HomeMy WebLinkAboutX2019-1900 - Permits�s11rt��- City of Newport Beach - Building Division , IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIII�� II COMB Permit: X2019-1900
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 1 9 9 8
3:.. Permit Counter Phone (949)644-3286 Project NO `. 1375-2019
it Inspection Requests Phone (949)644-3255
"rr�Jwnu`g., '� Combination Type - BLDG Issued Date: 06119/2019
Inspection Area : 7
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:
Construction Valuation: $2.000.00
Building Permit Fee:
$104.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Fire Inspection:
Overtime Plan Ck:.
$0.00
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
$6.00
Job Address:
4201 JAMBOREE RD NB
CA Seismic Safety:
$0.00
Disabled Access :
- •...
Hazardous Mat
Description:
INSTALLATION OF (6) TEMP FLAG POLES
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Legal Dose.:
N TR 7953 LOT 2
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Owner.
UPTOWN NEWPORT BUILDING LP
Contractor:
OUTDOOR DIMENSIONS
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LLC
Architect
Address:
5000 BIRCH ST STE 600
Address:
5325 E HUNTER AVENUE
Address:
NEWPORT BEACH, CA 92660
ANAHEIM, CA 92807"
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Phone:.
949-207-4500
Phone:
714-578.9555
Phone:
°•
State Lice
4 • °
Applicant:.
BAORAN MATTHEW
Con State Lie
1042246
Engineer: JACOB TONY
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Address:
: 5000 BIRCH ST STE 600
Lie Expire:
07/3112020
Address: P.O. BOX 802050
NEWPORT BEACH, CA 92660
Bus Lie:
BT30065064
SANTA CLARITA CA 91380 •
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Phone:
949-267-1500
Lie Exp Date:
11/3012019
Phone:. 661-259-0700
State LieC-059022 0 o e
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Code Edit :
2016
Worker's Compensation Insurance.
Designer.
°
° ° °
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Type of Construction:
Carrier:
REGENT
Address:
0000
Occupancy Group: U
Policy No:
CWC1344630
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:
Construction Valuation: $2.000.00
Building Permit Fee:
$104.00
Plan Check Fee: $90.48
Fire Inspection:
Overtime Plan Ck:.
$0.00
Investigation Fee:
$0.00
Record Management:
$6.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$0.00
Hazardous Mat
$0.00
Building Green Fee:
TOTAL FEE: $243.48
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Expire: 08/10/2019
Building Setbacks
Use Zone:
Excise Tax:
Additional Fee
Grading Bonds Fee:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
Rear: /
Front: /
Left: /
Right: /
rking Spai
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Phone:
Special Conditions: AUTH LETTER ATTACHED
Planning Department -
Plan check Fee
Fire Department.
Fair Share
Fire Inspection:
SJH Trans
Fire Plan Rev
In -lieu Housing Fee:
Demolition Fee
Public Works Department -
Park Dedication :
$0.00
PMI Plan Check:
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
Plan Check Fee
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 Fee Due at Permit Issuance : $243.48
PUBLIC WORKS APPROVAL:
PLAN CHECK BY: �1 ^
APPROVAL TO ISSUE: / v \
Fire Department.
$40.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 Fee Due at Permit Issuance : $243.48
PUBLIC WORKS APPROVAL:
PLAN CHECK BY: �1 ^
APPROVAL TO ISSUE: / v \
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 applicably 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 alicant for
is 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 penally of
of more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or `) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
nproved for the purpase of sale).
I, as owner of tfle property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
lUy tp.sf owner of plaperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
1 am exempt from.licensure under the Contractors' State License Law for the following reason:
I)& M1W slWature belgw I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
ell a Mfucture thajRl havg built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
'rofessions Cods,,.Isauallable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
lipnatweof Property Olner or Authorized Agent Dale
A"lld$ED COtMACTOR'S DECLARATION
I P,by L1ffirm und2f pAnalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section/LPENALTIES
) of Di isio 3 of the Business and Profe cions de, m II force
nd effect. License.Class License No DatContractor Signature
IIp -ta$s, CQVPMJSATION DECLARATION
�F�jjfRjNH&LN!�i+FF�AILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN AND CIVIL FINES UP TO ONE HUND EO THOUSAND DOLLARS ($'100,000), IN ADDITION TO THE
QSYDF Gr�SMPENSATj(jIJ, DQAAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
he4Waffirm urf4; gW<y of perjury one of the following declarations:
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
erformance of the work for which this permit is issued. Policy No.
I have 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
ns nce carrier and policy number are:
)arrier Policy Number Expiration Date
Vame of Agent Phone #
:1I certify that, in the pert ante 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 ogre
hat, if I should become bject t e workers' mpensation visions Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant Date
)ECLARATION REG RD STRU ION LENDING AGENCY
hereby affirm under ena ty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 30 , 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 rd' antes and state laws relating to building construction.
I authorize representatives of this city or county to n e -i roperty for inspection purposes.
3ignature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Nam t?+*hnu +tD'RAm to
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED
PERMIT EMENDED
CERTIFICATE OF
OCCUPANCYISSUED
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