HomeMy WebLinkAboutF2018-0412 - Permits,a P`iVo®d New orNF3each - Building Division
4' m 160 Cioc Center Grj ge, Mejport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Job Address: 745 DOVER DR NB
Inspector Area: FIRE
Owner: ENVIRONMENTAL NATURE CENTER
Address: 1601 E 16TH ST
NEWPORT BEACH CA 92663
Phone:
Applicant: SHELTON SCOTT
Address: 22745 LA PALMA AVE
YORBA LINDA CA 92887
Phone: 714-692-3573
Code Edit: 2016
Type of Construction:
V -B -SPR
Occupancy Group:
BIE
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
1
No of Units :
0
Flood Zone:
X
Bldg Sprinklers:
Y
III'IIIII ILII0IIII IIIII8IIIIIIII0II4IIII ILII III II
FIRE Permit: F2018-0412
Project No: 1730-2018
Inspection Requests Phone (949)644-3255
Description: COMM FIRE SPRINKLER (128) HEADS X2017.2426
Legal Description: TR 1218 LOT 148 POR OF LOT (P. M. 160-03 PAR 3 POR OF PAR)
Contractor:
SHELTON FIRE PROTECTION CO INC
Architect:
Address:
22745 LA PALMA AVENUE
Address:
$0.00
YORBA LINDA CA 92887
Phone:
714.692-3573
Phone:
Con State Lie:
677631
Engineer:
Lie Expire:
05131/2019
Address:
Bus Lie:
BT30064434
Building Extention Fee :
Lie Exp Date:
0 913 012 01 9
Phone:
Worker's Compensation Insurance
Designer:
Carrier:
GRANITE INS
Address:
Policy No:
QB1090898
$701.00
Expire:
03101/2019
Phone:
Issued Date: 09/11/2018 Special Conditions:
Setback- Front:
Rear:
Left: C-c-m_c \
Right:
State Lie:
State Lie:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
FEES
Construction Valuation:
$0.00
Building PC Fee:
$0.00
.Fire Residential Alarm PC Fee :
$0.00 Records Management:
$6.00
Building Overtime PC Fee:
$0.00
Planning Counter Review: -
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee: -.
$0.00
Building Investigation Fee:
$0.00
-
$0.00
Fire Plan Check Fee:
$701.00
Public Works PC Fee,
$0.00
$0.00
Fire Permit Fee:
$362.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$1,069.00
Plan Check Fee :
$701.00 Fee Due at Permit Issuance :
$366.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
e
.•• • • •oco
-•• ee
)WNER-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 hay% planed rkxt 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
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 Divisipn 3 of t�g Due ass 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 subjgct. tha applitAntto a civil penalty 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 int;ntiDd w offeretl for sIV(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 4roves 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 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
pply 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:
ly 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
ell 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.html.
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION11
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secti n 7000) of Division 3 of the Business and P ons&ksgeinII force
nd effect. `
.icense Class License No GettContractor Signatur
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:
-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 thi
e rmance of the work for which this permit is issued. Policy No.
ave 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' compensatior
1 ran
carrier and policy number are:
:arrier Policy Number Expiration Date
lame of Agent Phone #
�I certify that, in the performance of thew I hich pe s !as ed, I s It not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
iat. if I should become subiect Whe r ' an " �r gns Se on 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applican U r '
DECLARATION REGARDING CON TI I G AGENC
I hereby affirm under penalty of perjur;TNat there is a construction I riding agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have provided i ec .
I agree to comply with all applicable city and county ordinan an stat la ng t wilding construction. `�"
I authorize representatives of this city or count b 'd a e`, inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam Date
ACTION DATE BY
PERMITEXPIR€D
PERMITCANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCYiSSUED
61 OFTIILE40AND
AQMD.RULE1403.
❑ t SUBMITTEOASBESTOS NDTIFICATIOIV T0:
13 EPA
❑ AQMD
❑ ASBESTOS N077HCA170HIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE: