HomeMy WebLinkAboutF2021-0164 - PermitsOG",
City of Newport Beach - Building Division100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 1 0 1 6 4
Permit Counter Phone (949)644-3288
FIRE Permit: F2021-0164
Project No : 0966-2021 RGuda3- n (9a
Inspection Requests Phone (949)644-3255
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Job Address: 4000 A WAY NB Description: COMM FIRE ALARM TI (X2019.1471) ATRIA SR LIVING. 392 DEVICES
Inspector Area: FIRE Legal Description: TR 5854 LOT 6 AND LOT 7
Owner: NEWPORT BEACH PROPCO LP
Contractor: CAL - BUILDING SYSTEMS Architect:
Address: 300 EAST MARKET ST #100
Address: 3900 PROSPECT AV Address:
LOUSIVILLE, KY 40202
YORBA LINDA CA 92886
Phone'
Phone: Phone: State Lic:
Applicant:
HAUGH JEFF
Address:
283 S KATHLEEN LN
ORANGE CA 92869
Phone: 714-719-9716
Code Edit: 2019
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units
Flood Zone:
Bldg Sprinklers:
V-B-SPR
B
0
0
Con State Lic: 521087
Lic Expire: 01131/2023
Bus Lic:
BT30075383
Lic Exp Date:
05/3112022
Worker's Compensation Insurance
Carrier:
EVEREST NATIONAL INS CO
Policy No:
5300003506201
Expire:
07/1512021
3 Issued Date: 05/25/2021
0 Setback- Front:
Rear:
Y Left:
Right:
Engineer:
Address:
Phone:
State Lic:
Designer: HAUGH JEFF
Address: 283 S KATHLEEN LN
ORANGE CA 92869
Phone: 714-719-9716
Special Conditions:
FEES
Construction Valuation:
$120,000.00
Building PC Fee :
$0.00
Fire Residential Alarm PC Fee :
$0.00 Records Management :
$20.00
Building Overtime PC Fee:
$0.00
Planning Counter Review:
$0.00
Building Extention Fee :
$0.00
- Planning Zoning PC Fee :
$0.00
$0.00
Building Investigation Fee :
Fire Plan Check Fee:
$0.00
$1,042.00
Public Works PC Fee :
$0.00
$0.00
Fire Permit Fee :
$1,502.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$2,564.00
Plan Check Fee :
$1,042.00 Fee Due at Permit Issuance :
$1,522.00
PROCESSED BY: OTHER DEPARTMENT:
ZONING APPROVAL:
FIRE APPROVAL:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
�o 0
PERMIT EXPIRES 1110 DAYS AFTER ISSUANCE OR LAST VALID INSPECIION l
DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason (a) indi,
iection 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, dem
is permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License L
rofessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Secti,
of 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 tf
usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through e
nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of compl
nproved for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor
I am exempt from licensure under the Contractors' State License Law for the following reason:
y my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one p
all a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I unc
rofessions Code, is available upon request when this application is submitted or at the following Web site: http://www.leginf
ignature 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 7000) of
nd effect.
icense Class License No Qgte 2�° 2
COMPENSATION DECLARATION
:FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL'
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNE rS FEES.
affirm under penalty of perjury one of the following declarations:
6 and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of
ance of the work for which this permit is issued. Policy No.
e and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pe
:e carrier and policy number are:
Policy Number
of Agent
ad below by the checkmark(s) I have placed next to the applicable item(s)
;h, or repair any structure, prior to its issuance, also requires the applicant for
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
work, and the structure is not intended or offered for sale (Section 7044,
ployees' or personal effort, builds or improves the property, provided that the
Ion, the Owner -Builder will have the burden of proving that it was not built or
and Professions Code: The Contractors' State License Law does not
to the Contractors' State License Law).
to completion of the improvements covered by this permit, I cannot
that a copy of the applicable law, Section 7044 of the Business and
Date
lision 3 of the Business and Professions Code, and my lice is in full force
_ Contractor Sign
AND CIVIL FINES UP TO O E HUNDRED THOUSAND DOLLARS($100,000), IN ADDITION TO THE
Relations as provided for by Section 3700 of the Labor Code, for
of the work for which this permit is issued. My workers'
Date
certify that, in the performance of the work forwhich this permit is issued, I shall not employ any person in any manner s� as to become subject to the workers' compensation laws of California, and
if I should become subject to the workers' coo_mpensation provisions of Section 3700 of the Labor Code, I shall forthwith omply with those provisions.
Signature of Applican D
DECLARATION R A DI
I hereby affirm under pen of perjury that there is a construction lending agency for the performance of the work for which his 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 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 t I _ant a v -id ' ied roperty for inspection purposes. 11 (( C n�a
Signature of Property Owner or Authorized Agent � // Print Property Owner's or Aut orized Agent's Namat/ . J GY -GY®1 q _ Date
ACTION
7 AY
DECLARATION OF COMPLIANCE M TH
CODE OF
FOR OFFICE USE ONLY
.GATE
FEDERAL REGULATIONS PART 51 OF
AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICI
❑ EPA
❑ AQMD
TITLE40AND
T10N TO:
PERMIT EXPIRED
PERMIT CANCELLED
-
PERMIT EXTENDED
❑ ASBESTOS NOTIFICATION IS NOT
PROPOSED DEMOLITION.
APPLICABLE TO
PERMIT FINAL
`
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CERTIRCATEOF
OCCUPANCYISSUED
SIGNATURE: