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Home My WebLink AboutX2021-1843 - Permitswrrp c City of Newport Beach - Building Division *X2021-1843* COMB Permit: X2021-1843 e- 100 Civic Center Drive, Newporteac Beach, CA 92660 Project No : 1590-2021 c , � Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - CIP ELEC MECH PLUM Issued Date : 10/0612021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS M D /0 4 OR PERMIT WILL BE INVALID Construction Hours: Monday- Friday 7:00 a.m. to 6:30 p.m. and Saturday from a. o .m. No ork on Sundays or Holidays Job Address: 4699 JAMBOREE RD NB Description: COMM TI "HOAG JAMBOREE" 13195 SF "STOP WORK" Legal Desc.: P BK 142 PG 18 PAR 1 a Owner: HOAG MEMORIAL HOSPITAL PRESBYTERIAN Contractor: PDC INC Architect: HERNANDEZ DARCIA KAY ° ° Address: 4699 JAMBOREE RD Address: 1010 S HATHAWAY ST UNIT C Address: 300 SPECTRUM CENTER DR #370 .... ° NEWPORT BEACH, CA 92660 SANTA ANA, CA 92705 IRVINE CA 92618 Phone: Phone: (714) 664-0477 Phone: 714-206-2275 State Lic:C030188 =®>° 9 Applicant: KREUTZER MATTHEW Con State Lic: 988559 Engineer: V V Address: 300 SPECTRUM CENTER DR STE 730 Lic Expire: 11/30/2021 Address: IRVINE, CA 92618 Bus Lic: BT30055261 Phone: 949-727-9000 Lic Exp Date: 05/31/2022 Phone: State Lic Code Edit: 2019 Worker's Compensation Insurance Designer: Type of Construction: V-BSPR Carrier: EVEREST PREMIER INS CO Address: ° ' o0 Occupancy Group: B Policy No: 7600020452211 Added /New sq.ft. Bldg: 13195 Expire: 05/29/2022 Phone: 'J Added /New sq. ft. Garage: 0 No of Stories: 1 Building Setbacks Rear: I Special Conditions: No of Units : 0 Front: / Bldg Height: 0 Left: / Bldg Sprinklers: Y Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $1,500,000.00 Building Permit Fee: $8,671.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $7,543.77 Additional Fee : $0.00 Plan check Fee: $208.00 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $74,412.34 Fire Plan Rev $0.00 Investigation Fee: $8,671.00 Grading PC Consultant : $0.00 SJH Trans: $0.00 Demolition Fee Record Management: $160.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: $0.00 Building Dept Adm $26.00 Energy Compliance: $550.00 Grading PC Fee: $0.00 Public Works Department- General Service $219.00 CA Seismic Safety: $0.00 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $564.00 Disabled Access : $944.00 PAN Plan Check: $101.50 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $2,270.07 San Dist: $0.00 Building Green Fee : $60.00 Mechanical %: $1,783.62 NMUSD Fee: $0.00 $0.00 Plumbing %: $1,459.33 $0.00 TOTAL FEE : $107,643.63 Plan Check Fee : $86,014.99 Fee Due at Permit Issuance : $21,628.64 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: 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 :he 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 iot 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, 3usiness 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 mprovements 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 mproved 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'ptoperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). "I w exempt ircm licensure under the Contractors' State License Law for the following reason: 3y my signatu%WPJ9,A 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 legallt fall a'gtructure 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 �rdf&sions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. ,ni'I�JC nature of Pro ' 561-%Owner or Authorized Agent Date LIGEASED CMTRACTOR'S DECLARATION i horieby affirrQ ttft�enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 ) of ivi ion 3 of the Business and Pr f ' s Cod 9fHq-FeeRfi is in full force asl,{ERect License lass License No Date )O 6 Contractor Signatur NQ''R,KERS' COMPENSATION DECLARATION NARNZG: FAIL RE TO-WCURE WORKERS' COMPENSATION COVERAGE Is UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND LARS I8100,0 0), IN ADDITION TO THE � i OF COMP�W$P.'h0P1, DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm,unde�penalty of perjury one of the following declarations: .. I have and wi11 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 )erformance 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 of Agent Date I certify that, in the performance of the work forwhich 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 tat, if I should become su 'ect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ��AY %%%JJJ Iignature of Applicant I Date fe' c Z IECLARATION REG DI CO CT NDING AGENCY v l� hereby affirm under penalty of p ury the th a 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 ordinances and state laws relating to building construction. j I authorize representatives of this city or count y ns ectionpurposes. {icnature of Proertv Owner or Authorized AoentPrint Property Owner's or Authorized Agent's Name /� N-`�� Y�1Sj ` Da' iJ ACTION I DATE BY ' D�CTAR OM NICE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULA NS ART OF ITLE 40 AND AQMD RULE PERMIT EXPIRED EPA PERMIT EXTENDED AQM D PERMITFINAL r ASBEST N 15 NOT E TO CERTIFICATE OF I U'�j POSED MOUTION OCCUPANCYISSUED SIG TURE'