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Home My WebLink Aboutx2021-1016 - Permits1R.wr City of Newport Beach - Building Division III IIII IIIIIIIII�IIII III'llll ll�l lllll� 11 COMB Permit: X2021-1016 i'� 100 Civic Center Drive, Newport Beach, CA 92660 x 2 9 2 1 1 8 1 s Project No: 0928-2021 4 ,;; rs Permit Counter Phone (949)644-3288 sa. - ar Inspection Requests Phone (949)644-3255 ".t2j��y,-cc� Combination Type - BLDG Issued Date: 0510412021 Inspection Area : 3 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST SE COMPLETED BY 0510412024 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: 1561 MESA DR NB Description: MONUMENT SIGN (NON -ILLUMINATED) "VERCANTA NEWPORT BEACH" Legal Desc.: Owner: PALM MESA LTD Contractor: THIRD FLOOR NORTH CO Architect: INSPECTOR Address: 12121 WILSHIRE BLVD#700 Address: 3411 LAKE CENTER DR Address: •,°,°• LOS ANGELES CA 90025 SANTA ANA CA 92704 ° Phone: Phone: 714-556-0990x117 Phone: State Lie: • a °+ v ° ° ° ® v Applicant: GORDON ROBERT Con State Lic: 656202 Engineer: JACOB TONY • Address: 3411 W LAKE CENTER DR Lie Expire: 10131/2022 Address: P.O. BOX 802050 .... ° ° ° SANTA ANA CA 92704 Bus Lie: BT00017538 SANTA CLARITA CA 91380 ° .... ° Phone: 714-240-4175 Lie Ex Date: p 1013112021 Phone: 661-259-0700 State Lic:C-059022 ••°• Code Edit: 2019 Worker's Compensation Insurance Designer: GORDON ROBERT ° '0°• °°°°• °°°°°, Type of Construction: VB Carrier: EMPLOYEE SERV GROUP Address: 3411 W LAKE CENTER DR • Occupancy Group: U Policy No: WC52700071020SZ SANTA ANA CA 92704 ®° ° ° ° ° Added/New sq.ft. Bldg: 0 Expire: 07/01/2021 Phone: 714-2404175 : °•.° ° ° Added /News . ft. Garage: 0 q 9 ® ® ° • • ° ° ° No of Stories: 0 Building Setbacks Rear: I Special Conditions: •..... °O••• No of Units : 0 Front: I Bldg Height: 0 Left: I Bldg Sprinklers: Right: I Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $10,000.00 Building Permit Fee: $246.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $214.02 Additional Fee : $0.00 Plan check Fee : $46.25 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $18.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department- General Service $0.00 CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0.00 P/W Plan Check: $43.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $568.27 Plan Check Fee: $303.27 Fee Due at Permit Issuance : $265.00 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: \AAwm!!!! �r PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: 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, priorto 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). ] 1, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) 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 nproved for the purpose of sale). 7 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 toanowner 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'teUM 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 all a sLructure tRdti 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 reftsMons Ct dti is -a ailable upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.htmi. ignature of P6operEq66wner or Authorized Agent Date ICE14SED CONTRACTOR'S DECLARATION hereby affirm uggQr',penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se on 70 Pit f the BusKand Pro S Co nd y license is in full force h(j effgct. Lidt;p;sg PTass License No D �� Contra /ORKERS' GCMPENSATION �LARATION M111RCy FAILURE 1-9 E9QURE RS' 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 BST.QF COMPENSATION, GE' AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 6ereLy affirm u r penalty of perjury one of the following declarations: . 1 hd4 5dlZg4njntain 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 nce of the work for which this permit is issued. Policy No. Rave and & ma`latain 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 sLIance carrier and policy number are: t , f/ arrieruArfVA �S(rr:>5�11 1_,I14, 0 �r+—r O—Gr ��.R�Policy Number V C57^ o0d 71 — o l l? — S�� Expiration Date ame of Agent 0 Phone # :ertify that, in thSperformance of the work f 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 shrpek�b me sublet ,o the.Wj mpensatlon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. IECLARATION REGARDING CONSTRy1CTION LENDING AGENCY \ hereby affirm under penalty of peFjuly'that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). -enders Name Lender's Address 3y 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_ L� j/f��i%� I agree to comply with all applicable city and county ordinances and state laws relating to building construction. (� (f� ((� I authorize representatives of this city or county to bove-identified property for inspection purposes. .` 3ignature of Property Owner or Authorizeft Print Property Owner's or Authorized Agent's ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED OEPA PERMIT EXTENDED LJAQMD PERMITFINAL CERTIFICATE OF OCCUPANCY ISSUED .� 22 G NOTIFICATION IS NOT APPLICABLE TO —Ll PROPOSED POSED DEMOLITION SIGNATURE: