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Home My WebLink AboutX2021-2443 - Permits. City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIII'IIIIIIIIIIIp II COMB Permit: X2021-2443 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 2 4 4 31 4 <, Permit Counter Phone (949)644-3288 Project N0 : 0746-2021 Inspection Requests Phone (949)644-3255 Combination Type - BLDG ELEC Issued Date : 10/0612021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1010612024 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: 4699 JAMBOREE RD NB Description: DELTA 2 -REMOVE AND REPLACE WALL AT TRANSFORMER ENCLOSURE & ADD WALL AT TRASH ENCLOSURE 6' TALL X 24 LF Legal Desc.: P BK 142 PG 18 PAR 1 Owner: HOAG MEMORIAL HOSPITAL PRESBYTERIAN Contractor: NELSON HCS INC Architect: HERNANDEZ DARCIA KAY Address: 510 SUPERIOR AVE STE 290 Address: 1340 REYNOLDS AVE STE 105 Address: 300 SPECTRUM CENTER DR #370 NEWPORT BEACH, CA 92663 IRVINE, CA 92614 IRVINE CA 92618 Phone: Phone: 949.274-5828 Phone: 714-206-2275 State Lic:C030188 Applicant: KREUTZER MATTHEW Con State Lic: 1025484 Engineer: Address: 300 SPECTRUM CENTER DR STE 730 Lic Expire: 04/3012023 Address: IRVINE, CA 92618 Bus Lic: BT30075182 Phone: 949-727-9000 Lic Exp Date: 05/30/2022 Phone: State Lic: Code Edit : 2019 Worker's Compensation Insurance Designer: Type of Construction: Carrier: STARSTONE Address: Occupancy Group: U Policy No: T80210387881 Added /New sq.ft. Bldg: 0 Expire: Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: / Special Conditions: No of Units : 0 Front: / Bldg Height: 0 Leg: / Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $10,000.00 ?� A cc Building Permit Fee: $249.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $216.63 Additional Fee : $0.00 Plan check Fee : $52.00 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: $0.00 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 PAN Plan Check : $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $17.43 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: $536.06 Plan Check Fee: $268.63 Fee Due at Permit Issuance : $267.43 PROCESSED BY: c^ir ?UW IC WORKS APPROVAL: ` ZONING APPROVAL: \ iV F"e V 6 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 iterr(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 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 L) 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 legalh 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.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7> 000) of D'v' io 3 of the Business and Profesnc dl and my license is in full force and effect. License Class License No Da✓ta/�I l�T1l 1 Contractor Signature WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN)LLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: 111 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 th performance 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' compensatior u ante carrier and policy number are: rier Policy Number Expiration Date Jame of Agent Phone # :1I 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 agree hat, if I should become su ect he workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. yy "" signature of Applicant Date-� lL' IECLARATION REGARbING O STRUCTION LENDING AGENCY 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). .ender's 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 owners 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. ,lyi �,'(=}I+ j�/� ` ry >ignature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Name CEe-�tL ' �� ° o Datelb (P 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 71SUBMITTED ASBESTOS NOTIFICATION TD • .• • n " as• PERMIT CANCELLED EPA PERMITEXTENDED OAQMD • •• + �� e PERMIT FINAL ) 7 y ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF �6 �u'L� PROPOSED DEMOLITION •.,, OCCUPANCYISSUED SIGNATURE: ,•, • e e n oey eo e n one ea o c o0 eo e • ec s•°