HomeMy WebLinkAboutF2020-0311 - Permits (2)6- City of Newport Beach - Building Division IIIIIIII�IIIIIIIIIIIIIIIII�III�IIIIIIII�IIII FIRE Permit: F2020-0311
�' 100 Civic Center Drive, Newport Beach, CA 92660 Project No: 1325-2020
Eo Permit Counter Phone (949)644-3288
�yU"m1R"6 ; Inspection Requests Phone (949)644-3255
Job Address: 212 GOLDENROD AVE NB
Description: SFR FIRE SPRINKLERS (X2019-1556) 47 HEADS
Inspector Area:
Legal Description: RESUB OF CORONA DEL MAR LOT
12 BILK 34(AND LOT 14 BILK 34
Owner: JONES JEFF & SHELLY
Contractor:
FIREPROOF FIRE PROTECTION
Architect:
Address: 20429 NE 31 ST ST
Address:
1101 KINGSTON DR
Address:
SAMMAMISH WA 98074
LA HABRA CA 90631
co
425-557-7711
Phone:
714-476-5370
Phone: State Lie:
Applicant: CASEY MONTY
Con State Lie:
876004
Engineer:
Address: 1101 KINGSTON DR
Lie Expire:
04/3012022
Address:
LA HABRA CA 90631
Bus Lie:
BT30040107
Phone: 714476-5370
Lie Exp Date:
08/31/2021
Phone: State Lie:
Code Edit: 2019
Workers Compensation Insurance
Designer: CASEY MONTY
Type of Construction: V-B-SPR
Carrier:
NORGUARD INS CO
Address: 1101 KINGSTON DR
Occupancy Group: R3IU
Policy No:
MOWC148394
LA HABRA CA 90631
Added /New sq.ft. Bldg: 0
Expire:
02/15/2021
Phone: 714-476-6370
Added /New sq. ft. Garage: 0
No of Stories: 3
Issued Date: 1212112020
Special Conditions: HIGH DENSITY
No of Units : 0
Setback- Front:
Flood Zone: X
Rear:
Bldg Sprinklers: Y
Left:
Right:
FEES
Construction Valuation:
$4,700.00
Building PC Fee :
$202.00
Fire Residential Alarm PC Fee :
$0.00 Records Management: $6.00
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 :
$240.00
TOTALFEE
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
$448.00 Plan Check Fee: $0.00
"Of DE?ART,4ENT:
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Fee Due at Permit Issuance
APPROVAL TO ISSUE:
O I
PERMIT EXPIRES 180 DAYS AFTER IS&UAN&E OR 2ASY VALID INSPECTION
... 04 dd . . 6.. Ob
$448.00
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).
❑ 1 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 legall7
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 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 Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section,70001 of Division 3 of the Business and Professions Code, and my Il lhis ' in full force
and effect. �-
License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
NARNING: 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 1$1 ,000 IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3TD6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations: -
❑ 1 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
performance of the work for which this permit is issued. Policy No.
have and will rptlntain 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'
ne of Agent (:SX5Z— (.A../L/_ \QN
certify that, in the performance of the work for which this f
, if I should become_su�bb*ect a workers' compensation
iatureof Applicant � -
Date
is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and
;ions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. .
hereby affirm under penalty of perjury that there is on lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
censtr i
ender's Name Lender's Address
�y 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 coktty jo-e fpr-the above -identified property for inspection purposes.
ACTION
DATE
BY
DOCLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
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