HomeMy WebLinkAboutF2021-0191 - PermitsCity of Newport Beach - Building Divisions II�IIIIIIuII�IIIuIIII�IU�IIUpllllllllll II
100 Civic Center Drive, Newport Beach, CA 92660 m e HIN Vz !f
Permit Counter Phone (949)644-3288 ® ° ® ° m
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FIRE Permit: F2021-0191
Project No: 1062-2021
Inspection Requests Phone (949)644-3255
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Job Address: 355 PLACENTIA AVE NB St: 1 FI: 2 Unit: 210 ' ®° ' Vescriplila: dhiim - 4ri SP`m41NKLERS 9 HEADS (X2021-08611
Inspector Area: FIRE
Owner: KHOI NGUYEN
Address: 11 VINCENNES
NEWPORT COAST CA 92657
Phone:
Applicant: ORTIZ JORGE
Address: 1114 FIELDGATE AVE
HACIENDA HEIGHTS, CA 91745
Phone: 626-536-4416
Code Edit: 2019
Type of Construction: V -B -SPR
Occupancy Group: b
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 3
No of Units : 0
Flood Zone:
Bldg Sprinklers: Y
Legal Description: M 154.01 PAR 1 UNIT 5 OF PROJ LOC ON AP 425-111-06 TOGETHER
Contractor:
ORTIZ FIRE
Architect:
Address:
P O BOX 93691
Address:
CITY OF INDUSTRY CA 91745
Building PC Fee:
$0.00
Phone:
626-330-9819
Phone:
State Lic:
Con State Lic:
906038
Engineer:
Lic Expire:
11/30/2021
Address:
$0.00
Bus Lic:
BT30073363
$0.00
Lic Exp Date:
1013112021
Phone:
State Lic:
Worker's Compensation Insurance
Designer:
ORTIZ JORGE
Carrier:
INS COMPANY OF THE WEST
Address:
1114 FIELDGATE AVE
Policy No:
WTX604441402
$0.00
HACIENDA HEIGHTS, CA 91745
Expire:
11/30/2021 _
Phone:
626-536-4416
Issued Date: 05/13/2021 Special Conditions:
Setback- Front:
Rear:
Left:
Right:.. 5 �� (_( t.+
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PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
FEES
Construction Valuation:
$1,600.00
Building PC Fee:
$0.00
Fire Residential Alarm PC Fee :
$0.00 Records Management :
$2.00
Building Overtime PC Fee:
$0.00
Planning Counter Review,
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee:
$0.00
Building Investigation Fee:
$0.00
$0.00
Fire Plan Check Fee:
$135.00
Public Works PC Fee :
$0.00
$0.00
Fire Permit Fee :
$207.25
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$344.25
Plan Check Fee :
$0.00 Fee Due at Permit Issuance :
$344.25
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
DWNER-BUILDER DECLARATION •• ••• •• •. ...
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Stat;Li:f®r tha �eascn•(s) 'aldicated 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 PA conJtn(ct„alter, yndroye, 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 df the•CdntraBtors' 6tate licertse•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 ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation- —) aloof or J portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of prpjerty tho,11hrpEJh Qmdloyees' or personal effort, builds or improves the property, provided that the
improvements are not intended or offered for sale. If, however, the building or improvegkt II;I.spld withoorleyear of romptation, the Owner-Builderwill have the burden of proving that it was not built or
improved for the purpose of sale).
❑ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
ly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
I am exempt from licensure under the Contractors' State License Law for the following reason:
my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legall)
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of. Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 00) of Division 3 of the Business and Pr f$ssions Code, an y license is in full force
and effect.T
License Class License No Dato/ % ZOz /Contractor Signature O
NORKERS' COMPENSATION DECLARATION 611
NARNING: 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 ($100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 th
Derformance of the work for which this permit is issued. Policy No.
have and will maintain 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'
rance carrier and policy number are:
ie of Agent
certify that, in the performance of the work for
, if I should become subi4 to the workers' cq
Policy Number
Date
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
ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. f
hereby affirm under penalty of perjury�fhat 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 count rdinances and state I s relating to building construction.
I authorize representatives of this city or cougty i ter thy' ov identif' property for inspection purposes.
Signature of Property Owner or Authorized Ag t o-� Print Property Owner's or Authorized Agent's Namt? 1- rIQ Da
ACTION DATE
Vy
DECLARATIONOFCOMPLIANCE INITH CODEOF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART SI OF TITLE40 AND
AQMDRULE 1403:
PERMITEXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERM/TEXTENDED
❑ ASBESTOS NOTIRCARONISNOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTIFICATEOF
SIGNATURE: .
OCCUPANCYISSUED