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Home My WebLink AboutF2021-0253 - Permitsa"tl I4 City of Newport Beach - Building Division *F2021-0253* 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 � �'iilail4'�th 4® 1Bq '� " F- E c I FIRE Permit: F2021-0253 Project No : 1400-2021 Inspection Requests Phone (949)644-3255 Job Address: 9 VALORE DR NB Description: MFR FIRE SPRINKLERS (2 HEADS) X2021-0607 Inspector Area: 6 Legal Description: TRACT 14773 LOT 3 OF PROJECT 935-34 LOCATED ON AP 478-071-15 Owner: STEIN ALLEN Contractor: HC WEST LLC/DBA A & D FIRE Architect: Address: 9 VALORE DR Address: 7130 CONVOY CT Address: NEWPORT COAST, CA 92657 SAN DIEGO CA 92111 Phone: 9497157198 Phone: 858.277-3473 Phone: State Lic: Applicant: A&D FIRE SPRINKLERS Con State Lic: 1069002 Engineer: ' Address: 1601 W ORANGEWOOD AVE Lic Expire: 09/30/2022 Address: , ORANGE, CA 92868 Bus Lic: BT30073130 -' Phone: 714-634-3923 Lic Exp Date: 10/31/2022 Phone: State Lic: Code Edit : 2019 Worker's Compensation Insurance Designer: A&D FIRE SPRINKLERS Type of Construction: V-B Carrier: ZURICH AMERICAN INS CO Address: 1601 W ORANGEWOOD AVE- Occupancy Group: R2 Policy No: GLO100923506 ORANGE, CA 92868 Added /New sq.ft. Bldg: 0 Expire: 0110112022 Phone: 714-634-3923 .. . Added /New sq. ft. Garage: 0 No of Stories: 2 Issued Date: 12/10/2021 Special Conditions:No of Units : 0 Setback- Front: Flood Zone: X Rear: Bldg Sprinklers: Y Left: Right: FEES Construction Valuation: $3,000.00 Building PC Fee : $217.00 Fire Residential Alarm PC Fee : $0.00 Records Management: $2.00 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 $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 : $263.00 TOTAL FEE : $482.00 Plan Check Fee : $217.00 Fee Due at Permit Issuance : $265.00 PROCESSED BY: 7 OTHER DEPARTMENT: ZONING APPROVAL: T PLAN CHECKED BY:: FIRE APPROVAL: -J APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 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 Iicensure 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 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). ❑ 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). ❑ I am exempt from Iicensure under the Contractors' State License Law for the following reason: By my signatum belo.v 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 Iega11) sell a structure that I nave 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 Property Owner or Authorized Agent Date I_ICFNSED CONTRACTOR'S DECLARATION I ICreby affirm under penalty 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 license is in full force and effect. / �/ ,) %J�o C Linens- Class License No Date IZ O/ Z Contractor Signature /� N (� t- NORKERS' CGM'PENSATION DECLARATION NANNING: FAILURE 1 O SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (E700,000), IN ADDITION TO THE ,33, OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. ;i�iajv affirm under penalty of perjury one of the following declarations: 1 have and wi'l 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, lei/ormance of the wo,k 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' rance carrier and policy number are: ne of Agent - certify that, in the pi if I should become Policy Number Date 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 rkefs�compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those proyisions. r i nature of Applicant Date_[ CLARATION REGARDING CO RU LENDING AGENCY < ;reby affirm under penalty of perjury that t re is a construction lending agency for the performance of the work for which 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 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 tto/ent�7/} bo e-identified property for inspection purposes. �/ //�� j` ��// nature of Property Owner or Authorized Agent /�. ( Y�,{1✓ Print Property Owner's or Authorized Agent's Name X G'��e`FGI^dPi `ZV Date , ACTION DATE BY DECLARATIONOFCOMPLIQ CEMT CCODEOF FEDERAL REGULATIONS PART tit OF TITLE 40 AND AQMO RULE 1403. ❑ ] SUBMITTED ASBESTOS NORFICAI-m To:. ❑ EPA ❑ AQMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: FOR OFFICE USE ONLY PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL/O�.zS OtiF--- CERTIFICATFOF OCCUPANCYISSUED