HomeMy WebLinkAboutF2019-0084 - Permitsoxo ' City of Newport Beach - Building Division �IIIIIIIIIIII III IIIIIII IIIIIIIII IIIIII
FIRE Permit: F2019-0084
100 Civic Center Drive, Newport
Beach CA 92660
IIG F 2 �. 1 9 0 0 8 4
II
Project No : 0350-2019
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
I
Job Address: 4606 WAYNE RD NS
- Description: SFR FIRE SPRINKLERS (27) HEADS (X2018-2860)
inspector Area; -5
Legal Description:
N TR 3519 LOT 100
Owner: SCHWARTZ FAMILYE
Contractor:
WESTERN STATES FIRE PROT .Architect
tea.
Address: 4606 WAYNE RD
Address:
4740 NORGATE BLVD #150 -Address:
'CORONA DEL MAR, CA 92625
SACRAMENTO, CA 95834
Phone:
Phone:
909-924.1631 Phone:
State Lie::,
,y
Applicant: - BODEN TRAVIS
Con State Lie:
488359 Engineer.
Address: 1589 IN 9TH STREET #G
Lie Expire:
01/31/2020 Address: .
UPLAND CA 91786
Bus Lie:
BT30033616 -
-
Phone: 909.294-9434
.Lie Exp Date:
1113012019 - Phone:
State Lic
Code Edit: 2016
Worker's Compensation Insurance. Designer:
DELACRUZ PHIL
--J
Type of Construction: 'V-BSPR
Carrier:
.NEW HAMPSHIRE INS CO - Address:
1589 W 9TH STREET#G
Occupancy Group: R3/U
Policy No:
WC014629635
UPLAND CA 91786
- Added /New sq.ft. Bldg: 0
Expire:
12/31/2019 , - Phone:
909-294.9434'
Added /New sq. ft. Garage: 0
yn-:-�U
I.
No of Stories: 1
Issued Date:
Special Conditions:
-
No. of Units : 0
Setback- Front:-
.. Flood Zone: ; X
Rear.
'.
`..Bldg Sprinklers: Y_.
Left:
Right
FEES
'
Construction Valuation: $7,040.00
' Building PC Fee:
.$202.00
Fire Residential Alarm PC Fee: $0.00
- Records Management:
$0.00._
Building Overtime PC Fee:
$0.00
Planning Counter Review: $0.00 _
!l
Building Extention Fee ;
$0.00
Planning Zoning PCFee: : - $0.00
-
Ili
Building Investigation Fee :
$0.00
$0.00
Fire Plan Check Fee;
$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.:
$240.00
-
TOTAL FEE :
$442:00
Plan Check Fee: $0.00 Fee Due at Permit Issuance :
$442.00
PROCESSED BY:
,_ c. o.. o E ° - OTHER DEPARTMENT:
ZONING APPROVAL:
f
`_° ^ .:PLAN CHECKED BY::
°
, °
FIRE APPROVAL:
L.- ''
°•.� APPROVAL TO ISSUE:
t
-
PERMIT EXFiIRES 130DAYW°ASTER IS9&NCE OR LAST VALID INSPECTION
DECLARATION
I hereby affirm under penalty of perjury that 1 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 (_) 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 ihtended 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
mproved 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
Ip ly 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:
3ymy 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 legallS
e1) 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.htm].
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 an Professions Code, and my license is in full force
Ind effect.
Jcense Class License No �Contractor Signature�_�
VORKERS` COMPENSATION DECLARATION
IARNING: 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 ($100,000), IN ADDITION TO THE
;OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
7 I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
erjormance of the work for which this permit is issued. Policy No.
have and willaintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
rance carrier al$' oolicv number aQ n
Date
Te of Agent ZZ A Rf �, -✓ 1 ✓ 1 i none Is
certify that, in the performance 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
. if I should become subiect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
of
Z—/-7—/"
SLARATION REgARDIM CORS-YRUCTION LENDING AGENCY
"eby affirm undaf 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).
ter's Name Lender's Address
ny signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf. -� �f /
I have read this application and the information I have provided is correct. 6%to/ S lJ dd .Cl1-t
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 enter t e above- entified property for inspection purposes. t �
iature of ProUerty Owner or Authorized AGent Print Property Owner's or Authorized Agent's Name Y
AC77ON DATE BY rrr w., v, rvn vr.
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