HomeMy WebLinkAboutX2021-0687 - PermitsI' City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2021-0687
e 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 1 0 6 8 7 Project No : 0628-2021
4- Permit Counter Phone (949)644-3288
s1. - Inspection Requests Phone (949)644-3255
'1'�e�xvra'a Combination Type - CIP ELEC PLUM Issued Date: 04128/2021
0INS
PECT0I Inspection Area : 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0412812024 OR PERMIT WILL BE INVALID
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 (3) TEMPORARY MODULAR TRAILERS (TRAINING WORKROOM)
Legal Desc.: IRVINE SUB ELK 1 LOT 172 FOR OF LOT
Owner:
HOAG MEMORIAL HOSPITAL
Address:
1 HOAG
Record Management:
NEWPORT BEACH, CA 92663
Phone:
$0.00
Applicant:
LIEBKE STEVEN S
Address:
1340 REYNOLDS AVE #115
Hazardous Mat
IRVINE CA 92614
Phone:
949.400.5462
Code Edit : 2019
Type of Construction:
Occupancy Group: B
Added /New sq.ft. Bldg: 2670
Added /New sq. ft. Garage: 0
No of Stories: 0
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Construction Valuation: $60.000.00
Building Permit Fee: $889.00
Plan Check Fee: $773.43
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$32.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$91.00
Hazardous Mat
$0.00
Building Green Fee :
$3.00
TOTAL FEE: $2,148.68
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Contractor:
SOUTH COUNTY CONTRACTORS
Address:
161 EXETER WAY #87
Fair Share
CORONA, CA 92882
Phone:
949-205-6304
Con State Lic:
988175
Lie Expire:
11/30/2021
Bus Lie:
-BT30048035
Lie Exp Date:
07131/2021
Worker's Compensation Insurance
Carrier: WC EXEMPT
Policy No: (NO EMPLOYEES)
Expire:
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 %:
Rear: I
Front: I
Left: /
Right: /
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$232.74
$0.00
$80.01
Architect: LIEBKE STEVEN S
Address:
1340 REYNOLDS AVE 9115
•b°
Fire Inspection:
Fair Share
IRVINE CA 92614
°.
Demolition Fee
Phone:
949-400-5462 State Lic:CO28341
a ° ° •
m • ° ° °
$0.00
PAN Plan Check:
°•°°
San Dist:
Engineer:
NMUSD Fee:
$0.00
Address:
k
b O
•, -
Phone:
State Lie:
m u
nn ,
Designer:
•o o .
o°°.00
Address:
a
Phone:
mW• f•
n mo
•
Special Conditions:
....
°
as•nr
Planning Department -
Fire Department
Plan check Fee:
Fire Inspection:
Fair Share
Fire Plan Rev
SJH Trans
Demolition Fee
In -lieu Housing Fee:
Building Dept Adm
Public Works Department -
Park Dedication :
$0.00
PAN Plan Check:
$0.00
San Dist:
$0.00
NMUSD Fee:
$0.00
$0.00
$47.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee : $1,020.21 Fee Due at Permit Issuance : $1,128.47
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
Fire Department
$0.00
Fire Inspection:
$0.00
Fire Plan Rev
$0.00
Demolition Fee
$0.00
Building Dept Adm
General Service
Refund Deposit
Grading Bond:
$0.00
$47.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Plan Check Fee : $1,020.21 Fee Due at Permit Issuance : $1,128.47
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
he 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
)rofessions 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
lot 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,
3usiness 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
Tprovements 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
reproved for the purpose of sale).
7 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
Ipply 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:
3y my signaturep@IbW (+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
;ell a structure thatl 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
4afessrons Codepisavailable upon request when this application is submitted or at the following Web site:http:L/www.leginfo.ca.gov/calaw.html.
Agnaturd of Propeq)✓;Q)yner or Authorized Agent Date
JCVNSXD CONTRACTOR'S DECLARATION
tlerebl affirm under pe Calty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of ivis' n 3 of the Business and Professio Code, license is in full force
Ind effect. License Class License No Date Contractor Signature
VOR"ERS' COjWPI�NSATION DECLARATION
1ARRI&F. FAILURE40SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T OUSANo DOLLARS ($100,000), IN ADDITION TO THE
;9,4T,Q .dbMPENSAt10it,tlAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I;%gp4X affirm undEr penalty of perjury one of the following declarations:
I I have and will nSilrtain 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,
�eliorcrlance of the woreforwhich this permit is issued. Policy No.
Ih0a and wA141i9thin 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
isurance carrier and policy number are:
Policy Number
Agent
Date
)ceIfy that, in the performance of the kr whichthis 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 agreshould become subject t the wor s' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
re of Applicant Date
CLARATION REG D CONSTRUTCTION LENDING AGENCY
:reby 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 providedc rect.
I agree to comply with all applicable city and county ordinance nc state laws relating to building construction.
I authorize representatives of this city or cout0 a er the a entified property for inspection purposes. 1
nature of Prooertv Owner or Authorized ADent� �� _ Print Property Owner's or Authorized Agent's Name L�tiEZVC'a/JTEEEAG Date
ACTION DATE BY DECLARATION OF /r
REGULATIONS PART0MPLIANCE WITH CODE OF 61 OF TITLE 40 AND AQMD RULE
FOR OFFICE USE ONLY
PERMIT EXPIRED
PERMIT CANCELLED
ASBESTOS NOTIFICATION TO
PERMITFINAL
OCCUPANCTYOSUED ✓ V �� Gj� R AS EM TISIONIO IS OT APPLICABLE TO
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