HomeMy WebLinkAboutF2021-0628 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIII�IIIIIilll FIRE Permit: F2021-0628
d 100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 1 0 6 2 8 Project No : 2954-2021
i ` v Permit Counter Phone (949)644-3288 )
el�z,s�4} Inspection Requests Phone (949)644-3255
Job Address: 1101 BERKSHIRE LN NB Description: SFR FIRE SPRINKLERS ,9! HEADS (X2021-1062)
Inspector Area: 3 Legal Description: N TR 3031 LOT 9
Owner: BOTSFORD SCOTT
Contractor:
FIREGUARD SPRINKLER SYS INC
Architect:
Address: 1101 BERKSHIRE LN
Address:
7907 LEEDS ST
Address:
NEWPORT BEACH, CA 92660
DOWNEY CA 90242
Phone:
Phone:
714-310-0194
Phone:
State Lic:
Applicant: VO JOHN
Con State Lic:
992002
Engineer:
Address: 526 N SHADYDALE AV
Lic Expire:
0413012022
Address:
W COVINA CA 91790
Bus Lic:
BT30046886
Phone: 714-310-0194
Lic Exp Date:
04/30/2022
Phone:
State Lic:
Code Edit : 2019
Worker's Compensation Insurance
Designer:
VO JOHN
Type of Construction: V-B-SPR
Carrier:
FALLS LAKE FIRE & CASUALTY
Address:
526 N SHADYDALE AV
Occupancy Group: R3/U
Policy No:
FLA0080008
W COVINA CA 91790
Added /New sq.ft. Bldg: 0
Expire:
12129/2021
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2
Issued Date: 12/16/2021
Special Conditions:
No of Units : 0
Setback- Front:
Flood Zone:
Rear:
Bldg Sprinklers: Y
Left:
Right:
"
Construction Valuation:
FEES
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$6,000.00�'A.
i
Building PC Fee:
$222.00
Fire Residential Alarm PC Fee:
$0.00
Records Management: $4.00
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 :
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$269.00
TOTAL FEE :
$495.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance : $495.00
PROCESSED BY: -- •E• •ce OTHER DEPARTMENT:
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ZONING APPROVAL: PLAN CHECKED BY::
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FIRE APPROVAL: APPROVAL TO ISSUE:
GJ E
Cs N G.3H
E y L Y E 4 B 6
O Y
IPE RIMIT 41RES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Y YY aE YnY
rNER-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)
ction 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
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
fessions 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
more than five hundred dollars ($500). -
J I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throu
nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of ci
nproved for the purpose of sale).
1 I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7L
pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contra
I am exempt from licensure under the Contractors' State License Law for the following reason:
ly my signature below I acknowledge that, except for my personal residence in which I must have resided for at least o
ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors.
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.1(
signature of Property Owner or Authorized Agent
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700
nd effect. /`--
icense Class License No Date / '
VORKERS' COMPENSATION DECLARATION
rARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
work, and the structure is not intended or offered for sale (Section 7044,
Dloyees' or personal effort, builds or improves the property, provided that the
on, the Owner -Builder will have the burden of proving that it was not built or
Business and Professions Code: The Contractors' State License Law does not
pursuant to the Contractors' State License Law).
year prior to completion of the improvements covered by this permit, I cannot
understand that a copy of the applicable law, Section 7044 of the Business and
Date
of Division 3 of the Business
Contractor
my license is in full force
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
J I 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
e rp
rmance 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' compensa
Is rance carrier and policy number are:
1e of Agent
certify that, in the perfor anc of the
. if I should become sub ect to a wo
of
Policy Number
Date
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
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos�e ypfovision . J
� 1 nar2C. 1 Z7��/% I
CLARATION REGARD[rigrCOOSTRUtTION LENDING AGENCY I I I
;reby affirm under penalty f p ury that there is a construction lending agency for the performance of the work for wjlich this permit is issued (Section 3097, Civil Code).
tder'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
I have read this application and the information I hB
I agree to comply with all applicable city and cou h
I authorize representatives of this city or county t
mature of Property Owner or Authorized Agent
owner's behalf.
led is correct.
s and state laws relating to building construction.
a oy,&-i4entified property for inspection purposes.
Date
AC71ON
DATE
BY
DECLARATION OF COMPLIANCE KITH CODE OF
FOR OFFICE USEONLY
FEDERAL REGU£ATIONSPART6F OF TIVVApAN6 •••
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PERMIT EKPiRED
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PERMIT CANCELLED
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PERMITEYTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION. e°e ° •
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PERMIT ANAL
CERTIFICATEOF
SIGNATURE:
OCCDPANCYISSOEO
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