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HomeMy WebLinkAboutF2019-0242 - Permits0r City of Newport Beach - Building Division IIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIII II FIRE Permit: F2019-0242 a' '. 100 Civic Center Drive, Newport Beach, IIA 92660 F 2 Project No : 0905-2019 Permit Counter Phone (949)844-3288 el�ry,y .Inspection Requests Phone (949)644-3255 Job Address: 500 SUPERIOR AVE NB St: 1 Ft: 2 Unit: 210 Description`. COMM FIRE SPRINKLERS (6) HEADS (X2019-0278) Inspector Area: FIRE ...legal Description: IRVINE SUB LOT 169 BILK 2 PORS OF LOT Construction. Valuation: $1,250.00 Owner: NEWPORT HEALTHCARE Contractor: FIRE PROT SPECIALISTS Architect: Fire Residential Alarm PC Fee: $0.00 Records Management: $2.00 Address; PO BOX 6100 Address: 2810 E MIRALOMA AVE Address: _ NEWPORT BEACH, CA 92658 $0.00 ANAHEIM CA 92806 - -" Phone: Phone: 714-635-6500 Phone: State Lic: $148.00 Applicant: AUSTIN/FIRE PROTECTION Con State Lic: 464915 Engineer: $191.00 Public Works Traffic Plan Check Fee; $0.00 Address: 2810 E MIALOMA AVE Lic Expire: 1013112020. Address: ANAHEIM CA 92806 Bus Lia BT30042894`. Plan Check Fee: $0.00 Fee Due at Permit Issuance : $341.00 PROCESSED BY: Phone: 714-635-6500 Lic Exp Date: 0613012019 Phone: State Lic: +i Code Edit: 2016. Worker's Compensation Insurance Designer: ANDERSON ROBERT Type. of Construction: V -A -BPR - Carrier: COMP WEST INS. CO. Address: 2810 E MIRALOMA AVE Occupancy Group: B Policy No: WCV5602952 ANAHEIM CA 92806 Added /New sq.ft. Bldg: 0 Expire: 12/02/2019 Phone: 714-635-6500 •_ , Added /New sq. ft. Garage: 0 " No of Stories: 3 Issued. Date: 04/2212019 Special Conditions: No of Units :. 0 Setback- Front: Flood Zone: - X Rear. Bldg Sprinklers: Y Left: Right:. FEES Construction. Valuation: $1,250.00 Building PC Fee : $0.00 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 Building Investigation Fee: $0.00 $0.00 Fire Plan Check Fee: $148.00 Public Works PC Fee: $0.00 $0.00 Fire Permit Fee: $191.00 Public Works Traffic Plan Check Fee; $0.00 Building Permit Fee: $0.00 TOTAL FEE : $341.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $341.00 PROCESSED BY: ._,.� • . - OTHER DEPARTMENT: ZONING APPROVAL: O?rAN. CHECKED BY:: FIREAPPROVAL; APPROVAL TO ISSUE: c ovr. c c o o o PERMIT EXPIReS 180•DA oo AFo'ER I JSUAt'JC'f OR LAST VALID INSPECTION )WNER-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 he 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 'rofessions 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 lot more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or l—) portions of the work, and the structure is not intended or offered for sale (Section 7044, 3usiness 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 mprovements 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 m roved 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 Ipply 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: 3y 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) yell 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 'rofessions 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 -ICENSED CONTRACTOR'S DECLARATION hereby affirm under. penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business d Pr essions�Code, nd my license is in full force Ind effect. .1cense Class License No Date �• cVCrJ • 19 Contractor Sign atur H + VORKERS' COMPENSATION DECLARATION 1ARNING: FAILURE TO SECURE 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 :OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 11 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 the ormance of the work for which this permit is issued. Policy No. have and will�alQtain 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 dad ndlicv number aur. -- ie of Agent certify that, in the pi if I should become lature of Applicant Date 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 hQ ylprl5ers;pompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. - areby 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). ider'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 count)Lto_p*r Ylp_aboye-identified property for inspection purposes. .�Y ACT70N DATE BY DECLARATION OF COMPLIANCEW7TN CODEOF - FOR OFRCE USE ONLY FEDERALREOIPTIO"PARF 610F47TLE40APED AQMDRId&E14d8. a• •' ••• i i � IsuBMiTT�ASB�Tpsrrl;nf�IcxT¢�F�Tg: © EPA ° PERMITEXP/RED PERMITCANCELIED ❑ AQM0 PERMITEXTENDED ASBESTOS N077FICA170MIS NOT APPLICABLE TO POSFj7�EAJOj1T(Ol�. ,'. ••, •:' • : 's : •. PERMITFINAI. 'a,s� (� CERTIFICATE OF SIONATUPA �r �� OCCUPANCYISSUED