HomeMy WebLinkAboutX2016-1327 - Permits (2)�wF�, City of Newport. Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIII COMB Permit: X2016-1327
�+ 100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 1 6 1 3 2 7 Project No: 0874-2016
t,. t - Permit Counter Phone (949)644-3288
ki > - Inspection Requests Phone (949)644-3255
°'rcairam4t* , Combination Type - CIP Issued Date : 07/13/2016
.. - Inspection Area : 2
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Job Address: 2501 CLIFF DR NB
Description: COMM TI "NEWPORT THEATRE ARTS CENTER' BEAM REPAIR W/REROOF -CITY JOB"
Legal Desc.: TR 919 LOT A POR OF LOT
Owner:
CITY OF NEWPORT BEACH
Address:
PO BOX 1768
NEWPORT BEACH, CA
Phone:
9496443141
Applicant:
KOSBAB CAMERON
Address:
2610 ARON ST
NEWPORT BEACH CA 92663
Phone:
949-515d350
Code Edit: 2013
Type of Construction: VB
Occupancy Group: A3
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:
Flood Zone: X
Contractor:
OPTIMA R P M INC
Address:
17945 SKY PARK CIR BL#D
IRVINE CA 92614
Phone:
949-724-1399
Con State Lic:
961714
Lic Expire:
0613012017
Bus Lic:
BT30045675
Lic Exp Date:
12/31/2017
Worker's Compensation Insurance
Carrier:
GRANITE SLATE INS
Policy No:
13673863
Expire:
04/10/2017
Building Setbacks Rear: /
Front: /
Left: I
Right: /
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
MILCZEWSKY JUERGEN
3040 SATURN #201
BREA, CA 92621
714-985-1100 State Lic:S-002450
Special Conditions: LANDSLIDE AREA
Hazard Zone : N
Building Permit Fee:
$1,324.00
Excise Tax:
$0.00
Planning Department -
Plan Check Fee:
$1,161.88
Additional Fee :
($2,513.38)
Plan check Fee
Overtime Plan Ck:
$0.00
Grading Bonds Fee:
$0.00
Fair Share
Investigation Fee:
$0.00
Grading PC Consultant:
$0.00
SJH Trans
Record Management:
$0.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee
Energy Compliance:
$0.00
Grading PC Fee:
$0.00
Public Works Department -
CA Seismic Safety:
$0.00
WQ Insp. Fee:
$0.00
Park Dedication :
$0.00
Disabled Access :
$0.00
PAN Plan Check :
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
San Dist:
$0.00
Building Green Fee :
$6.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
Plumbing %:
$0.00
IITOTAL
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Fire Department
$37.50
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
Plan Check Fee: $0.00 Fee Due at Permit Issuance :
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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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 applica`ii to item(s)
te
(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).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do U 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).
❑ 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 Iegall
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 PrbQe*,Owner or Authorized Agent Date
LICENSED CQNTUCTOR'S DECLARATION
tgerebyaffirm ender penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section!0 IVI io of the Business and PrQfes,sw ode, an license is in full force
and efct. License Class License No Date�S?Contractor Signature,.V
4eldRKtRS' COMPENSATION DECLARATION
NARNING: FAILUR®i1319"RE 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
OOSr OF COMPENSATION, ITAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I her py affirm I>rdgr O nalty of perjury one of the following declarations:
ve 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
pe p" ce of the work for which this permit is issued. Policy No.
!I ha and wAl•IMi?i&in 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' compensatio
e carrier policy number are:
Cawier• . Policy Number Expiration Date
Name of Agent • Phone #
❑I 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 agre
that, if I should become subject to the orkers' corm ensat� io=ions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant
DECLARATION RE RDING CONSTRUCTION LENDING AGENCY
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 ordinances and state laws relating to building construction.
I authorize representatives of this city or county - .to enter,t�e above{= entified^property for inspection purposes.
Signature of Property Owner or Authorized Ageny� �M' % Print Property Owner's or Authorized Agent's Na •VV&V' Dat
PERMIT EXTENED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYISSUED
DATE BY( DECLARATION OF II REGULATIONS PART0610 TIITLE 40 AND ACMD RULECE WITH CODE OF
FOR OFFICE USE ONLY
NOTIFICATION TO
NOTIFICATION IS NOTAPPLICABLE TO
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