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Home My WebLink AboutX2020-1699 - Permits/ City of Newport Beach - Building Division ' - 100 Civic Center Drive, Newport Beach, CA 92660 h Permit Counter Phone (949)644-3288 r"i n Inspection Requests Phone (949)644-3255 e"'ttre,w++ Combination Type - CIP ELEC MECH PLUM IIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIu11 II COMB Permit: X2020-1699 Project No: 1341-2020 Issued Date : 09/1012020 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0911112023 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: 4631 TELLER AVE NB Description: COMM TI "ADVANTAGE HEALTHCARE SERVICES" 1566 SF Legal Desc.: N TR 9626 LOT 6 Owner: 4631 TELLER LLC Address: 4631 TELLER AVE NEWPORT BEACH, CA 92660 Phone: Applicant: SANCHEZ PHIL Address: 37 BROOKLINE ALISO VIEJO, CA 92656 Phone: 949.842-3418 Code Edit: 2019 Type of Construction: V-B Occupancy Group: B Added /New sq.ft. Bldg: 1566 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Y Building Permit Fee: $1,089.00 Plan Check Fee: $947.43 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $38.00 Energy Compliance: $61.00 CA Seismic Safety: $0.00 Disabled Access: $91.00 Hazardous Mat $0.00 Building Green Fee : $4.00 Contractor: PACIFIC ORCA CORPORATION Address: 37 BROOKLINE ALISO VIEJO CA 92656 Phone: 714-647-1791 Con State Lic: 644807 Lic Expire: 05131/2022 Bus Lic: BT3006543 Lic Exp Date: 1213112020 Worker's Compensation Insurance Carrier: NO EMPLOYEES Policy No: Expire: 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: I Left: I Right: I 'irking Spa $0.00 ($28.08) $0.00 $0.00 $0.00 $0.00 $0.00 $285.10 $224.01 $183.28 TOTAL FEE : $2,940.99 Plan Check Fee: e aeo 0 om da E e o PROCESSED BY: c" o o c Architect: LUX TIMOTHY J Address: 10602 FLENNIGAN WAY CHARLOTTE NC 28277 Phone: 949-581-2255 State Lic:C019769 Engineer: Address: Phone: State Lic: Designer: Address: Phone: Special Conditions: �s If I I N S P EC� Planning Department - Plan check Fee: Fair Share SJH Trans In -lieu Housing Fee: Public Works Department - Park Dedication : $0.00 PAN Plan Check: $0.00 San Dist: $0.00 NMUSD Fee: $0.00 Fire Department $46.25 Fire Inspection: $0.00 $0.00 Fire Plan Rev $0.00 $0.00 Demolition Fee $0.00 Building Dept Adm $0.00 General Service $0.00 Refund Deposit $0.00 Grading Bond: $0.00 $0.00 $0.00 $1,670.73 Fee Due at Permit Issuance : $1,270.26 PUBLIC WORKS APPROVAL: ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: �� oar c°o o°o coc ono APPROVAL TO ISSUE: % E e c o 0 o < c c ac cco o c oc oco oco 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 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 '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 (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Iusiness 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' Slate License Law for the following reason: Iy 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 legal 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. ;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 Professions Code, and my license is in full force nd effect. License Class License No Date Contractor Signature COMPENSATION DECLARATION 'ARNING: FAILURE TO SECURE 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, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: 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 IN 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' rance carrier and policy number are: Policy Number Date ne of Agent vnone s 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 , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ignature of Applicant Date_ DECLARATION REGARDING CONSTRUCTION LENDING AGENCY hereby affirm under penally 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). ender's Name Lender's Address y 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 county to enter the above -identified property for inspection purposes. innnture of Pmnertv Owner or Authorized Anent Print Prooertv Owner's or Authorized AGent's Name ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 • •• ••• • •.• PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO • • • • • • • • • • • • • • • • •• PERMIT CANCELLED EPA' PERMIT EXTENDED QMD PERMITFINAL Ll ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATEOF PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: • • • • • •