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Home My WebLink AboutX2020-0552 - PermitsLegal Owner: Address: Phone: Applicant: Address: Phone: City of Newport Beach s Building Division *X2020-0552* 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - CIP ELEC COMB Permit : X2020-0552 Project No : Issued Date : 03/02/2020 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 am. to 6:00 p.m. No work on Sundays or Holidays Job Address: 1 HOAG DR NB Description: COMM - INSTALL NEW H-FRAME CONDUIT RO RUN NEW FIBER FROM PMMP TO EXTG CLW CABINET (N TOWER, E TOWER & BSMT) " Desc.: IRVINE SUB BLK 1 LOT 172 POR OF LOT HOAG MEMORIAL HOSPITAL- 1 HOAG DR NEWPORT BEACH, CA 92658 BROKEN ARROW COMM INC 10250 BIRTCHER DR JURUPA VALLEY CA 91752 951-790-1046 Code Edit : 2019 Type of Construction: V-A- SPR Occupancy Group: B Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 3 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Y Flood Zone: Construction Valuation: $29,000.00 Building Permit Fee: $515.00 Plan Check Fee: $0.00 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $0.00 Energy Compliance: $0.00 CA Seismic Safety : $0.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee : $2.00 TOTAL FEE : $691.83 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: BROKEN ARROW COMM INC 10250 BIRTCHER DR JURUPA VALLEY CA 91752 951-790-1046 853651 01/31/2021 BT30070655 01/31/2021 Worker's Compensation Insurance Carrier: OLD REPUBLIC INS CO Policy No: AIDW08501 Expire: 08/15/2020 Building Setbacks Use Zone: Excise Tax: Additional Fee : Grading Bonds Fee: Grading PC Consultant : Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: JA $134.83 $0.00 $0.00 Plan Check Fee : Rear: / Front: / Left: / Right: / Parking Spaces: Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: State Lic: KANTHA SAMY MADHAN KUMAR 830 STEWART DR STE 108 SUNNYVALE CA 94085 State Lic:C-077991 Special Conditions: Fire Hazard Zone : N $0.00 Planning Department - $0.00 Plan check Fee : $0.00 Fair Share : $0.00 SJH Trans : $0.00 In -lieu Housing Fee : $0.00 Public Works Department - $0.00 Park Dedication : $0.00 PNJ Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $40.00 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Grading Bond: $0.00 Fee Due at Permit Issuance : Vet • •s•• • e �re••e e + • • o• em o eo•• •oom 00 t o e e • 00 a0 0 t 0 e 00 00.0 0 000®0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $691.83 0 e e000C • o • t • o m ee ° O m • 0 C om 0 tote• O 0000 eeeeee o e m • 00000 one PUBLIC WORKS APPROVAL: PLAN CHECK BY: 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 (_) 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). ' ❑ 1, 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). ❑ I 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 Cods!is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Prpperf j Owner or Authorized Agent Date LICEIpSED CONTRACTOR'S DECLARATION Irhereby affirm:iv-Rlpp penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000 of ivi ion 3 of the Business and Professio de, an,, my license is in full force end effect. License Class License No Date 2 Let"— Contractor Signature (r' 'Wb&gERS' C¢II01ENSATION DECLARATION %ARNIHG: FAILUFCE TQQ,$F•CURE 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 COTCOMPENATI N, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. T�hhrIereby affirm Ode/penalty penalty of perjury one of the following declarations: L.I.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 rpance of the work for which this permit is issued. Policy No. and vAl1lea inlain 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 ipsurareee carrier pprj policy number are: Carsr. •Policy Number Expiration Date Name of Agent Phone # ❑I 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 that, if I should become ssuuprect to the workers'(Z7 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant 0 C C. C� Date 20ZJ DECLARATION REGARDING C NSTRUCTION LENDING AGENCY I hereby affirm under penalty of p rjury that there is a construction lending 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 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. Zp� I authorize representatives of this city or county toe he above -identified property for inspection purposes. ��D� L /J✓��/9 L Signature of Property Owner or Authorized Agent — — C — Print Property Owner's or Authorized Agent's Name /,4 Date ACTION DATE BY DECLA ATION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 FOR OFFICE USE ONLY PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED DEPA PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED S-1I-78b4 ❑AQMD Gam' ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION SIGNATURE: