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Home My WebLink AboutX2019-2168 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - CIP IIIIIIII I1111H IIIIIIIIIIIII1IIIIIIIO III COMB Permit : X2019-2168 Project No : 1572-2019 Issued Date : 02/06/2020 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 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 1 HOAG DR NB Description: COMM NEW METAL TRELLIS 360 SF Legal Desc.: IRVINE SUB BLK 1 LOT 172 POR OF LOT Owner: Address: Phone: Applicant: Address: Phone: HOAG MEMORIAL HOSPITAL 301 N NEWPORT BLVD NEWPORT BEACH, CA 92869 RABBEN BILL 833 DOVER DR #9 NEWPORT BEACH, CA 92663 949-548-3459 Code Edit : Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: 2016 VB U X 0 0 Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: Worker's Compensation Insurance Carrier: Policy No: Expire: Building Setbacks Use Zone Rear I Front: / Left: I Right: / Parking Spaces: Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: HERMAN DANIEL 833 DOVER DR #9 NEWPORT BEACH CA 92663 949-548-3459 State Lic:C002985 WELTON JEREMY 26461 RANCHO PARKWAY SOUTH LAKE FOREST CA 92620 949-916-3440 State Lic:S-004614 HERMAN DANIEL 833 DOVER DR #9 NEWPORT BEACH CA 92663 949-548-3459 Special Conditions: Fire Hazard Zone : N co rn 0 0 Construction Valuation: $100,000.00 Building Permit Fee: $1,113.00 Plan Check Fee: $968.31 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $0.00 Energy Compliance: $0.00 CA Seismic Safety : $28.00 Disabled Access $0.00 Hazardous Mat $0.00 Building Green Fee : $4.00 TOTAL FEE : $2,153.31 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Excise Tax: Additional Fee : Grading Bonds Fee: Grading PC Consultant : Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: $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 PAN Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $0.00 $0.00 $0.00 Plan Check Fee : $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: $968.31 Fee Due at Permit Issuance : o ° °,'PUBLIC VIOliKS APPROVAL: o e 0 0 v PLAN°CHECK BY: , AP,PROVAL TO ISSUE: ° $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1,185.00 mx� 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 U 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). ❑ 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 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 Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) 3 of the Business and Pr and effect. License Class License No Date `_s/ _:.r Contractor Signatur WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE 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 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: ❑ 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 permance of the work for which this permit is issued. Policy No. Date have and wi insurance carrier Carrier Name of Agent ntain 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 policy numberpery: ❑ l certify that, in the performance o the work fo that, if I should beco subject to the workers' Signature of Applica DECLARATION REGA I hereby affirm under penalty Lender's Name umber Expiration Date Phone # which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compentiorylaws of California, and agree n provisions of S- . •on 3700 of the Labor Code, I shall forthwith comply with those provisions. •�I' C.N'PVATIONL GAGEN — 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). 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 owners behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicab e city and county ordinances an state laws relating to building construction. I authorize representatives of this city or county r th abo a le pro ert nspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's N ACTION PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED DATE PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED BY J/7 DECLARATION OF C MPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 ❑ !SUBMITTED ASBESTOS NQrWFICA•TION TO* • : • • • • • •• • • • • • • • • ❑EPA ❑AQMD • • •• • FOR OFFICE USE ONLY ••• • • • • • • • IP • • • • • • • • • ❑ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION •• •0 SIGNATURE: • • ! : : • •• • •0• • • • • •• • I •• • • • • • • • •• •••