HomeMy WebLinkAboutF2022-0283 - Permitsw.ac City of Newport Beach - Building Division III�IIIIIIIIIIIIIIII�II�IIIIIIIIIIIIII II
+ 100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 2 0 2 8 3
Permit Counter Phone (949)644-3288
FIRE Permit: F2022-0283
Project No : 1425-2022
Inspection Requests Phone (949)644-3255
Job Address: 355 PLACENTIA AVE NB St: 1 Ft: 2 Unit: 202
Description: COMM FIRE SPRINKLER TI - 38 HEADS (X2022-0107)
Inspector Area: FIRE
Legal Description:
M 154-01 PAR 1 UNIT 5 OF PROJ LOC ON AP 425-111-06 TOGETHER
Owner:
COSTA MESA MEDICAL
Contractor:
ORTIZ FIRE Architect:
Address:
3520 CADILLAC AV STE B
Address:
P O BOX 93691 Address:
NEWPORT BEACH CA 92663
CITY OF INDUSTRY CA 91745
Phone:
Phone:
626-330-9819 Phone:
J
Applicant:
CINDY/ORTIZ FIRE
Con State Lic:
906038 Engineer:
Address:
PO BOX 93691
Lie Expire:
11130/2023 Address:
CITY OF INDUSTRY CA 91715
JT1T-1
Code Edit: 2019
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units
Flood Zone:
Bldg Sprinklers:
V-B-SPR
B
State Lie:
Bus Lie:
BT30073363
Lie Exp Date:
1013112022
Phone: State Lie:
Worker's Compensation
Insurance
Designer: CARRILLO JAIME
Carrier:
INS COMPANY OF THE WEST
Address: 1114 FIELDGATE AV
Policy No:
WTX504441402
HACIENDA HEIGHTS CA 91745
0 Expire: 1113012022 Phone:
0
2 Issued Date: 06/02/2022 Special Conditions:
0 Setback- Front:
Rear.
Y Left:
Right:
FEES'
Construction Valuation:
$5,900.00
Building PC Fee,
$0.00
Fire Residential Alarm PC Fee :
$0.00
Records Management:
$2.00
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:
$196.00
Public Works PC Fee :
$0.00
$0.00
Fire Permit Fee :
$305.50
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$503.50
Plan Check Fee :
$0.00
Fee Due at Permit Issuance :
$503.50
PROCESSED BY: 1 OTHER DEPARTMENT:
• •
ZONING APPROVAL: PLAN•CHEQKED 9Yo:a 4 a
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FIRE APPROVAL: APPROVAL TO ISSUE: `a
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PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR IsA.TT VAt I6INSPy C'TICeN ` V
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ao wee a . ae we ewa
DWNER-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).
❑ 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).
❑ 1 am exempt from Iicensure 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 legall)
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.govlcalaw.html.
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 Sectiop270�) of Division 3 of the Business and P �gssions Code, air y license is in full force
and effect. �f
License Class License No Date C'JZZ/UContractor Signature .1
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 ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
qe ormance of the work for which this permit is issued. Policy No.
and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
carrier and policy number are:
Policy Number
ie of Agent
certify that, in the performance of th work for which this
if I should become, subject torkers' compensatip
of
Date
issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and
is of Section 3700 of the Labor Code, I shall forthwith comply with those provisions; 7 4
DECLARATION RE$ARDING CONSTRUCTIOJf LENDIttPAGENCY —1/ - /
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 Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf. C
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 I s elating to building construction. J �/
I authorize representatives of this city or coune I�above- ntif d p perty for inspection purposes. ty to h
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name Liz Date
ACTION
BA T€
BY
DECLARATION OF COMPLIANCE VATH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 01 OF TITLE 40AND
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