HomeMy WebLinkAboutX2017-0429 - Permits (2)1/•�, _ City of Newport Beach - Building Division
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COMB Permit: X2017-0429
100 Civic Center Drive, Newport Beach, CA 92660
X 2 0 1 7 0 4 2 9
Project No : 0300-2017
t, Permit Counter Phone (949)644-3288
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. Inspection Requests Phone (949)644-3255
'�dta+u:u'��D Combination Type - CIP GRAD
Issued Date: 06/07/2017
Inspection Area : 7
PERMITS EXPIRE 180 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 an Sundays or Holidays
Job Address: 401 NEWPORT CENTER OR NB
Description: PRECISE GRADING FOR ADA IMPROVEMENTS "PHASE 1"
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Legal Desc.: P BK 221 PG 30 PAR 2
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Owner: IRVINE CO Contractor:
CUESTA CONSTRUCTION CO Architect:
Address: 550 NEWPORT CENTER DR Address:
3195A AIRPORT LOOP DR Address:
NEWPORT BEACH, CA 92660
COSTA MESA
CA 92626
Phone: Phone:
714-557-5877
Phone:
State Lie:
73 li rzr'
Applicant: HOLLAND ROB Con State Lie: 568466
Engineer: THIESSEN
MITCHELL
Address: 38 TECHNOLOGY STE 100 Lie Expire:
05/31/2019
Address: 38 TECHNOLOGY
IRVINE, CA 92618 Bus Lie:
BT20012806
IRVINE CA 92618 ....
Phone: 949.923.6260 Lie Exp Date:
1213112017
Phone: 949-923.6293 State Lic:C-056967 ......
Code Edit: 2016 Worker's Compensation Insurance
Designer:
°•O°
°• • `o
o °
•BO°°°
Type of Construction: Carrier:
SENTINEL INS
Address:
•
Occupancy Group: U Policy No:
72WE010610
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Added /New sq.ft. Bldg: 0 Expire:
1 2101 /2 01 7
Phone:
0000
° ° ° ° • •
° • ° ° °
Added /New sq. ft. Garage: 0
No of Stories: 0 Building Setbacks
Rear: /
Special Conditions:
000 0
• °
°. ° ° °
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: $312.506.00
°O°
o °
o000
Building Permit Fee: $2,160.00 Excise Tax:
$0.00
Planning Department-
..
Fire Department
Plan Check Fee: $1,879.20 Additional Fee :
$0.00
Plan check Fee: $300.00
Fire Inspection: $0.00
Overtime Plan Ck: $0.00 Grading Bonds Fee:
$0.00
Fair Share : $0.00
Fire Plan Rev $358.00
Investigation Fee: $0.00 Grading PC Consultant:
$0.00
SJH Trans : $0.00
Demolition Fee
Record Management: $66.00 Grading Permit Fee:
$820.00
In -lieu Housing Fee: $0.00
Building Dept Adm $0.00
Energy Compliance: $0.00 Grading PC Fee:
$713.40
Public Works Department -
General Service $0.00
CA Seismic Safety: $0.00 WO Insp. Fee:
$0.00
Park Dedication : $0.00
Refund Deposit $0.00
Disabled Access : $312.51
PAN Plan Check: $304.00
Grading Bond: $0.00
Hazardous Mat $0.00 Electrical %:
$0.00
San Dist: $0.00
Building Green Fee : $13.00 Mechanical %:
$0.00
NMUSD Fee: $0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $6,926.
Plan Check Fee :
$6,764.03 Fee Due at Permit Issuance : $162.08
PROCESSED BY:
PUBLIC WORKS APPROVAL:
Y V `
4
ZONING APPROVAL: \
PLAN CHECK BY:
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 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
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 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).
❑ 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.gov/calaw.htm].
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 7000) of Division 3 of the Business and Professio s_ Cgje, agd license'is full force
and effect. Licens: �Iass License No Date,t' Contractor Signature
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WORKERS' CCW?VNSATION DECLARATION l
V>yly(r AILURE TO URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE
Cp T1 OMPENSATI�N, MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm underpenalty of perjury one of the following declarations:
I M3ve and w4l•raintain 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
formnce of the workforwhich this permit is issued. Policy No.
Ph1ade and wyl maigtpin 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' compensatior
1IVL?2ntg carrieg Irld policy number are:
CBT11@r• Policy Number Expiration Date
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 agree
t,*ii ishould becomecub'ect to / the
j worjcers,' cAom�pen�sa�tio-n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /� �--7
nature of Ap�liSant , �/% Date �(!J ' /
CLARATION REGARDING CONSTRUCTION LENDI GENCY
)reby affirm under penalty of perjury that there is a c struction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Ider's Name Lender's Address
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 ordinances and state laws relating to building construction. �/
I authorize representatives of this city or county tt nter this a4ove-identified property for inspection purposes. . .V �/�✓.Jr,
nature of ProOertv Owner or Authorized Apent L/ /�l.?JLg� Print Property Owner's or Authorized Agent's Name / _ lam. �Y zc_/ _ Date dl' /� y
ACTION
DATE
BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED
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CERTIFICATE OF
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