HomeMy WebLinkAboutF2021-0223 - Permitsr, City of Newport Beach - Building Division *F2021-0223*
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
r:++c INSFIEC"'TOR
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Job Address: 5020 CAMPUS DR NB St: 1 FI: 1 Unit: 250
Inspector Area: FIRE
Owner:
NEWPORT CAMPUS LLC
Address:
4701 VON KARMAN AVE #100
Planning Zoning PC Fee :
NEWPORT BEACH, CA 92660
Phone:
N TR 9626 LOT 9
Applicant:
C J SUPPRESSION INC
Address:
205 LEWIS COURT
Architect:
CORONA CA 92882
Phone:
909-735-5560
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: 1
No of Units : 0
Flood Zone:
Bldg Sprinklers: N
Construction Valuation
Building PC Fee:
Building Overtime PC Fee:
Building Extention Fee:
Building Investigation Fee:
Fire Plan Check Fee:
Fire Permit Fee :
Building Permit Fee
TOTALFEE:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
$5,000.00
FIRE Permit: F2021-0223
Project No : 1273-2021
Inspection Requests Phone (949)644-3255
$0.00
$0.00
$0.00
$0.00
$155.00
$239.75
$0.00
$396.75
FEES
Fire Residential Alarm PC Fee :
$0.00
Planning Counter Review:
$0.00
Planning Zoning PC Fee :
Description: COMM FIRE At * MSYSTEM 19 HEADS (X2021.1046)
Legal Description:
N TR 9626 LOT 9
Public Works Traffic Plan Check Fee;
$0.00
Contractor:
C J SUPPRESSION INC
Architect:
Address:
205 LEWIS COURT
Address:
' CORONA CA 92882
Phone:
909-735.5560
Phone:
State Lic:
Con State Lic:
721124
Engineer:
Lic Expire:
05/31/2023
Address:
Bus Lic:
BT30069705
Lic Exp Date:
11/3012021
Phone:
State Lic:
Worker's Compensation
Insurance
Designer:
MOYER ROBIN
Carrier:
EMPL SVC GROUP
Address:
205 LEWIS COURT
Policy No:
WC6896996
CORONA CA 92882
Expire:
1210112021
Phone:
Issued Date: 06/08/2021
Special Conditions:
Setback- Front:
Rear:
Left:
Right:
$0.00
$0.00
$0.00
$0.00
$155.00
$239.75
$0.00
$396.75
FEES
Fire Residential Alarm PC Fee :
$0.00
Planning Counter Review:
$0.00
Planning Zoning PC Fee :
$0.00
Public Works PC Fee:
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Plan Check Fee: $0.00
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
Records Management
Fee Due at Permit Issuance :
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
0000
00 0
0 0 0
00 0
0
00
0
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0 0
00000a
0
$2.00
$0.00
$0.00
$396.75
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00000
0
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0 0
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0
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IWNER-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, priorto its issuance, also requires the applicant for
ie 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
of 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,
lusiness 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
nprovements 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
nproved 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
pply 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 exempbfroro licensure under the Contractors' State License Law for the following reason:
Iy my signaturt".lplil 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
g1l;I �:ucture t4VJ j ave 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
'rofessions Code} is available upon request when this application is submitted or at the following Web site:http://www. leginfo.ca. gov/calaw. html.
gnature of Properly°Owner or Authorized Agent Date
.IUMED CONTRACTOR'S DECLARATION
Dereby affrm VI)d&*penalty of perjury that I am licensed under provisions of Chapter 9 (commencing w th ection 7000) of Division 3 of the Business aP fessions Code, and my license is in full force
nd effect.
icense Class . .. License No Date is /8/ZO2( Contractor Signature 1
YORKERS' COIVtFHENSATION DECLARATION
ARMING: 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 1$100,0001, IN ADDITION TO THE
0aVCP'COMPENS JTIOI DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
herebtaffirm tgq& penalty of perjury one of the following declarations:
..I4have 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
Wr&ance of't g&&:c for which this permit is issued. Policy No.
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'
..carrier and policy number are:
Policy Number
Date
me of Agent Phone #
I certify that, in the performance 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
It, if I should become�subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those„proyllons.
of Applicant /�. /
(v /Yi /ZO
hereby 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 Cade).
ender's Name Lender's Address
sy 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 c�ounfy ordinances and state laws relating to building construction.
I authorize representatives of this city or cou t enter t e above -identified Taperty for inspection purposes.
signature of Property Owner or Authorized Agent �''�. Print Property Owner's or Authorized Agent's Name SaC'` tio.�x� Ft
ACTION
DATE BY
DECLARATION OF COMPLIANCE MTH CODE OF
FOROFRCEUSEONLY
FEDERAL REGULATIONS PART 61 OF TITLE AND
AOMDRULE 14(0.7.
PERMIT EXPIRED
D I SUBMITTED ASBESTOS NOTIFICATION TO:
D EPA
D AOMO
PERMIT CANCELLED
PERMIT EXTENDED
D ASBESTOS NOHFICAT1ONISNOT APPLICABLE TO
PROPOSED DEMOLITION
PERMIT FINAL
/ A
CERTIFICATEOF
SIGNATURE:
OCCUPANCYfESUED