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Home My WebLink AboutX2017-2165 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive. Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - BLDG ELEC 101111111112111111111 COMB Permit : X2017-2165 Project No : 1538-2017 Issued Date : 08/25/2017 Inspection Area : 7 Job Address: Description: Legal Desc.: Owner: Address: Phone: Applicant: Address: Phone: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. 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 1 HOAG DR NB COMM ELECTRIC VEHICLE CHARING STATION IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR OF LOT HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH, CA 92663 TRAN SON 12681 PALA DR GARDEN GROVE CA 92841 562-572-5633 Code Edit : 2016 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Construction Valuation: $30,000.00 Building Permit Fee: $492.00 Plan Check Fee: $428.04 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $8.00 Energy Compliance: $0.00 CA Seismic Safety : $0.00 Disabled Access : $82.00 Hazardous Mat $0.00 Building Green Fee : $2.00 TOTAL FEE Contractor: VIDEO VOICE DATA COMMUNICATIONS Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: 12681 PALA DRIVE GARDEN GROVE, CA 92841 794-897-6300 821598 07/31/2019 BT30048732 10/31/2017 Worker's Compensation Insurance Carrier: Policy No: Expire: Address: Phone: Engineer: Address: Phone: Designer: HDI GERLING - AMERICA INSURANC Address: EWGCC000224716 11/14/2017 Phone: Building Setbacks Rear: / Front: I Left: / Right: / Use Zone: Parking Spaces: Excise Tax: Additional Fee : Grading Bonds Fee: Grading PC Consultant : Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : $1,113.94 EIe ical %: Mec anical %: Plu Ling %: $64.40 $0.00 $0.00 Plan Check Fee : Architect: State Lic: State Lic: TRAN SON 12681 PALA DR GRADEN GROVE CA 92841 562-572-5633 Special Conditions: Fire Hazard Zone : N $0.00 Planning Department - $0.00 Plan check Fee : $0.00 Fair Share : $0.00 SJH Trans : $0.00 In -lieu Housing Fee : $0.00 Public Works Department - $0.00 Park Dedication : $0.00 PNV Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $0.00 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Grading Bond: $495.50 Fee Due at Permit Issuance : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $618.44 0 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBLIC WORKS APPRO. L: PLAN CHECK BY: 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 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 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 U all of or L) 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 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 legal) 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 Sectio 00) f Divis)on 3 of the Business and Pros Co. , and�ay license is in full force and effect. License Class License No 25 )% Contractor Signatur .WORKERS' CAACI3ENSATION DECLARATION WARNING: FAILUFrE.TJ.CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER O CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED COST ORCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY' FEES. •aw • .. ereby affirm eirI erFenalty of perjury one of the following declarations: e and wW 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 the ce of the wx,k for which this permit is issued. Policy No. and wul.rnailltain 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' compensation Policy Number E WG, cc Coo ._t 3 '7i i Ic Expiration Date 1t I (r-( 26 11 Phone# 9c-fq - `SS 9-- /�ou e carrigbynd policy number are: er. l: Cite\-»J 1ivs. Nameof Agent `hbboITck4- CD.. LLARS ($100,000), IN ADDITION TO THE �►--I?carry thatA £h„e, erformance 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 Sect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. t:c,;.-ietufe of Appli®an — DECLARATIOhi RE ARDING RUCTION LENDING AGENCY a I hereby affirm under] penalty of perjuryvhat 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 wi h all applicab e city and county ordinances and state laws relating to building construction. I authorize representatives of this city or cou 4er�the above -identified property for inspection purposes. Signature of Property Owner or Authorized Agentrty Owner's or Authorized Agent's Name OlOcis..E ACTION DATE By LDECLARAJYION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 FOR OFFICE USE ONLY ZS r PERMIT EXPIRED LI I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED DEPA PERMIT EXTENDED ❑AQMD PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED 0 3.11 ❑ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION SIGNATURE: