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Home My WebLink AboutX2021-1976 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 u... Inspection Requests Phone (949)644-3255 `arrc'`g Combination Type - BLDG COMB Permit: X2021-1976 IIIIXII2III�II�IIII�I�IIIIII�II7�III II Project No: 0746-2021 Issued Date : 07/29/2021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 07/29/2024 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: 5190 CAMPUS DR NB Description: COMM RETAINING WALL 4' MAX 20 LF (INSIDE PIL) Legal Desc.: P BK 142 PG 18 PAR 1 Owner: HOAG MEMORIAL HOSPITAL Contractor: NELSON HCS INC Architect: HERNANDEZ DARCIA KAY Address: 510 SUPERIOR VE #290 Address: 1340 REYNOLDS AVE STE 105 Address: 300 SPECTRUM CENTER DR #370 NEWPORT BEACH CA 92663 IRVINE, CA 92614 IRVINE CA 92618 Phone: Phone: 949-274-5828 Phone: 714-206-2275 State Lic,C030188 Applicant: KREUTZER MATTHEW Con State Lic: 1025484 Engineer: KILPATRICK DAVID Address: 300 SPECTRUM CENTER DR STE 730 Lic Expire: 04130/2023 Address: 1962 WILCOX CIR IRVINE, CA 92618 Bus Lic: BT30075182 PLACENTIA CA 92670 Phone: 949-727-9000 Lic Exp Date: 05/30/2022 Phone: State Lic:S-003142 Code Edit : 2019 Worker's Compensation Insurance Designer: Type of Construction: Carrier: STARSTONE Address: Occupancy Group: U Policy No: T80210387881 Added /New sq.ft. Bldg: 0 Expire: Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: 0' Special Conditions: No of Units : 0 Front: 30' campus Bldg Height: 0 Left: 0 Bldg Sprinklers: Right: 30' jamboree Flood Zone: X Use Zone: Parkina Soaces: 0 Fire Hazard 7nne Building Permit Fee: $334.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $290.58 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: $0.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: $0.00 Building Dept Adm $0.00 Energy Compliance: $0.00 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 : $0.00 PM Plan Check : $50.75 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $0.00 San Dist: $0.00 Building Green Fee : $1.00 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $676.33 Plan Check Fee : $0.00 Fee Due at Pe o.J Voa 3:a aQm 't Issuance : $676.33 PROCESSED BY: e e PoU�LIP: VIORK$ B„PP;OVAL: ono a o u o ZONING APPROVAL: PLAN CHECK BY: GRADING APPROVAL: ° oAP,FIPONIAIh T(JASbL oo a o (i�U IfV �V V O JJJ .iJ Z f 1i 0 i 0 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 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 'rofessions 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). 7 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, Iusiness 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). 1 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 exempt from licensure under the Contractors' State License Law for the following reason: ly 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 legall, 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.html. signature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION �a hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 lL11 n,4 of the Business and Prof s ' s ode, and my license is in full force nd effect. License Class License No Date �1 GULI Contractor Signature PORKERS' COMPENSATION DECLARATION DARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (6100,000), 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: 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 elormance of the work for which this permit is issued. Policy No. have and will maintain workers' compensation insurance, as reeguired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' rance carrier and ohc)rnumber are: _ _ % / ; Date of Agent certify that, in the performance of the work for which this permit i§ issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre I, if I should become su act to In workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /t nature of Applicant 7� JIZ- 1 l202 CLARATION REGA DING CO TRUCTION LENDING AGENCY areby 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). Ider's Name Lender's Address 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 provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county Ver t_ heiabove-identified property for inspection purposes. , n , n,)� � 1. \ �,_ a nature of PrODertv Owner or Authorized Agent Print Prooertv Owner's or Authorized Aqent's pk'>k+7� �-('(1{")%1/ D P ACTION DATE BY DECLARATION I REGULATIONS OART 61 O TNT E CE WITH CODE OF EDLERAL I FOR OFFICE USE ONLY PERMIT EXPIRED U I SUBMITTED A6BEST®S NOTIW@ATION TO PERMIT CANCELLED EPA PERMIT EXTENDED QMD PERMITFINAL /' ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF g'�3'Ly GS PROPOSED DEMO`ITIpN••: ••• ••• ••• •�• OCCUPANCYISSUED SIGNATURE: o c o 0 0 0 o c co oco 0 o co 00 oco