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Home My WebLink AboutX2020-1181 - 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 ELEC IIIIIIIIIIIIII11J111IIIIIIIIIIIIIIIIIIIIIIIIIIII 1 COMB Permit : X2020-1181 Project No : 0902-2020 Issued Date : 06/22/2020 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 06/23/2023 OR PERMIT WILL BE INVALID 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: INSTALL FOUNDATION AND ACCESSIBLE RAMP FOR STATE APPROVED OFFICE MODULAR BUILDING Legal Desc.: IRVINE SUB BLK 1 LOT 172 POR OF LOT Owner: Address: Phone: Applicant: Address: Phone: HOAG MEMORIAL HOSPITAL- 1 HOAG DR NEWPORT BEACH, CA 92663 LIEBKE STEVEN S 1340 REYNOLDS AVE #115 IRVINE CA 92614 949-400-5462 Code Edit : 2019 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : Bldg Height: Bldg Sprinklers: Flood Zone: 0 0 X Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: SOUTH COUNTY CONTRACTORS 161 EXETER WAY #87 CORONA, CA 92882 949-205-6304 988175 11/30/2021 BT30048035 07/31/2020 Worker's Compensation Insurance Carrier: WC EXEMPT Policy No: (NO EMPLOYEES) Expire: Building Setbacks Use Zone: Rear: I Front: I Left: / Right: / Parkin S aces: Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: LIEBKE STEVEN S 1340 REYNOLDS AVE #115 IRVINE CA 92614 949-400-5462 State Lic:CO28341 LEE DONALD 21008 SYLVANWOOD AVE LAKEWOOD CA 90715 562-860-7896 State Lic:S-002311 Special Conditions: Fire Hazard Zone : N OCGC C 0 0 00 00 0 O 0 m o 00 00 0 O 0 0 • 00 00 0 o o • o oo 0000 O 0 Como CO1 Io 0 00000 0000 Construction Valuation: $30.000.00 Building Permit Fee: $542.00 Plan Check Fee: $471.54 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $28.00 Energy Compliance: $0.00 CA Seismic Safety : $0.00 Disabled Access : $89.00 Hazardous Mat $0.00 Building Green Fee : $2.00 TOTAL FEE : 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 %: $1,316.94 $141.90 $0.00 $0.00 Plan Check Fee : $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 P/W Plan Check : $42.50 San Dist : $0.00 NMUSD Fee: $0.00 $0.00 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Grading Bond: $521.69 Fee Due at Permit Issuance : PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $795.25 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 ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, § yailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Propee�rtyypyner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I QeIF$ltp firm uryfe1 mgalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000 of Division 3 of the Business and Profes o�n ode, and li nse is in full force and•effep. License eltss License No Date 04 77 WContractor Signature ! WpfWgRS' COMPENSATION DECLARATION WAVINGVAILURE IBSE011E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDR D THOUSAND DOLLARS ($100,000), IN ADDITION TO THE CAST JF CGMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under penalty of perjury one of the following declarations: q.••• • • • lye and wileMaintain 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 performance of the work for which this permit is issued. Policy No. L_p Ave $nd winomaia k 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' compensation in%uj%rlc;Farrier and polity number are: C2hpef• _ • • • •' Policy Number e of Agent •'•• certify that, in the perfo ante of the w,,��ff11 forr/mm/Which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' co pensation laws of California, and agrec a , ' I should become s jet o the work pensation ' C pensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant satti��11LL//TTlif DECLARATION REG DONSTRUCTION I hereby affirm under a ii Lender's Name 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 hay provided is correct. I agree to comply with all applicab e city and county rdinances and sta law relating to building construction. I authorize representatives of this city or county to nter/�e�a�boove-ide I perty for inspection purposes. Signature of Property Owner or Autho ized Agent t-t'Awry Print Property Owner's or Authorized Agent's Nam. _ s he / - 1r=F ISECLARATION OF COMPLIANCE WITH CODE OF FEDERAL REGU ' TIONS PART 61 OF TITLE 40 AND AQMD RULE 14r. ACTION PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED Expiration Date Phone # Date LENDING AGENCY n Ity 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 DATE /•v-Z/ BY 9 I SUBMITTED ASBESTOS NOTIFICATION TO DEPA CIACIm0 !� :ESTOS TIFICATION IS N 'ROPO %DE OL SIGNATURE: LICABLE TO FOR OFFICE USE ONLY 22 2.0