The URL can be used to link to this page

Home My WebLink AboutX2020-0552 - Permits�'''a City of Newport Beach s Building Division *X20200552* COMB Permit: X2020-0552 +off 100 Civic Center Drive, Newport Beach, CA 92660 Project No w �, Permit Counter Phone (949)644-3288 '' Inspection Requests Phone (949)644-3255 i+res�r,#�' Combination Type - CIP ELEC Issued Date : 03102/2020 Inspection Area : 7 TOTAL FEE: $691.83 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: N Plan Check Fee $0.00 Fee Due at Permit Issuance : $691.83 PUBLIC WORKS APPROVAL: PLAN CHECK BY: led APPROVAL TO ISSUE: 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 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 1 HOAG DR NB ,. �41il Description: COMM -INSTALL NEW H -FRAME CONDUIT RO RUN NEW FIBER FROM PMMP TO EXTG CLW CABINET IN TOWER, E TOWER & BSMT) ,., Legal Desc.: IRVINE SUB BLK 1 LOT 172 FOR OF LOT Owner: HOAG MEMORIAL HOSPITAL- Contractor: BROKEN ARROW COMM INC Architect: Address: 1 HOAG DR Address: 10250 BIRTCHER DR Address: A_ NEWPORT BEACH, CA 92658 JURUPA VALLEY CA 91752 Phone: Phone: 951-790-1046 Phone: State Lic: esee + A esee !� Applicant: BROKEN ARROW COMM INC Con State Lic: 853651 Engineer: KANTHA SAMY MADHAN KUMAR • • • m, eA ° Address: 10250 BIRTCHER DR Lic Expire: 01/31/2021 Address: 830 STEWART DR STE 108 • . ° e m ° JURUPA VALLEY CA 91752 Bus Lic: BT30070655 SUNNYVALE CA 94085 • • a Phone: 951-790-1046 Lic Exp Date: 01131/2021 Phone: State Lic:C-077991 esee Code Edit: 2019 Worker's Compensation Insurance Designer: •O°O6e e° .°° Type of Construction: V-A- SPR Carrier: OLD REPUBLIC INS CO Address: Occupancy Group: B Policy No: AIDWO8501 4 ° ° e ° ...... Added /New, sq.ft. Bldg: 0 Expire: 08/15/2020 Phone: a Oe•°° Added /New sq. ft. Garage: 0 No of Stories: 3 Building Setbacks Rear: / Special Conditions: e %.0 e ° No of Units: 0 Front: / °•e°•° Bldg Height: 0 Left: / OeO° ° Bldg Sprinklers: Y Right: I 0490 .... Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $29.000.00 Building Permit Fee: $515.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $0.00 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: $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 PAN Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $134.83 San Dist: $0.00 Building Green Fee : $2.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE: $691.83 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: N Plan Check Fee $0.00 Fee Due at Permit Issuance : $691.83 PUBLIC WORKS APPROVAL: PLAN CHECK BY: led 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). ' ❑ 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 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!i5 available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.govlcalaw.html. Signature of Prpperlt/ Owner or Authorized Agent Date LICEISED CONTRACTOR'S DECLARATION Mereby affirrTStiMpp Penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of ivi ion •3`f the Business and Professio ' de, and my license full force and effect. License Class License No Date 2 Contractor Signature C� WbRIZERS' C¢ffi-ENSATION DECLARATION NWRNIHG: FAILUFfE ifQ ffCURE 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 PCOMPENS�A'fI N, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. thhereby affirm phdpr penalty of perjury one of the following declarations: n, :have and witi 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 JIL tDairlilain 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 ipSurarce carrier pgq policy number are: Carwer•* • Policy Number Expiration Date is of Agent certify that, in the p, . if I should become Ice 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 to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. � � of Applicant �•�� Dated 3/z/ZOZe� CLARATION REGARDING C NSTRUCTION LENDING AGENCY ireby 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). 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 to ehe above -identified property for inspection purposes. �D� /J✓fix nature of ProDertV Owner or Authorized Agent �" !tea— q- – e–,— Print Property Owners or Authorized Agent's Name L ACTION DATE BY I REGULATIONS PART061 OF IITLE 40 AND QMD RULE CE WITH CODE OF AL PERMIT EXPIRED L iI SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA PERMITFINALYIN (�Ga �`® U ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: FOR OFFICE USE ONLY u