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Home My WebLink AboutX2021-2839 - PermitsRear I Front: / Left: / Right: / Parking Spaces: City of Newport Beach - Building Division *X2021-2839* COMB Permit : X2021-2839 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - CIP ELEC Project No : 2477-2021 Issued Date : 10/25/2021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 10/25/2024 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: COMM TI "TELE COMMAND CENTER RELOCATION" (BUILDING 21) 1327 SF 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: I-ASPR Occupancy Group: B Added /New sq.ft. Bldg: Added /New sq. ft. Garage: 0 No of Stories: No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Y Flood Zone: 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 07/31/2022 Worker's Compensation Insurance Carrier: WC EXEMPT Policy No: (NO EMPLOYEES) 1327 Expire: Construction Valuation: $20,000.00 Building Permit Fee: $419.00 Plan Check Fee: $364.53 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $18.00 Energy Compliance: $61.00 CA Seismic Safety : $0.00 Disabled Access : $91.00 Hazardous Mat $0.00 Building Green Fee : $1.00 TOTAL FEE : $1,116.22 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Building Setbacks Use Zone: Excise Tax: Additional Fee : Grading Bonds Fee: Grading PC Consultant : Grading Permit Fee: Grading PC Fee: WQ Insp. fee : Electrical %: Mechanical %: Plumbing %: s $109.69 $0.00 $0.00 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: 0 Fire Hazard Zone : N $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 PNV Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 Plan Check Fee : 000 0 00 a 00 O 0 O 0 • 0 O 0 CO $52.00 $0.00 $0.00 $0.00 LIEBKE STEVEN S 1340 REYNOLDS AVE #115 IRVINE CA 92614 949-400-5462 State Lic:CO28341 State Lic: 000•• •00• • • 00®• 0 00 0 • • •• • • 0•••00 • 0 0 0 • o • •• • • • • • a 00 • 00• 000.00 ®®/\�_ 0 00000 I PEV� R040004 00 e 0 0 •• Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Grading Bond: $619.56 Fee Due at Permit Issuance : 000 0 00 0®0 • 000 • ••• FpIJBLIC•WORIT RPPROVAL: 0 00 0 0 0 0 PI:MN CHECK BY ° o • APPROVAL TO ISSUE:. 0,.0 0 00 •• 0 0 0 00 0 0 0 LitlOOG 0 0 0 U00 0 0 00 00 0 0 0,0 04404400 0 00000 0000 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $496.66 gspie 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 L) 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 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 Coda, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of PrBp'errItvner or Authorized Agent Date GI,CiFinED COhT.RACTOR'S DECLARATION Mherebyaffirm erial Lgenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 of Division 3 of the Business and Pr. - .si./. Code FyC license is in full force and effect. License Class License No Date �' Contractor Signature WORKERS' CQMPgJ4SATION DECLARATION WARNING: FAILURL•TO SECERE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE 10ST TIE COMPENSA•rtON, ITAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I.h&Epy affirm Ott 13e,paity of perjury one of the following declarations: • • 1•0tve 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 • PBifpwance of the work for which this permit is issued. Policy No. • • • • •• • J have and wfllewninttin 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 iReueame carrier and policy number are:• • Ca!r!cr• Name of Agent rtify that, in the performance of the rk f r 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 agree I should become sybject;p the worj's' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant DECLARATION REGAr(DIN N'C=ONSTRUCTION LENDING AGENCY I 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 Code) 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 have provide • 's iirrect. I agree to comply with all applicable city and cot,nty or inanc - state laws relating to building construction. I authorize representatives of this city or coup .o e r t e -. -�•entified property for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name, VIE2 CO1J'1'PerC6 D Policy Number Expiration Date Phone # Dat,O 9 5 21 ACTION DATE BY Lender's Address DECLARAT ON OF COMPLIANCE WITH CODE OF FEDERAL ULATIONS PART 61 OF TITLE 40 AND AQMD RULE 40 FOR OFFICE USE ONLY 14p 2.5 24 PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED -11-zbo / I SUBMITTEDAN EPA AQMD • 5ESTQS NOTIEIc4TIO4 TO • • • • • • • • • u• •• • • • BESTOS NOTIFICAyVWIS NOT APPLICABLE TO C 0 00 0 0 000 00^