HomeMy WebLinkAboutX2021-0752 - PermitsCity of Newport Beach - Building Division
` e4 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
;... - Inspection Requests Phone (949)644-3255
'"uvmit Combination Type - CIP ELEC MECH
*X2021-0752* COMB Permit: X2021-0752
Project No: 0690-2021
Issued Date : 04/21/2021
Inspection Area : 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0412112024 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: 3601 JAMBOREE RD NB St: 1 FI: 2
Description: COMM TI "CBRE" (1800 SF) 2ND FLOOR CORRIDOR
Legal Desc.: N TR 12528 LOT 3
Owner: SK HART BAYVIEW LLC - Contractor: NOURSE M A INC Architect: DWYER SUSAN M�j�®
Address: PO BOX 11623 Address: 2822 WALNUT AVE SUITE E Address: 4770 CAMPUS DR
SALT LAKE CITY, UT 84147 TUSTIN CA 92780 NEWPORT BEACH CA 92660
Phone: Phone: 714.734.6074 Phone: 949-851-3080 State Lic:C033724 ......
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Applicant: RASKA JORDAN
Address: 4770 CAMPUS DR
NEWPORT BEACH CA 92660
Phone: 949.851-3080
Code Edit :
2019
Type of Construction:
I -A -SPR
Occupancy Group:
B
Added /New sq.ft. Bldg:
1800
Added /New sq. ft. Garage: 0
No of Stories:
6
No of Units :
0
Bldg Height:
0
Bldg Sprinklers:
Y
Flood Zone:
X
Building Permit Fee: $1,209.00
Plan Check Fee: $1,051.83
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$54.00
Energy Compliance:
$70.00
CA Seismic Safety:
$0.00
Disabled Access :
$100.00
Hazardous Mat
$0.00
Building Green Fee :
$4.00
TOTAL FEE: $3,562.29
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Con State Lie:
617556
Lie Expire:
04/30/2021
Bus Lie:
BT30075047
Lie Exp Date:
04/3012022
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9058832
Expire: 06/0112021
Building Setbacks
Excise Tax:
Additional Fee:
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: /
Front: /
Left: /
Right: I
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
$0.00
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$46.25
Fire Inspection:
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State Lie:
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Fire Plan Rev
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m em
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Demolition Fee
om c
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In -lieu Housing Fee:
oe000
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Public Works Department -
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$0.00
$0.00
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Grading Bond:
oomeoc
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San Dist: $0.00
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$248.69
$0.00
Planning Department -
Fire Department
$0.00
Plan check Fee:
$46.25
Fire Inspection:
$0.00
$0.00
Fair Share :
$0.00
Fire Plan Rev
$462.00
$0.00
SJH Trans :
$0.00
Demolition Fee
$0.00
In -lieu Housing Fee:
$0.00
Building Dept Adm
$0.00
$0.00
Public Works Department -
General Service
$0.00
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
PNJ Plan Check: $0.00
Grading Bond:
$0.00
$316.52
San Dist: $0.00
$248.69
NMUSD Fee: $0.00
$0.00
$0.00
$0.00
Plan Check Fee
: $1,993.04 Fee Due at Permit Issuance :
$1,569.25
PUBLIC WORKS APPROVAL:
_
PLAN CHECK BY:
APPROVAL TO ISSUE:
u
OWNER -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
:he permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Slate 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 for a permit subjects the applicant to a civil penalty of
iot 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,
3usiness 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
mprovements 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
mproved 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 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:
3y 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 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, iso%vailable 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
LICENSED COATNACTOR'S DECLARATION
}Ioefebjreffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 0 o Divisi n 3 of the Business and Pro sions de, and my 1'9¢ e is in full force
ano effect. Licenst"das License No Dat - ( �-- Contractor Signature � ? ,/% ; /.1,
QIO%K1!RS' COMPENSATION DECLARATION
VAJ NIN%: FAILURE�& 69tIRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED HOUSAND DOLLARS ($100,000), IN ADDITION TO THE
)OS& OF aOMPENSANISN, DAMAGES AS PROVIDED FOR IN SECTION 7706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm unser penally of perjury one of the following declarations:
..... ......
and will mal;tain 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 thr
)erformance of the work for which this permit is issued. Policy No.
ri Rave;and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this pe it i issued. My workers' compensalior
carrier 4M oTic number are: C'r[m a
%'aYIPf �e .1 �' u'�� Policy Number ` 7/ U ` 2 0 2r' Expiration Date LP / ! / -2,(
Jame of Agent Phone #
I certify that, in th pe ormance 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' compensate n laws of California, and agre(
hat, if I should beco a ubjec the worrkkers' pomp nation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of App, ✓�"L ' `� Dat 2-f 2�
)ECLARATION REGJFVINGtONSTRUCTION LENDING AGENCY
hereby affirm Vr pen ty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, ail Code).
.ender's Name Lender's Address
3y my signature �e Dw, 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 coQuntyy ordinances and state laws relating to building construction. /0�
I authorize representatives of this city or count enter h�bove-' e d property for inspection purposes. , / y
3ianature of Prooertv Owner or Authorized ADent �x� Print Property Owner's or Authorized Agent's Name X � Dat
ACTION DATE BY 7 I REGULATIONS OF COMT 61 LIANT CE E WITH
AND DE OF EDEERAL FOR OFFICE USE ONLY
PERMITEXPIRED I SUBMITTED ASBESTOS
PERMIT CANCELLED �( EPA
PERMITFINAL ASBESTO N TIFICATION IS NOTAPPLICA LE TO
CERTOCCUI PANTY OF
7.1-2 SIG OTURE: OLITI n 77