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Home My WebLink AboutX2021-0742 - Permitsa„� City of Newport Beach - Building Division *X2021-0742* COMB Permit: X2021-0742 �,� * %- 100 Civic Center Drive, Newport Beach, CA 92660 Project No : 0678-2021 5.. Permit Counter Phone (949)644-3288 v , �" rae:v s " Inspection Requests Phone (949)644-3255 Combination Type -0 CIP ELEC MECH PLUM 1 I N -r Issued Date : 05106I2021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 0510612024 OR PERMIT WILL BE INVALID Construction Hours: Monday - Friday 7:00 a.m, to 6:30 p.m. and Saturday from 9:00 a.m. to 6:00 p.m. No work on Sundays or Holidays Job Address: 5190 CAMPUS DR NB Description: COMM TI -INTERIOR DEMO PRIOR TOT] (10,756 SF) Legal Desc.: P BK 142 PG 18 PAR 1 Owner: HOAG MEMORIAL HOSPITAL PRESBYTERIAN Contractor: NELSON HCS INC Architect: HERNANDEZ DARCIA KAY Address: 510 SUPERIOR AVE STE290 Address: 1340 REYNOLDS AVE STE 105 Address: 15615 ALTON PKWY #270 NEWPORT BEACH, CA 92663 IRVINE, CA 92614 IRVINE CA 92618 ° °GJq° Phone: Phone: 949-274-5828 Phone: 949-727-9000 State Lic:C030188 0 000 oo°aeo Applicant: KREUTZER MATTHEW Con State Lic: 1025484 Engineer: Address: 3600 SPECTRUM CENTER DR #730 Lic Expire: 04130/2023 Address: IRVINE CA 92618 Bus Lic: BT30075182 ,,,6.° C° ' Phone: 9479-727-9000 Lic Exp Date: 0513012022 Phone: State Lic: Code Edit: 2019 Worker's Compensation Insurance Designer: wG . Type of Construction: V-B-SPR Carrier: STARSTONE Address: Occupancy Group: B Policy No: T80210387881 AddedNew sq.ft. Bldg: 10756 Expire: Phone: G _w Added/New sq. ft. Garage: 0 o® No of Stories: 1 Building Setbacks Rear: / Special Conditions: No of Units: 0 Front: / Bldg Height: 0 Left: I ° Bldg Sprinklers: Y Right: I Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $75,000.00 Building Permit Fee: $1,009.00' Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $877.83 Additional Fee : $0.00 Plan check Fee : $0.00 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $0.00 Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $28.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: $0.00 Building Dept Adm $0.00 Energy Compliance: $61.00 Grading PC Fee: $0.00 Public Works Department - General Service $0.00 CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $91.00 PAN Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $264.16 San Dist: $0.00 Building.Green Fee : $3.00 Mechanical %: $207.55 NMUSD Fee: $0.00 $0.00 Plumbing %: $169.81 $0.00 TOTAL FEE : $2,711.35 Plan Check Fee : $1,176.29 Fee Due at Permit Issuance: $1,535.06 PROCESSED BY: C) PUBLIC WORKS APPROVAL: ZONING APPROVAL: 9 ` l A iLl PLAN CHECK BY: GRADING APPROVAL: APPROVAL TO ISSUE: (L - 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 U 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). 1, 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 legally sell a structure thtf Ptfaye 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 Cod2,'9evailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Sigaatare of Prooypee.ty, Owner or Authorized Agent Date LICENSED CG .@A`CTOR'S DECLARATION 10%ebyaffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section Di ision of the Business and Pro .l9�Cte6e, and my license is in full force end AFPad. LiceW.Qass License No Date �2b2- Contractor Signature /� Wt%RKERS' CQN l?ENSATION DECLARATION VTARNiN&: FAILURE TAAPPURE 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 GOSW ID5COMPENSITIDN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. Ihaob31 affirm under penalty of perjury one of the following declarations: Y ;•Y, ifd and wil maiptain 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 Vrform9nce of t Sprifforwhich this permit is issued. Policy No. ilavi: and will.maintein 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' compensatioi st?&Ibe carrief $IVocticy number are: Policy Number of Agent Date 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 agre iat, if I should becomes je to t workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. I Z 1 signature of Applicant Date J IECLARATION REGARDING cONOrRUCTION LENDING AGENCY 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). ender's Name Lender's Address ly my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county rdinan es and state laws relating to building construction. I authorize representatives of this city or countytoknte ly�above-identified property for inspection purposes. �� _ C�_ LL' y r r V r,� I jh DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY RE9ULATIONS PART 61 OF TITLE 40 AND AQMD RULE EPA PERMITEXTENDED AQMD PERMITFINAL 2 BESTOS OTMCATION IS NOTAPPLICABLE TO CERTIFICATE OF '� / ' R OSED D OUT ON OCCUPANCY ISSUED SIGN TURE: