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Home My WebLink AboutX2019-0758 - PermitsCity of Newport Beaohr Baiidjiag Qivigion IIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIII� COMB Permit: X2019-0758 $� 100 Civic Center Drive, Newport. Biach, G 92660 a y e ® a X 2 0 1 9 0 7 5 8 Project No: 0508-2019-- - rk Permit Counter Phone (949)644-3.2.88 • ® • ° o a 'w.. • ° o ° • ^ Inspection Requests Phone (949)644-3295 ° ®^ Combination Type - CIP ELEC" PLUM MECH Issued bate :. 03120/2019 a Inspection Area : 7 e s • i PF°NMIT� RXP R 180 YS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction Hours: Monday - Friday 7W a.nnAI66a9p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 3406 VIA LIDO NB Description: COMM TI 'UPS STORE' 528 SF Legal Desc.I N TR 1235 LOT 3 Owner: A SQUARE LLC Contractor: CIMA C M & D Architect Address: 845 VIA LIDO NORD Address: ' < 1016 SHARON ROAD Address: NEWPORT BEACH,CA 92663 SANTA ANA CA 92706 Phone: Phone:. 714-785-1919 Phone: State Lia Applicant. RODRIGUEZ ADRIAN Con State Lia 757047 Engineer. Address: 12800 GARDEN GROVE BLVD UNIT H - Lie Expire`_ 09130/2020 Address: GARDEN GROVE CA 92843 ' Bus Lia 'BT30066529 - Phone: . 714-265-1919 Lie Exp Date: 03130/2020 Phone: State Lia Code Edit: 2016 Worker's Compensation Insurance Designer: RODRIGUEZ ADRIAN Type of Construction: III -13 Carrier: NORGUARD INS CO Address: 12800 GARDEN GROVE BLVD UNIT H Occupancy Group: B. Policy No: CIWC981764 GARDEN GROVE CA 92843 Added /New sq.ft. Bldg: 528 Expire: 09/01/2019 Phone: Added /New sq. ft. Garage: 0 No of Stories:. 2 Building Setbacks Rear: / Special Conditions: No of Units : 0 Front: / Bldg Height: 0 Left: / �,i_�jr s Bldg Sprinklers: N - Right. / : ,I Flood Zone: .02 Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation - $20.000.00 . g'00 6 Building Permit Fee. $392.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee:- $341.04 Additional Fee : -. $0.00 -Plan check Fee :. $40.00 Fire Inspection: $0.00. Overtime Plan Ck. $0.00 Grading Bonds Feer $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Investigation Feer- $0.00 ' Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $24.00 GradingPermitFeer.... $0.00 In -lieu Housing Fee: $0.00 Building Dept Adm $0.00 Energy Compliance:'. $0.00. Grading PC Fee: .$0.00 Public Works Department- General Service $0.00 CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication :- $0.00 Refund Deposit $0.00 Disabled Access'. , $0.00 '. PNV Plan .Check: . $0.00 . Grading Bond:. $0.00 Hazardous Mat $0.00 Electrical %: $102.63 - San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: , $43.12 NMUSD Fee: $0.00 $0.00 Plumbing %: ..$35.26 $0.00 TOTAL FEE'. $9179.07 Plan Check Fee : $428.79 Fee Due at Permit Issuance : $550.28 PROCESSED BY: - PUBLIC WORKS APPROVAL:. - ZONING APPROVAL: 1AW PLAN CHECK BY: cul K GRADING APPROVAL: 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 reasons) fndjcatetI betovCby Ite cteckms;5k(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, ZemoliisIr. Or repal4 @Ay 9tpktgrb,•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 Licens'e`Law•.(bhapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he orshe 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). - .1 00 • • • •. ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portiorpthe;*org, &c*hs stiuolureis not ilI�f�ended 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 erloyeet of peltgnal e:or; i lilds 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 %rppl¢_ on, the GwnerABuilder vffiII hadb the burden of proving that it was not built Or. im 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 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). ❑ 1 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 least one year prior to completion of the improvements covered by this permit, I cannot Iegalll 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.htmi.. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9 (commencing with Section 70 ) o Divisiopp 3 of the Business and of ssio s ode, nd ieense is in full force and effect. License Class V3 License No -2s-104-1 D ''. W l Contractor Signat WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THW D DOLLARS ($100,000(, IN ADDITION TO. THE COST 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: 1 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 th rmpnce of the work for which this permit is issued. Policy No. Z1I ha a 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' compensatiol nsuran a carrier and policYe number are: FF Sadel'l_9fll2&Ix1 C -A Policy Number _1C.4 Expiration Date Name of Agent - Phone # :3I certify that, in the if 'a of th 0rk f which this permit is issued, I shall not employ any person in any manner so as to became subject to the workers' compensation laws of California, and agre :hat, if I should become subject to of ers' c mpensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. - - ii - iignatureofApplica t Date. 3 7.0 11 `7 )ECLARATION RE AR ING CONSTUC N LENDING AGENCY - hereby affirm under penalty of perjury th there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). -ender's Name Lender's Address 3y 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 with all applicable city and county ordi a ces an state laws relating to building construction. I authorize representatives of this city or co_untfy to enter t abov -iden ified property for inspection purposes. ;Innahrre of Prnnartv Owner or Authnrized Ane'IlN - O Print Pronertv Owner's or Authorized ADent's Name\N/ I-' f Ut &) riOky l q0e Z- __ Date I W ACTION DATE BIV C RA N OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY ECU ONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED f U I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED OEPA PERMIT EXTENDED QMD - PERMITFINAL G �'��\Ot ASBESTOS NOTIFICA 0 IS NO PLICABLE TO CERTIFICATEOF PROPOSED DEMOUTIO OCCUPANCVISSUED SIGNATUR