HomeMy WebLinkAboutX2022-0778 - Permits (3)w.rYot City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
s' Permit Counter Phone (949)644-3288
r3. - Inspection Requests Phone (949)644-3255
Combination Type - CIP ELEC MECH
COMB Permit: X2022-0778
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Project No : 0689-2022
Issued Date : 04/2512022
Inspection Area : 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY OR PERMIT WILL BE INVALID
Construction Hours: Monday- Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays
Job Address: 1 HOAG DR NB -
Description: COMM - (2) 24'x40' MODULAR TRAILERS FOR TRAINING WORKROOMS. ADD POWER TO TRAILERS AND RAMP ENTRANCES. RE -STRIPE PARKING AREA,
Legal Desc.: IRVINE SUB BILK 1 LOT 172 FOR OF LOT
Owner: HOAG MEMORIAL HOSPITAL-
Contractor:
SOUTH COUNTY CONTRACTORS Architect:
LIEBKE STEVEN S�
R
Address: 1 HOAG DR
Address:
23639 RIDGEWAY Address:
1340 REYNOLDS AVE #115
d'
NEWPORT BEACH, CA 92663
MISSON VIEJO CA 92692
IRVINE CA 92614
'
Phone: 949-764-4496
Phone:
949-205-6304
Phone:
949-400-5462 State Lic:CO28344,;
Applicant: LIEBKE STEVEN
Con State Lie:
988175
Engineer:
NIEMAN ADAM
Address: 1340 REYNOLDS AVE #115
Lie Expire:
11/30/2023
Address:
11624 N 151ST LANE
IRVINE CA 92614
Bus Lie:
BT30048035
SURPRISE AZ 85379q
Phone: 949-752.5052
Lie Exp Date: 07/31/2022
Phone:
81-571-9877 State Lic:C-091181.
�1
Code Edit : 2019
Worker's Compensation
Insurance
Designer:
Type of Construction: V-B
Carrier:
WC EXEMPT
Address:
Occupancy Group: B
Policy No:
(NO EMPLOYEES)'
Added /New sq.ft. Bldg: 1780
Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 1
Building Setbacks
Rear: I
Special Conditions:
No of Units : 0
Front: /
LANDSLIDE & LIQUEFACTION
Bldg Height: 0
Left: /
Bldg Sprinklers: N
Right: /
Flood Zone: X
Use Zone:
Parking Spaces:
0 Fire Hazard Zone : N --
Construction Valuation: $50,000.00
Building Permit Fee: $810.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $704.70
Additional Fee,
$0.00
Plan check Fee :
$52.00 Fire Inspection:
$0.00
Overtime Plan Ck: $0.00
Grading Bonds Fee:
$0.00
Fair Share :
$0.00 Fire Plan Rev
$0.00
Investigation Fee: $0.00
Grading PC Consultant :
$0.00
SJH Trans :
$0.00 Demolition Fee
Record Management: $32.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee:
$0.00 Building Dept Adm
$0.00
Energy Compliance: $0.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety: $0.00
WQ Insp. Fee:
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
Disabled Access : $91.00
PAN Plan Check: $50.75
Grading Bond:
$0.00
Hazardous Mat, $0.00
Electrical %:
$212.06
San Dist : $0.00
Building Green Fee : $2.00
Mechanical %:
$166.62
NMUSD Fee: $0.00
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $2,121-13��
I
Plan Check Fee :
$1,074.63 Fee Due at P rmit Issuance : $1,046.50
PROCESSED BY:
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° o PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
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PLAN CHECK BY:
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GRADING APPROVAL:
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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,
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 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 legally
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.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 Sectio .7090) of Divi3 of the Business and Pro fes i0� Code, d y license is in full force
and effect. License Class License No Date sionContractor Signatur
WORKERS' COMPENSATION DECLARATION
WARNING: 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 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
perfgr mance of the work for which this permit is issued. Policy No.
have and wi{main workers' co 22ennsation insurance, as reyuged by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
rance carrier �qd p\licy number ,af€ ( ) , _ J
to of Agent
certify that, in the performance of the work for yyr'hich
, if I should become Su ect to the work r ' c mpem
nature of Applicant
Date
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
ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
hereby affirm under natty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097
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 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 a stap laws relating to building construction.
I authorize representatives of this city or count oo me the abo ride Ified property for inspection purposes. ��
signature of ProDertv Owner or Authorized Agent X 7,nJ1 / Print Property Owner's or Authorized Agent's Narc��
ACTION DATE BY jLECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED UEPA • • • . • • • i
PERMIT EXTENDED ! Q e • • c
PERMITFINAL %-13bal A-FAf Lei SBESTOS NOTIFICATION IS NOT APPLICABLE Ttl • ••
CERTIFICATE OF PROPOSED DEMOLITION
OCCUPANCY ISSUED SIGNATURE:
P nGD p?
P//__._S /99
Code).