HomeMy WebLinkAboutF2019-0033 - Permits0v�
City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIFIRE Permit: F2019-0033
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 1 9 0 0 3 3 Project No: 0146-2019
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 4501 HAMPDEN RD NB
Description: SFR FIRE SPRINKLERS (67) HEADS (X2018-0502)
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Inspector Area: 5
Legal
Description:
N TR 3357 LOT 10
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Owner: HOGAN ROGER & MARIE
Contractor:
STEPHEN CUCULIC FIRE PROTECTION Architect:
Address:. 4501 HAMPDEN RD
Address:
33041 CALLE PERFECTO Address:
CORONA DEL MAR, CA92625
SAN JUAN CAPISTRANO, CA 92675
Phone:
Phone:
714.608-1175 Phone:
State Lic:
Applicant: CUCULIE STEVE
Con State Lic:
954483 Engineer:
Address: 33041 CALLE PERFECTO
Lic Expire:
11/30/2020 Address:
SAN JUAN CAPISTRANO CA 92675
Bus Lic:
BT30065741
Phone: 714.608-1175
Lic Exp Date:
01/31/2020 Phone:
State Lic:
Code Edit: 2016
Worker's Compensation Insurance Designer:
CUCULIC STEVE
Type of Construction: V-BSPR
Carrier:
NO EMPLOYEES Address:
33041 CALLE PERFECTO
Occupancy Group: R31U
Policy No:
SAN JUAN CAPISTRANO CA 92675
Added /New sq.ft. Bldg: 0
Expire:
Phone:
714-608-1173
Added /New sq. ft. Garage: 0
No of Stories: 1
Issued
Date: 011/1812019 Special Conditions:
No of Units: 0
Setback- Front:
Flood Zone: X
Rear:
Bldg Sprinklers: Y
Left:
Right:
FEES
Construction Valuation: $13,400.00
Building PC Fee :
$202.00
Fire Residential Alarm PC Fee: $0.00
Records Management:
$2.00
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:
$0.00
Public Works PC Fee: $0.00
$0.00
Fire Permit as :
$0.00
Public Works Traffic Plan Check Fee; $0.00
Building Permit Fee :
$240.00
TOTAL FEE :
$444.0_0^
Plan Check Fee: $202.00 Fee Due at Permit Issuance:
$242.00
PROCESSED BY:
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ZONING APPROVAL:
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FIRE APPROVAL:
APPROVAL TO ISSUE:
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PERMIT EXPIRES 184 DAYS AFPER iy.4Sfd, INCE OR -LAST VALID INSPECTION
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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 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 contractsfor 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 leg -all:
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.htmi.
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 Professions Code, and my license is in full force
and effect. ,/
License Class License No Dat Contractor SignaJLME�
NORKERS' COMPENSATION DECLARATION �'
NANNING: 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 th
)erfSpmance of the work for which this permit is issued. Policy No. -
have and will a tain 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'
rance carrier nd licy number are: k% k
Date
of Agent
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
if I should become supject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ;
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ULA" I JUIN KCGAKUIINU UWN51 KUU I IUN LCNUINU AU6NGY I f
areby 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).
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 t`Ien��Na above -identified property for inspection purposes. '�%�
nature of Property Owner or Authorized Agent .JC �-�� — Print Property Owner's or Authorized Agent's Name Xhm PAI ✓I -F
ACTION DATE BY
DECLARA TION OF COMPLIANCE MTN CODEOF
FOR OFFICE USE ONLY
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