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Home My WebLink AboutX2019-3377 - Permitst City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit: X2019-3377 100 Civic Center Drive,. Newport Beach, CA 92660 X 2 0 1 9 9 3 7 7 Project No : 0804-2018.:. _ Permit Counter Phone (949)644-328a .. 'O Inspection Requests Phone (949)644-3255 Combination Type -BLDG ELEC ELEC Issued Date: $� EtE�w' rea :�Y `_ Inspection Area : 7 i�n�_ PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction Hours: Monday - Friday TOO 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:, 4321 BIRCH ST NB Description. "COMM - (2) LIGHT STANDARDS (X2019-0752) Legal Desc.i N TR5169 LOT 5 Owner: 4321 BIRCH PTNRS LTD Contractor. : D B A C INC Architect: MARTIN RICHARD K Address: ' 26023. ACERO#150 Address: 101 SHIPYARD WAY #A Address: 1400 QUAIL ST #120 MISSION VIEJO, CA 92691 : NEWPORT BEACH CA 92663. - NEWPORT BEACH CA 92660 Phone. Phone: 949-723-0147 - - Phone: 949-851.3044 State Lic:C014204 m ° Applicant. MARTIN RICHARD K Con State Lie. 637651 Engineer: MONTOYA HERNAN ` a; Address: 1400 QUAIL ST #120 Lie Expire: 02/29/2020 Address: - 22421 GILBERTO, STE E -:NEWPORT BEACH CA 92660 Bus tic: BT00016282 RANCHO SANTA MARG CA 92688 .... s < Phone. 949-851-3044 - Lie Exp Date: ' 1013112019 Phone: 9491713-7624 State Lic:S-002819. - • • •, ° Code Edit: 2016 Worker's Compensation Insurance Designer: Type of Construction Carrier.. STATE COMP Address: Occupancy Group: U. Policy No:9117372 Added /New sq.ft.Bldg 0 Expire 11111/2019 ` Phone: Added /New. sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: / Special Conditions: No of Units: 0 Front: / Bldg Height: 0 . 'Left../ 'OSC :. Bldg Sprinklers; ...Right: / Flood Zone: Use Zone: Parking Spaces: ` 0 Fire Hazard Zone : N Construction Valuation: $2.400.00 Building Permit Fee: ' $120.00 Excise Tax :$0.00 - Planning Department - Fire Department - Plan Check Fee: .$104.40 Additional Fee: $0.00 Plan check Fee :. $40.00 Fire Inspection:. $0.00 Overtime Plan Ck $0.00 Grading Bonds Fee. $0.00 Fair Share :... $0.00 fire Plan Rev $0.00 Investigation Fee: '$0.00 Grading PC Consultant: $0.00 SJH Trans: $0.00 Demolition Fee Record Management : $0.00 Grading Permit Fee r $0.00 In -lieu Housing Fee $0.00 ` Building Dept Adm ' $0.00 Energy Compliance: .$0.00 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 [ $0.00 PfW Plan Check: $0.00 Grading Bond: ' $0.00 - Hazardous Mat $0.00 - Electrical %: $15.71 San Dist: $0.00 .Building Green Fee: .,$1.00 - Mechanical %: - :-$0.00 NMUSD Fee: $0.00- $0.00 Plumbing %: '$0.00 .$0.00 TOTAL FEE : $281.11 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $281.11 PROCESSED BY: PUBLIC WORKS APPROVAL: 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 J 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 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 legal 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.html. Signature of Prop§qy QVner or Authorized Agent at LJCENgED CONTRACTOR'S DECLARATION I releby effirm un dol•ppa alty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70gQ) o QQ�I i n of the Business and Pr fie n Co my lic se is in full force and effect License .lass License No Date e[ Contractor Signatu MORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SE®URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU R THOUSAND DOLLARS ($100,000), IN ADDITION TO THE CAI OF•C40MPENeI111j1R, DPMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. flereb9 affirm udder penalty of perjury one of the following declarations: 'MI•have and vital msintain 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 Mance of theyvork for which this permit is issued. Policy No. avj• ave and will•mgginlein 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 • urance carrier aridpdicy number are: •.•0•A 3arrier • •• • Policy Number Expiration Date Name of Agent ...• 4 Phone# :1I certify that, in the performa e. the work r whic this permit is i , I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre :hof, if I should become subj to workers' c mp sation provi ' of Secti 3700 of the Labor Code, I shall forthwith comply with those provisions. / Signature of Applicant Date! DECLARATION REG DING CON UCAN LENDIN GENCY hereby affirm under penalty of pe ry t there is 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 certi 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 inform ' n I have ovided is correc I agree to comply with all applicable city nd county ordi nc and s we rel ing to building construction. I authorize representatives of this city or my to enter bov ; ti 'ed p art f ' ses. Signature of PropertyOwner or Authorized Agent Print Property Owner's or Authorized Agent's Nan)- Date ACTION DATE BYCLARA N OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY ZR4EGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 03 PERMITEXPIRED I Ll I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT EXTENDED I I I LIAQMD PERMITFINAL LJ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEMOLITION