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Home My WebLink Aboutx2020-2558 - PermitsCity of Newport Beach - Building Division ` `� 100 Civic Center Drive, Newport Beach, CA 92660 E+ Permit Counter Phone (949)644-3288 s`5 t12,&•* " Inspection Requests Phone (949)644-3255 Combination Type - BLDG PLUM ��'lJil COMB Permit: X2020-2558 x 2 0 2 9 2 5 5 a Project No : 2602-2019 Issued Date: 1110312020 Inspection Area : 3 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1110412023 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: COMM DEMO FITNESS CENTER, INCLUDES SEWER CAP "PALM MESA APARTMENTS" I E CTO R Legal Desc.: Owner: PALM MESA LTD Contractor: REFINO INC Address: 12121 WILSHIRE BLVD #700 Address: 9706 4TH AVE N E #401 LOS ANGLES CA 90025 SEATTLE, WA 98115 Phone: Phone: 206-260-1509 Applicant: REFINO INC Con State Lic: 787509 Address: 9706 4TH AVE N E #401 Lic Expire: 06130/2021 SEATTLE, WA 98115 Bus Lic: BT30072366 Phone: 206-260-1509 Lic Exp Date: 0713112021 Code Edit: 2019 Type of Construction: V-B Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Construction Valuation: $15,000.00 Building Permit Fee: $331.00 Plan Check Fee: $287.97 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $0.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee : $1.00 TOTAL FEE: $2,683.76 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Worker's Compensation Insurance Carrier. STATE FUND Policy No: 9161474 Expire: 06/25/2021 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: 1 Right: / 3arkina Spaces $0.00 $0.00 Woo $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.79 Plan Check Fee Architect: WINTERS PATRICK Address: 1990 S BUNDY #400 LOS ANGELES CA 90067 Phone: 310-626.2100 State Lic:CO22032 Engineer: VARELA BEN Address: 6007 WASHINGTON BLVD CULVER CITY CA 90232 Phone: 424-208-4764 State Lic:S-005714 Designer: Address: Phone: Special Conditions: CR S R TO HAUL Fire Hazard Zone : N 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 $0.00 Fire Inspection: $0.00 Fire Plan Rev $0.00 Demolition Fee $0.00 Building Dept Adm General Service Refund Deposit Grading Bond: $0.00 $0.00 $26.00 $316.00 $1,692.00 $0.00 $0.00 $0.00 $0.00 Fee Due at Permit Issuance : $2,683.76 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: 0 0 o OWNER -BUILDER I hereby affirm under penalty of perjury that 1 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 the 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 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 not more than five hundred dollars ($500). 111, 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, Business 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 improvements 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 improved 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 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). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By 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 legalll 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 Professions 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 Propejty O%%ner or Authorized Agent Date LICENSED COtHRAVTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sec�ry700 )(of ivision 3 A the Busin and Professio n li se is in full force aruief%�ci LiceosaGlass License No a ontractor ignature , --- WORKERS' COMPEISSATION DECLARATION WARNINBr 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 ADDMON TO THE COST OFFOMPENS 17%VI9AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST; AND ATTORNEY'S FEES. I he y�Ta undCPp"nally of perjury one of the following declarations: ' 1 Innll me' am 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 th af t&'drR for which this permit IS issued. Policy No. e 7nd 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' compensatioi rance carnerend policy number are: Policy Number Expiration Date I certify that, in the performance of the work forWhich 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 agre that, if I should eco subject �to`'e coon r ' m e anon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Appl' t /� Dates DECLARATIONRDI CONSTRUCTION LENDING AGENCY rr^" I hereby 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). Lender's Name Lender's Address By 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 ordinanceeel? slat taws relating to building construction. 1 authorize representatives of this city or county to r t Ified property for inspection purposes. ISignature of Property Owner or Author' gent Print Property Owner's or Authorized Agent's men 3 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 I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED EPA PERMIT EXTENDED QMD PERMITFINAL TTASBESTOS NOTIFICATION IS NOTAPPLICABLE TO CERTIFICATE OF �.L6� PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: