perjury one of the following declarations:
11 a
24e and t✓ill•�intain 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
0 o nce of the work for which this permit is issued. Policy No.
..
0 and wfl4 Ai*in 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' compensatior
19 Ace carrier and policy number are:
Policy Number
e oT Agent*
_
Date
the work for which this mit is issued, I shall not employ any person in any manner so as to become subject to the workers'
workers' compensaf'porovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Of
3reby 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)
ider's Name Lender's 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 correc
I agree to comply with all applicable city and countypprdinances and st laws relating to building construction.
I authorize representatives of this city or county tonVthe above -id fled property for inspection purposes. X ® r
of Prooertv Owner or Authorized
f:Gr1191sT!
DATE I BY
I PERMIT€XPIR€D I I I
PERMITCANCELLED
,RMIT EXTENDED
OCCUPANCYISSUED.
❑ f SUBMITTED ASBESTOS M077FICATION TO.
13 EPA
❑ AOMD
❑ ASBESTOS NO77RCANONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE.
laws of California, and
Date
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