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Home My WebLink AboutF2021-0400 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 330 OLD NEWPORT BLVD NB Inspector Area: FIRE Owner: ADVANCED MEDICAL PROPERTIES LLC Address: 320 SUPERIOR AVE STE 250 NEWPORT BEACH, CA 92663 Phone: Applicant: SRIPIPAT SARINTIP Address: 1354 S PARKSIDE PL ONTARIO, CA 91761 Phone: 909-628.7773 Code Edit: 2019 Type of Construction: II-A-SPR Occupancy Group: B/A-2 Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 3 No of Units : 0 Flood Zone: X 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 $7,162.50 *F2021-0400* FIRE Permit: F2021-0400 Project No : 2118-2021 Inspection Requests Phone (949)644-3255 Description: COMM TWO WAY COMMUNICATION SYSTEM "KECK MEDICINE OF USC" Legal Description: Contractor: H C I SYSTEMS INC Address: 1354 S PARKSIDE PL ONTARIO CA 91761 Phone: 909.628-7773 Con State Lic: 906493 Lic Expire: 02/28/2022 Bus Lic: BT30042287 Lic Exp Date: 02/28/2022 Worker's Compensation Insurance Carrier: FEDERAL INSURANCE Policy No: 54309498 Expire: 0310212022 Issued Date: 10120/2021 Setback- Front: Rear: Left: Right: FEES Architect: Address: m°•ome Phone: State Lic: m °.®. e . e o ....¢¢ • o Engineer: meee . ¢ Address: m¢ e ee Phone: State Lic: c ¢ o �. e e • ° ¢ es ¢ Designer: MONTOYA VANESSA omm¢ 'oo••m Address: 4585 MURPHY CANYON RD mo•moo •. ¢ ¢ o SAN DIEGO, CA 92123 ' omm¢cn Phone: 858-560-7000 0 0¢ mmooco Special Conditions: • ° ommmmm ¢ m000� $0.00 Fire Residential Alarm PC Fee : $0.00 $0.00 Planning Counter Review: $0.00 $0.00 Planning Zoning PC Fee : $0.00 $0.00 $396.00 Public Works PC Fee: $0.00 $164.00 Public Works Traffic Plan Check Fee; $0.00 $0.00 TOTAL FEE : $568.00 Plan Check Fee PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL: Records Management:. $8.00 $0.00 $0.00 $396.00 Fee Due at Permit Issuance : $172.00 OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION )WNER-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 1e 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 got 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 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 exemptfrom 4censure under the Contractors' State License Law for the following reason: ly my signaturedo0o"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) ell a sVucture 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 Tdf661ons Co.A*lt%ailable upon request when this application is submitted or at the following Web site:httpXwww. leginfo.ca.gov/calaw.html. {ignature of ProporlyOwner or Authorized Agent % Date 1QET46ED CONTRACTOR'S DECLARATION hereby affirm uoder.penalty of perjury that I am licensed under provisions of Chapter 9 (commencin witJ1 Section 7000 of Division 3 of the Business VHUNiD/OETD:THOUSAND 'sions Code, and y-lic9psa"is in full force fi J efFgct. �� — �� icense Class License No Date Contractor Signatur VORVRS' CQjVjP•LNSATION DECLARATION IARMOG: FAILURE T2 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO 01�DOLLARS ($100,000), IN ADDITION TO THE 6)9T•OF.COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereb$affirm under p'¢nalty of perjury one of the following declarations: .. • •I•tY�e and yiil majntain 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 sOwmance of tlIa wo* for which this permit is issued. Policy No. I 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' compensatiol Isurance carrier and policy number are: - Policy Number me of Agent F'none ; I certify that, in the performan¢� of the work for which this permit is issued, I shall not employ any person in any manner so as to become sL 3, if I should becomk stibject�A{ the workers' gompgrsatipp provisions of Section 3700 of the Labor Code, I shall forthwith comply with those ignature of Applicant l IECLARATION REGA DI STRUCTlCf4 LENDING AGENCY hereby affirm under penalt f perjury that there is a construction lending agency for the performance of the work for which this permit is Ender's Name Lender's Address Date to the workers' compensation laws of California, and Code). By my signature below,-116ertify 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 pr vlded is correct. I agree to comply with all applicable city and county dilances and state laws r lating 9,building construction. I authorize representatives of this city, or count o nterrJhe above -id nti�fie ;opp€5.y!or inspection purposes. — I Signature of Property Owner or Authorized Agent lh .�.�-� /r/� Print Property Owner's or Authorized A ent's Name? Q' V Date (� ACTION DATE / BY DECLARATION OF COMPLIANCE tMTH CODE OF FOR OFFICE USEONLY I' ( FEDERAL REGULATIONS PART 69 OF TITL.E40 AND AQMD RULE 1403. PERMIT EXPIRED ❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMIT EXTENDED ❑ -ASBESTOS NOTIFICATIONIS NOT APPLICABLE TO PROPOSEDDEMOLITION. PERMIT FINAL p y 'p.f CERTIFFCATEOF SIGNATURE: OCCUPANCYISSUED