The URL can be used to link to this page

Home My WebLink Aboutf2019-0616 - PermitstswPa City of Newport Beach - Building Division II VIII IIIIIIII III II III IIIIII IIIIIII II FIRE Permit: F2019-0616 100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 1 9 0 6 1 6 Project No : 2507-2019 Permit Counter Phone (949)644-3288 v 4t Inspection Requests Phone (949)644-3255 Job Address: 2865E COAST HWY NB St: 1 FI: 3 Unit: 300 Description: COMM MED GAS PIPING FOR OUTPATIENT SURGERY FACILITY "DR Inspector Area: FIRE Legal Description: TR 323 LOT 6 BILK F AND CORONA DEL MAR LOTS 1/3/5 BILK 534 Owner: OCEAN RIDGE PLAZA LLC Contractor: rg�{ COZART CONSTRUCTION INC Architect: INSPECTOR ■ Address: 450 NEWPORT CENTER DR #490 Address: 2863 BROKEN ARROW STREET Address: NEWPORT BEACH CA 92660 NORCO CA 92860 Phone: Phone: 951-377-6344 Phone: State Lic: Applicant: COZART CONSTRUCTION INC Con State Lic: 669871 y -c Engineer: 0 Address: 2663 BROKEN ARROW STREET Lic Expire: 04130/2021 CONN" -p �r Address: NORCO CA 92860 Phone: 951.377-6344 Bus Lic: Lic Exp Date: BT30066461 " ' uc-r,0 1 t f . State Lic: 12131/2019 r 4Pno@®is Code Edit: 2016 Worker's Compensation Insurance Designer: HASSAN TARIO Type of Construction: III -A -SPR Carrier: HARTFORDAddress: 270 ELDERBERRY ST -rHE Occupancy Group: B Added /New sq.ft. Bldg: 0 Policy No: Expire: 72WECDS3926 ' TM 06112/2020 WE JE�E ae LA VERNE CA 91750 Added /New sq. ft. Garage: 0 No of Stories: 3 Issued Date: 11/22/2019 Special Conditions: No of Units : 0 Setback- Front: Flood Zone: Rear: Bldg Sprinklers: Y Left: Right: FEES <•.•° Construction Valuation: $8,000.00 ...... 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: $456.00 Public Works PC Fee : $0.00 0 '$0.05 Fire Permit Fee: $418.00 Public Works Traffic Plan Check Fee; $0.00 , pOoo Building Permit Fee : $0.00 • ® o TOTAL FEE : $880.00 Plan Check Fee: $456.00 Fee Due at Permit Issuance : $424.00 ° • ° ° PROCESSED BY: OTHER DEPARTMENT: ZONING APPROVAL: PLAN CHECKED BY:: FIRE APPROVAL: A /� APPROVAL TO ISSUE: J� PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 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). V 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, 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 alicensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure. udder,the. Contractors'. State License Law for thefollowing. 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 legalll 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 000V�3oritorand 3 f the B 6iness and Professions Code, and my license is in full force and effect. - �D$1e �// License Class License No ignature WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL ES 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. I hereby affirm under penalty of perjury one of the following declarations: 64 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 the WroMance of the work for which this permit is issued. Policy No. of 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' carrier and policy number are: Policy Number Date that, 0 the Qerformance 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 IoulrPbecovle subject to/tFho ers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. of Ap ant r,greby afflr y o perjury that there is a construction lending agency for the performance of the work for which this pe enr%r's Name Lender's Address 'y'fiy siguatera I certify to each of the following: • 1 am the pr*opertfl owner or authorized to act on the property owner's behalf. '•1;11ave readihis application and the information I have provided is correct. Pagree fo cpjq* with all applicable city and county ordinances and state laws relating to building construction. ' •:authorize reprEsentatives o Inty to er wave -identified property for inspection purposes. Idnature of plooedv Ow DrA cent / ® Print Prooertv Owner's or Authorized (Section 3097, Civil Code). Ip%1 f (C 2 61,E -,- ACTION DATE BY ACTION DECLARATION UI- COMPLIANCL W/ t H t UOLV&✓ FOR OFFICE USE fid FEDERAL REGULATIONS PART IN OF TITLE40AND AQMD RULE 7403. (1��,e+' PERMIT EXPIRED ❑ I SU BMITTEDASBESTOS NOTIFICATION T0: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED PROPOSED DEMOLITION.ASBESTOS DON LS NOT APPLICABLE TO PERMITFINAL i pt(L CERTIFICATE OF OCCUPANCYISSUED SIGNATURE: