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Home My WebLink AboutF2021-0102 - PermitsCity of Newport Beach - Building DivisionI II�III�IIIIIIII�IIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIII FIRE Permit: F2021-0102 a4 100 Civic Center Drive, Newport Beach, CA 92660 Project No: 0571-2021 ry. Permit Counter Phone (949)644-3288 0 e+Lertru'� Inspection Requests Phone (949)644-3255 l� 1 � C�nwtel la'itc�iG st Job Address: 1011 CAMELBACK ST NB Description: COMM FIRE SPRINKLERS (25 HEADS) "TEMPLE BAT YAHM" Mo ll. 4o) I Inspector Area: FIRE Legal Description: TR 6680 LOT 2 POR OF LOT 2 AND POR OF LOT 3 _ Owner: BAT TEMPLE Contractor: INLAND EMPIRE FIRE & SAFETY Architect: Address: 1011 CAMELBACK ST Address: 2300 S RESERVOIR ST STE 312 Address: NEWPORT BEACH CA 92660 - POMONA CA 91766 Phone: Phone: 909.622.8911 Phone: State Lic: Applicant: THIEN GREG Con State Lic: -Lic 1053382 Engineer: Address: 18265 MOUNT BALDY CIRCLE. Expire: 05/31/2021 Address: FOUNTAIN VALLEY CA 92708 Bus Lic: BT30073885 Phone: 949.458-4459 Lic Exp Date: 01131/2022 Phone: State Lic: Code Edit: 2019 Worker's Compensation Insurance Designer: LEEMAN BRAD Type of Construction: V -B -SPR Carrier: STATE FUND Address: 1230 N JEFFERSON ST UNIT K Occupancy Group: B Policy No: 9281901 ANAHEIM CA 92807 Added /New sq.ft. Bldg: 0 Expire: 0811212021 Phone: Added /New sq. ft. Garage: 0 No of Stories: 1 Issued Date: 03/1712021 Special Conditions: No of Units : 0 Setback- Front: Flood Zone: X Rear: Cc Bldg Sprinklers: Y Left: V Right: q //��//�� //�� //�q /} I V`I "`"l ��' (0 4`l'i FEESpk� Construction Valuation: $13,250.00 ll Building PC Fee : $0.00 Fire Residential Alarm PC Fee: $0.00 Records Management: $4.09® 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: $167.00 Public Works PC Fee: $0.00 $0.00 Fire Permit Fee : $259.25 Public Works Traffic Plan Check Fee; $0.00 Building Permit Fee : $0.00 TOTAL FEE : $430.25 Plan Check Fee: $167.00 Fee Due at Permit Issuance : $263.25 PROCESSED BY: OTHER DEPARTMENT: o ZONING APPROVAL: PLAN CHECKED BY:: FIRE APPROVAL: J(s) APPROVAL TO ISSUE: u 'o PE1,2MFT EYFIA; S°AMDAYS AFTER ISSUANCE OR LAST VALID INSPECTION •• •YY i YP` 4P tWNER-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) lection 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 is 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 Irofessions 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 U all of or U 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 n roved 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). 7 1 am exempt from licensure under the Contractors' State License Law for the following reason: ly my signature below 1 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 ell 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 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. signature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION 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 a d Pr ssiio Code a icense is in full force nd effect. ,!cense Class License No Date Contractor Signa �� VORKERS' COMPENSATION DECLARATION (/ IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP O ON NDRED TH USANO DOLLARS ($100,000), IN ADDITION TO THE OST 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: IV -have andwill 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 thi N Orr of the work for which this permit is issued. Policy No. Nl h ve 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' compensatior Isu nce carrier and rllcy umber are: mer ��P I'I )hC� Policy Number Expiration Date lame of Agent Phone # 31 certify that, !n the performance - the work for w 'eff 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 agree tat, if I should become subject t the woykers� c pRnsation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions. r lature of Applicant - hereby affirm undealtyp�perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Ender's Name r n�� Lender's Address ly my signature below, 1 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 courdinan s and s e laws relating to building construction. I authorize representatives of this city or county ter th ab entifiedproperty for inspection purposes. ri .// /�- Print Pronertv Owners or Authorized ADent's Nam ACT10N DATE BY urr.isvvanuu v, ..................�--._.. FEDERAL REGULAFIONS•PART SI.QF TITLE40 ff& AQMDRULE9403.� : • • •:• PERMlTEXPIREO ❑ ISUBMITTED:AJOL-W.OSqiQTIFICATION.TO:'. • • • .• PERMIT CANCELLED ❑ EPA • ••• • ..,. . . P€RMITEXT€NDED ❑ AQMO ASBESTOS NORRCATION IS NOT APPLICABLE TO PERMIT FINAL Z • Zp'L PROPOSED DEMOLIRC=N. • • • . • • . • i • , CER77FICATEOF • • • • • i SIGNATURE: . OCCUPANCYISSUED . __ __ • • .