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Home My WebLink AboutX2014-3760 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII e�COMB Permit: X2014-3760 0 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 4 3 7 6 0 Projeot No: 2817-2014 N Permit Counter Phone (949)644-3286 u. Inspection Requests Phone (949)644-3255 Combination Type - CIP PLUM Issued Date : Inspection Arearea :2014 2 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBIC WOgKS 4PUROVAL: c a PLAN CHECK BY APPROVAL TO ISSUE: r •e• c a v a • e o c.,� co oa occ oc� PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Job Address: 200 W PROMONTORY DR NB Description: COMM VOLUNTARY RECREATION BLDG RESTROOM UPGRADE Legal Desc.: PARCEL MAP 49-15 PAR 1 POR OF PAR Owner: PROMONTORY POINT APARTMENTS LLC Contractor: M. R. C. Architect: MYERS TRACY ELIZABETH �9 Address: 550 NEWPORT CENTER DR Address: 5400 TECH CIRCLE Address:. 3041 CLUB HOUSE CIRCLE NEWPORT BEACH, CA 92660 MOORPARK CA 93065 COSTA MESA CA Phone: Phone: 805-584-1213 Phone: State Lic:CO27797 Applicant: JENNER FLOYD CIRCLE Con State Lic: 795729 Lie Expire: 05/31/2015 Engineer: Address:, _ e --' Address: 7300 TEC MOORPARK CA 93021 Bus Lie: BT30041026 Phone: 562-5774788 Lie Exp Date: 10/31/2015 Phone: State Lie: f Code Edit : 2013 Worker's Compensation Insurance Designer: _ Type of Construction: Carrier: GREAT AMAERICAN INSURANCE Address: Occupancy Group: Policy No: AICW93601304 ¢"---^-' Added /New sq.ft. Bldg: 0 Expire: 07/15/2015 Phone: Added/New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: / Special Conditions: No of Units : 0 Front: / Bldg Height: 0 Left: / _ Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $5.000.00 Building Permit Fee: $144.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $103.68 Additional Fee : $0.00 Plan check Fee : $32.00 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee Record Management : $4.00 Grading Permit Fee: $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 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $14.40 $0.00 TOTAL FEE : $299.08 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $299.08 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBIC WOgKS 4PUROVAL: c a PLAN CHECK BY APPROVAL TO ISSUE: r •e• c a v a • e o c.,� co oa occ oc� 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 items) (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 L) 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). ❑ 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 at least one year prior to completion of the improvements covered by this permit, I cannot legally 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.govicalaw.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 Section 700 .gfls;opf the Business and Pr fessio �. a+f��ny nse is in full force and effect. License Class License No Dat OL [ Contractor Signatur cL� WORKERS' COMPENSATION DECLARATION WARNING: 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 COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I 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 the performance "a work for which this permit is issued. Policy No. 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' is ofAgerk_/ �— 4,%)..J certify that, in the performance of the work if I should become subject to the'Workefs re of Date 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 agree ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 11. DEW< iECLARATION REGARDING CONSTRUCTION LYNDING AGENCY hereby 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). Ender's Name Lender's Address y 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 ordinan es and state laws relating to building construction. I authorize representatives of this city or county to an ab s �I led property for inspection purposes. T ignature of Property Owner or Authorized Agent ab S— Print Property Owner's or Authorized Agent's Nam ,t V f ACII'MYa !HSTF RV DECLARAT[OH#TFCOMPLUWCEW;THCODEOF FM01-MLEE&kitl .T FEDERAL REGULATIONS PART 61 OF TITLE40AND PFRfuf1TF)rP1RFf) ••a •A0WRVILC44tT. 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