HomeMy WebLinkAboutF2022-0603 - Permits�EwPORT City of Newport Beach
OF @ Community Development Department- Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Z Permit Counter Phone: (949) 644-3288
Inspection Requests Phone: (949) 644-3255
Cqt/FORN�P newportbeachca.gov/inspections
Combination Type -
Work Class - Other
11111111111111111111111111�1111111111111111111111111111111111 JillCOMB Permit : F2022-0603
Plan Check No: PC2022-2970
Issued Date :
Inspection Area : FIRE
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address: 1301 DOVE ST, STE 200
Description:
COMM FIRE ALARM TI - 3 DEVICES (XG'Lb9
Owner:
1301 DOVE OWNER LLC
Address :
2101 ROSECRANS AVE STE3270
EL SEGUNDO, CA 90245
Phone:
Applicant:
CHARLI PAGE
Address :
1354 PARKSIDE PL
ONTARIO, CA 91761
Phone:
(909)628-7773
Owner/Builder :
Address
Phone:
Code Edition :
Type of Construction
Occupancy Groups:
Bldg Height:
Building Setbacks
Flood Zone:
Use Zone:
PROCESSED BY:
2019
V-B
X
PC - Newport Place
SPECIAL CONDITIONS:
Legal Desc : P BK 120 PG 27 PAR,1
rL-1SO
Contractor: H CI SYSTEMS'INC
Architect
Address : 1354;S PARKSIDE PL
Address
ONTARIO, CA 91761
Phone :' (909), 628-7773
Phone
Con State Lie : ' 905493
State Lie
Lie Expire : 02/29/2024
Bus Lie: BT30042287"".
Engineer:
Bus Lie Expire: 02/28/2023
Address
Workers' Compensation Insurance
Phone:
Carrier: FEDERAL INSURANCE
COMPANY
Fk
Policy No: 54309498
Designer: CHARLI PAGE
W. C.'Ezpire : 3/2/2023
Address : 1354 PARKSIDE PL
ONTARIO, CA 91761
Phone: (909)628-7773
Fire Sprinklers-:, YES
Construction Valuation : $1,700.00
Fire Hazard Zone NO
Added/New/Tl sq. ft. Bldg : 0
No of Units : 0
Alteration sq. ft. Bldg :
No of`Stories : 2
Added/New sq. ft. Garage: 0
TOTAL sq. ft.: 0
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GOP PAP
0 P
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B .'1 POP
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rovements are
roved for the p
I,. as Owner of.
lyto an owner
I am exempt III
Below, by the checkmark(s) I have placed: ne;
Die. If, however, the building or Improvement is sold within one-year of completion, the Owner-Suitderw ll have the burden orproving that it not built or
Contractingwith licensed Contractors to construct the project{Sectlon 7D44.. Business and Professions Code; The Contractors State License Law does not.
proves thereon, and who contracts for the projects With a licensed Contractor pursuant to the Contractors' State License Law),
Signature of Property owner or.Authonzed Agent: - - - - Date.
LICENSED CONTRACTOR'S DECLARATION
I hereby s ISm under penalty of perjury that I am gcensed under provisions of Chapter g (commencing with Section 70 O) f M iaion 3 of fha Buslnessand rof SMO Code, and my license: is to full force:
and effect. License Class License No Delp4�M% 9 Contractor S gna - `z7
WORKERS'COMPENSATION DECLARATION
ARNING: FAILURE TO SECURE .wORKERS' COMPENSATION COVERAGE IS: UNLAWFUL;: AND. SHALL: SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO DNS HUNDRED THOUSAND DOLLARS (S100.000): IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION370S OF THE LABOR CODE, INTEREST, AND ATTORNEr3 FEES.
II hereby affirm under penalty of perjury one of the IbIlowingdecla€ations."
u 1 have and will maintain a -Certificate of consent to self.inaure for workers'. compensation, Issued by: the Director of Industrial Relations as provided for by Section 3700 of the Labor Code,. for IN
rformanCa of the work I which this permit Is issued. Policy No,
have and wiltmaintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performanceofthe work for which this:: permit is issued, My workers' compensado
IT rance, carder and policy number are-
arrier. Policy Number: Expiratton Date
ame of Agent. Phone
1 certify that. in the performance of the work for which 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
that, if I should. become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /•
Signature of Applicant -�- D �
DECLARATION REGARt CONS T18N LENDiNfis AGENCY
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 3 7 Cfvil Cade):
Lender's Name. Lender's Address
By my signature below, I Certify to each of the following:
I am the property owner orauthorized 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 to an the abov county e identified property for inspection purposes.
Signature of Pr a Owner Or Authorized A 4 Print Pro edy_0wner's or -Authorized A ent's Na - 5 RI T gRrPTEE Date
ACTION DATE BY I I DECLARMN OF COMPLIANCE WITH CODE OF FEDERAL FORD CE.. USE ONLY
PERMOFCANCE€LED.—'-rUEPA
PER,bftT EMENDED _ -t yy AC!'V6
PERMiTFINAL •a Q a r"t' [NtBf5T6S NOTIF'jCX-n0.%IJ NOT APPUCABI£ TO
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