HomeMy WebLinkAboutF2021-0625 - Permitsw City of Newport Beach - Building Division
,/....., 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 330 PLACENTIA AVE NB
Inspector Area: FIRE
Owner: THE HOAG MEMORIAL HOSPITAL
Address: 500 SUPERIOR AVE #200
NEWPORT BEACH CA 92663
Phone:
Applicant: CRAIG/CG SYSTEMS INC
Address: 1470 N HUNDLEY ST
ANAHEIM CA 92806
Phone: 951-216.5694
Code Edit : 2019
Type of Construction:
VB
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:
X
Bldg Sprinklers:
N
Construction Valuation: $0.00
*F2021-0625*
i��PETR
FIRE Permit: F2021-0625
Project No: 2935-2021
Inspection Requests Phone (949)644-3255
Description: COMM FIRE ACCESS KNOXBOX (X2021-3373)
Legal Description:
N TR 4692 LOT 100
Contractor:
CALIFORNIA GATE & ENTRY SYS
Address:
1470 N HUNDLEY ST
ANAHEIM CA 92806
Phone:
714-632-8882
Con State Lic:
520990
Lic Expire:
11/30/2023
Bus Lic:
BT30029597
Lic Exp Date:
10131/2022
Worker's Compensation Insurance
Carrier:
CYPRESS INSURANCE COMPANY
Policy No:
CGWC351140
Expire:
01/01/2023
Issued Date: 01/27/2022
Setback- Front:
Rear:
Left:
Right:
FEES
Architect:
Address:
Phone:
State Lic:
Engineer:
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Phone:
State Lic:
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Designer:
CG SYSTEMS
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Address:
1470 N HUNDLEY STREET
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ANAHEIM, CA 92806
Phone:
951-216-5684
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Special Conditions:
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Building PC Fee :
$0.00
Fire Residential Ala" PC Fee :
$0.00 Records Management:
$0.00
Building Overtime PC Fee:
$0.00
Planning Counter Review:
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee :
$0.00
Building Investigation Fee :
$0.00
$0.00
Fire Plan Check Fee:
$0.00
Public Works PC Fee :
$0.00
$0.00
Fire Permit Fee :
$109.50
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$109.50
Plan Check Fee :
$0.00 Fee Due at Permit Issuance :
$109.50
PROCESSED BY: �J
ZONING APPROVAL: 5$
FIRE APPROVAL:
OTHER DEPARTMENT: & A
PLAN CHECKED BY:: r K -=
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
r
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 far
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).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or l_) 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).
❑ 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).
❑ 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 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
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 PrQpBrty%wner or Authorized Agent Date
J,ICENPED CONTRACTOR'S DECLARATION
0 hereby affirm uRder�enalty 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 lic nse is in full force
and effect." .
L?c@nsk,Class _ License No Date I � 22' Contractor Signature
WOMERS' CONIMeJNSATION DECLARATION
C{ WAQNINFAILURE JQ SEyRE 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
EOSPOiF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
FMereby affirm ender penalty of perjury one of the following declarations:
8111 ve and wig 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
r tftipnce of tqe wgr� 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
Sranre carrierand"licy number are:
mer �..% : D I Policy Number Expiration Date
of Agent
issued. My workers'
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' compepsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. I
of Applicant ?�
CLARATION REGARDING COtATRUCTION LENDING AGENCY L
areby affirm under penalty of peaty that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097
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 correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction. Crcc q
I authorize representatives of this city or county to ter the bov€Lideentifpd property for inspection purposes.
mature of Prooertv Owner or Authorized Aoent K �+�f/-rv''7Z Print Property Owners or Authorized Agent's Name
Civil Code).
ACTION
DATE
BY
ut LLAHA f IUN Or LUMPUAIYUL YVI r N I-VUt Ur
tURuttILE USE ONLY
FEDERAL REGUTATIONSPART 61 OF T1TLE40AND
AQMD RULE 1401
PERMIT EXPfRED
❑ I SUBMITTEDASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMO
PERMITCANCELLED
PERMITEXTENDEO
❑ ASBESTOS NO71FICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERA41TFINAL
j
CERTIFICATEOF
OCCUPANCYISSUED
SIGNATURE: