HomeMy WebLinkAboutF2021-0173 - PermitsCity of Newport Beach - Building Division II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
Ly. " 100 Civic Center Drive, Newport Beach, CA 92660 2 0 2 1 0 1 7 3
Permit Counter Phone (949)644-3288
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FIRE Permit: F2021-0173
Project No : 0996-2021
Inspection Requests Phone (949)644-3255
Job Address: 520 NEWPORT CENTER DR NB St: 1 FI: 7 Unit: 750 Description: COMM FIRE ALARMS 6 DEVICES (X2021.1076)
Inspector Area: FIRE Legal Description
Owner: IRVINE CO
Contractor:
SIMPSON DAVID CONST CO INC
Architect:
Address: 111 INNOVATION DR
Address:
17177 GILLETTE AVE #A
Address:
IRVINE, CA 92617
IRVINE CA 92614
$0.00
Phone: 949-720-2400
Phone:
949.250-1348
Phone:
Applicant: YAM MARK
Con State Lie:
381149
Engineer:
Address: 392 LEMAY CT
Lie Expire:
03/31/2023
Address:
ORANGE, CA 92867
Bus Lic:
BT00006013
Phone: 626-757-2320
Lie Exp Date:
06/30/2021
Phone:
Code Edit: 2019
Worker's Compensation Insurance
Designer:
Type of Construction: I -A -SPR
Carrier:
CYPRESS INSURANCE CO
Address:
Occupancy Group: B
Policy No:
DAWCC222034
Added/New sq.ft. Bldg: 0
-Expire:
-05/0112022 - -
- Phone:
Added /New sq. ft. Garage: 0
$173.50 Fee Due at Permit Issuance :
$251.50
No of Stories: 21
Issued Date: 06/1412021
Special Conditions:
No of Units : 0
Setback- Front:
Flood Zone: X
Rear:
Bldg Sprinklers: Y
Left:
Right:
State Lie: - 1
State Lie: IM
TAYLOR RICK
2246 LINDSAY WAY
GLENDORA, CA 91740 _
909.305-1603
PROCESSED BY:
pO° ° � .®4)THE�DEPAqTMENT:
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ZONING APPROVAL: _ � �° , ° O -?LAN C`K�--dKdO BY::
FIRE APPROVAL: ` APPROVAL TO ISSUE:
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PERMIT EXPIRES 180 DAYS -AFTER 1SS`JJANCE O!2 LA4T VALID INSPECTION
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FEES
Construction Valuation:
$1,496.00
Building PC Fee :
$0.00
Fire Residential Alarm PC Fee :
$0.00 Records Management:
$4.00
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:
$173.50
Public Works PC Fee:
$0.00
$0.00
Fire Permit Fee :
$247.50
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$425.00
Plan Check Fee :
$173.50 Fee Due at Permit Issuance :
$251.50
PROCESSED BY:
pO° ° � .®4)THE�DEPAqTMENT:
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ZONING APPROVAL: _ � �° , ° O -?LAN C`K�--dKdO BY::
FIRE APPROVAL: ` APPROVAL TO ISSUE:
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PERMIT EXPIRES 180 DAYS -AFTER 1SS`JJANCE O!2 LA4T VALID INSPECTION
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DWNER-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 L) 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).
❑ 1 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 legal])
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 D to
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professio ode, and n e i in full force
and effect.
License Class License No Date , v Contractor Sign re
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 00, 0), 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 th(
ffp�gg1Irf'ormance of the work for which this permit is issued. Policy No.
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workers' compensation insurance, as re wired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatior
Ifni-isurance carrier a glicy numberj�
Carrier O�Rc� u i Expiration Date
Name of Agent Phone #
s
❑1 certify that, in the perfonnance f e work for hick th s p- -mit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
that, if I should become s ject to t wor ers' co pensat o r/ visions o ec lo 700 of the Labor Code, I shall forthwith comply with those provisions 1
Signature of Applicant P v D TeN
DECLARATION REG G N UCTION LEN6196 AGENCY
' - f th t thtruction lendin a an for the performance of the work for which this permit is issued (Section 3097, Civil Code). _
Treby affirm under enalty o pequry a ere Is a cons g g Iy
Ider's Name Lender's Address
my signature below, 1 certify to each of the following:
I am the property owner or authorized to act on the property owni behalf.
I have read this application and the information I have provi ed s correct. .
I agree to comply with all applicable city and county ordina c and state s atin to building construction.
I authorize representatives of this city or county Idente bove-identif d prope for inspection purposes.
nature of Pmnertv Owner or Authorized AGenk / Print Property Owner's or Authorized Agent's Name
ACTION I DATE F � BY
1 PERMIT EXPIRED I I H
I PERMIT CANCELLED I 1 /11
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PERMIT FINAL O�.SEDDD ION.
CERTIFICATEOF SttiN • :s� is /
OCCUPANCYISSUED • s 1
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