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Home My WebLink AboutX2019-0688 - Permits�, f� City of Newport Beach - Building Division IIIIIIIIII'IIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit X2019-0688 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 9 9. 6 8 8 Project No : 0478-2019 ' Permit Counter Phone (949)644-3288 +§ Inspection Requests Phone (949)644-3255 a,r,r v�" " Combination Type - CIP ELEC MECH PLUM Issued Date: 04/01/2019 9 Inspection Area : 7 PERMITS EXPIRE 980 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. 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 Job Address: 4631 TELLER AVE NB St: 1 FI: 1 Unit: 100 Description: COMM TI @ SUITE 100, 140, 150,&:COMMON AREA RESTROOMS (1,505 SF) "HARBOR PSYCHIATRY& MENTAL HEALTH" Legal Desc.: N TR 9626LOT 6. Owner 4631 TELLER LLC Contractor: PACIFIC ORCA CORPORATION Architect: LUX TIMOTHY J Address: '4631 TELLER AVE Address: 37 BROOKLINE Address:. 3001 CAPRI LN NEWPORT BEACH, CA 92660 ALISO VIEJO CA 92656 COSTA MESA CA 92626 1 16 - Phone: Phone: 714.647.1791 Phone: 949-581-2255 State Lic:C019769 Applicant: SANCHEZ PHIL Con State Lic 644807 Engineer: HAKEMI FAHIM Address 37 BROOKLIME Lie Expire: 0513112020 Address: 26982 MARBELLA ALISO VIEJO CA 92656 Bus Lie: BT3006543 MISSION VIEJO CA 92691 Phone: 714-647-1791' : Lie Exp Date:. 1213112019 Phone: 714-427-9778 State Lic:S-005160 r Code Edit: 2016 Worker's Compensation Insurance Designer. Type of Construction: V -B -SPR Carrier: NO EMPLOYEES Address: Occupancy Group: B. Policy No: - Added /New sq.ft. Bldg: 1505 Expire: Phone:; '.. Added /New sq. ft. Garage: 0 r' No of Stories: 1 Building Setbacks Rear: I Special Conditions: No of Units : 0 Front: Bldg Height:. 0 Left: Bldg. Sprinklers: Y Right: Flood Zone: X Use Zone: Parking Spaces: 0. Fire Hazard Zone : N Construction Valuation: $120.000.00 . Building Permit Fee: $1,288.00 Excise Tax: $0.00 Planning Department- Fire Department Plan Check Fee: $1,120.56 Additional Fee : $0.00 Plan check Fee : $0.00 Fire Inspection:. $0.00 Overtime Plan Ck:. $0.00. Grading Bonds Fee: $0.00 Fair Share : $3,280.12 Fire Plan Rev $0.00 Investigation Feer $0.00 Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $46.00 - Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $84.00 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: $120.00 PNV Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $337.20. San Dist: .$0.00 Building Green Fee : $5.00 Mechanical %: $264.94 NMUSD Fee: $0.00 $0.00 Plumbing %: $216.77 $0.00 TOTAL FEE : $6,762.59 Plan Check FOG: $1,705.55 Fee Due at Permit Issuance : $5,057.04 PROCESSED BY: w¢ PUBLIC: WORKS APPROVAL: a ° 6. ZONING APPROVAL: ° °° PLANCH&' UtBY: GRADING APPROVAL: ° ° ,. APPROVAL TO ISSUE: , . ° °°c ..... .. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) 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 C-) all of or L) 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). - ❑ 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:.. Bymy 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 ofthe 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.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700) ^i isi 3 of the Business and P fess' n de, n my license is in full force and effect. License Class License No Date Contractor Signatur NORKERS' COMPENSATION DECLARATION MARNING: 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 $100,0001, 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: :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 Zormance of the work for which this permit is issued. Policy No. haveand w' 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 nsurance carne d policy nu r are: ;arrier.. - olicy Number Expiration Date Vame of Agent Phone # 4F��I certify that, in the performance of t Vmpensation 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 agree hai, if I should become su ' ct to t provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 3ignature of Applican Da< )ECLARATION REGARDING CO TRUCTION NDING AGENCY hereby affirm under penalty of perjury that ther i 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 provid W is PQrrect. I agree to comply with all applicable city and county o I n aI d tate laws relating to building construction. (r I authorize representatives of this city or cou t o en oft e f ov -i nti iad property for inspection purposes. WL �' ,tL�',2. to `,. 31gnature of Property Owner or Authorized Agent / Print Property Owner's or Authorized Agent's Na ACTION DATE BY DECLARATIONOF C PLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 10F TITLE 40 AND AOMD RULE. 1403 PERMIT EXPIRED U I SUBMITTED ASBESTOS NQIIFICQ'GION T®• • • i PERMITCANCELLED EPA • • • �•• PERMIT EXTENDED AOMn • •.• "_� •• + PERMITFINAL 47-Nti S:; > ASBESTOS NOTIFICAT LIS T P LICABLE TO CERTIFICATE OF,'W`^0' P POS ED DEMOLITI �•" OCCUPANCYISSUED SIGNATURE: • +••