HomeMy WebLinkAboutF2021-0211 - Permits„I , City of Newport Beach - Building Division 11111111111111In111111111111111In1111111111111 Jill FIRE Permit: F2021-0211
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 1 0 2 1 1
g p Project No: 1195-2021
w, i '. ._ �, Permit Counter Phone (949)644-3268
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'tiarte'�'' Inspection Requests Phone (949)644-3255
Job Address: 29 MONTECITO DR NB Description: SFR FIRE SPRINKLERS - 58 HEADS (X2020-1806)
Inspector Area: 6 Legal Description: N TR 7844 LOT 71
Owner: STORM KIM & ANNE
Contractor:
FIREGUARD SPRINKLER SYS INC
Architect:
Address: 29 MONTECITO DR
Address:
7907 LEEDS ST
Address:
CORONA DEL MAR CA 92625
DOWNEY CA 90242
Phone: 949-230.5654
Phone:
714-310.0194
Phone:
State Lic:
Applicant: VO JOHN
Con State Lic:
992002
Engineer:
Address: 526 N SHADYDALE AV
Lic Expire:
04130/2022
Address:
WEST COVINA CA 91790
Bus Lic:
BT30046886
Phone: 714-310-0194
Lic Exp Date:
04/30/2022
Phone:
State Lic:
Code Edit : 2019
Worker's Compensation Insurance
Designer:
VO JOHN
Type of Construction: V-BSPR
Carrier:
FALLS LAKE FIRE & CASUALTY
Address:
526 N SHADYDALE AV
Occupancy Group: R3/U
Policy No:
FLA0080008
WEST COVINA CA 91790
Added /New sq.ft. Bldg: 0
Expire:
1212912021
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 1
Issued Date: 06127/2021
Special Conditions:
No of Units : 0
Setback- Front:
Flood Zone:
Rear:
Bldg Sprinklers: Y
Left:
Right:
FEES
I►
Construction Valuation:
$8,000.00y
CT
S L
Building PC Fee,
$217.00
Fire Residential Alarm PC Fee :
$0.00
Records Management :
$4.00
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:
$0.00
Public Works PC Fee:
$0.00
$0.00
Fire Permit Fee :
$0.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee:
$263.00
TOTAL FEE :
$484.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance :
$484.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
OTHER DEPARTMENT:
. a PLAN CHECKED BY:: _
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•W • • ® APPROVAL TO ISSUE: _
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PERMIT EXPIRES 1P,0 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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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 items)
ction 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
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
fessions 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
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,
liness 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
rovements 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
roved 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
,ly 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).
U 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 tl
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
Professions 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
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 00) f Division 3 of the Business
and effect. (
License Class License No Date Z 1 Contractor Signat�
WORKERS' COMPENSATION DECLARATION
law, Section
Date
and
Code, and my license is in full force
Y
(ARNING: 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 ($100,000(, IN ADDITION TO THE
:DST 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:
�l-iave 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(
4Fferty�ance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
1e of Agent
certify that, in the performance
if I should become subject toll
Policy Number
Date
which this permit is issued, I shall not employ any person in any manner so as to become subject to the workerscompensation laws of California, and
npensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.I j _
signature of Applicant �/" Da "
)ECLARATION REGARDI NSTRUC O LENDING AGENCY
hereby affirm under penalty of perjury that t' 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
iy my signature below, I certify to each of the following:
I am the property owner or authorized to act on the prninancew
ner's behalf.
I have read this application and the information I haveis correct.
agree to comply with all applicable city and county oand state laws relatingto building constmction.I mrthnri7p rpnmspntntives ofthis rite nr cnunfv to entnvP-identified nrnnprtv fnr insnertinn nDmnsps 1 /
of Property Owner or Authorized
G'
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ACTION
DATE
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DECLARATION OF COMPLIANCE MTN CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART 61 OF TITLE40AND
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SIGNATURE: o�'
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PERMITEXPIRED
PERMITCANCELLED
PERMITEXTENDED
PERMIT FINAL
CERTIFICATE OF
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OCCUPANCYISSUED
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