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Home My WebLink AboutXC2022-2063 - PermitsCity of Newport Beach �aEWPOa> p. @ Community Development Department- Building Division 'r 100 Civic Center Drive, Newport Beach, CA 92660 S Permit Counter Phone: (949) 644-3288 o- Inspection Requests Phone: (949) 644-3255 cq<�FonT'�P newportbeachca.gov/inspections Combination Type - ELEC MECH Work Class - Other X C2i2 2206uu3 COMB Permit : XC2O22-2063 Plan Check No: PC2022-2872 Issued Date : 12/08/2022 Inspection Area : 7 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 : 510 SUPERIOR AVE, 100 Legal Desc : A TR IRVINE SUB BILK 2 LOT 169 IRVINE SUB LOT 169 BLK 2 PORS OF LOT Description: COMM INSTALL X-RAY EQUIPMENT AND T-BAR SUSPENDED CEILING AND LIGHTING 443 SF Owner: HEALTHCARE NEWPORT Address: 1 HOAG DR NEWPORT BEACH, CA 92663 Phone : Applicant: CAEZAR CHAVEZ Address: 4770 CAMPUS DR NEWPORT BEACH, CA Phone: (949)851-3080 Owner/Builder : Address: Contractor: PDC INC Address: 1010 S HATHAWAY ST UNIT C SANTA ANA, CA 92705 Phone: (714)664-0477 Con State Lic: 988559 Lic Expire : 11/30/2023 Bus Lic: BT30055261 Bus Lic Expire : 05/31/2023 Workers' Compensation Insurance Carrier: EVEREST PREMIER INSURANCE COMPANY Policy No: 7600020452211 W. C. Expire : 5/29/2023 Architect: DWYER SUSAN M Address : 4770 CAMPUS DR NEWPORT BEACH, CA 92660 Phone: (949)851-3080 State Lic Engineer: Address : Phone: Designer: Address : Phone: Phone: Code Edition : 2019 Fire Sprinklers : YES Construction Valuation : $804000.00 Type of Construction : I -A Fire Hazard Zone : NO Added/New/Ti sq. ft. Bldg : 0 ...... Occupancy Groups: B No of Units : 0 Alteration sq. ft. Bldg Bldg Height: No of Stories : 2 Added/New sq. ft. Garage: 0 TOTAL sq. ft.: 0 Building Setbacks: Flood Zone: X Use Zone: OM - Office --Medical ' PROCESSED BY: SPECIAL CONDITIONS: ai d i 4B it�i OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indic led below by the checkmark(s) I have placed next to the applicable item(s) ction 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 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 fessions 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 more than five hundred dollars ($500). J 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of 0 usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through e nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of comp) nproved for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, poly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor I am exempt from licensure under the Contractors' State License Law for the following reason: y my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one y ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I unl 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http:/1www.leginf ignature of Property Owner or Authorized Agent ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of nd effect. License Class License No Date .RS' COMPENSATION DECLARATION FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. work, and the structure is not intended or Offered for sale (Section 7044, ployees' or personal effort, builds or improves the property, provided that the ion, the Owner -Builder will have the burden of proving that it was not built or and Professions Code: The Contractors' State License Law does not to the Contractors' State License Law). to completion of the improvements covered by this permit, I cannot that a copy of the applicable law, Section 7044 of the Business and Date ,i on 3 of the Business and Prof s Code, a my license is in full force ZTi Contractor Signature I ✓G-^— AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (11100,000), IN ADDITION TO THE hereby affirm under penalty of perjury one of the following declarations: 3 1 have and wilt 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 thl r)e o>e ormance of the work for which this permit is issued. Policy No. ave 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 oompensatior nsurance carrier and policy number are: >mer Policy Number Expiration Date Jame of Agent Phone # :1I certify that, in the performanc a work for which this 96rmit is issued, I shall not employ any parson in any manners as to become subject to the workers' compensatio Iaws of California, and agree hat, if I should become sub' o the workers' compensati provisions of Section 3700 of the Labor Code, I shall forthwith omply With those provisions. ) signature of Applicant Date_ l Z 2i7i 7ECLARATION REGARDING CONMUCTION LENDING AGENCY I hereby affirm under.Venalty of perjury that there is a construction lending agency for the performance of the work for which phis permit is issued (Section 3097, Civil Code). Lenders Name �: Lenders Address By my sigeature beigw, I;ildify to each of the following: I am the properly[ pwn$r or authorized to act on the property owner's behalf. 4Iifave gimrl this application and the information I have provided is correct. i agfe`e to compiywith all applicable city and county ordinances and state laws relating to building construction. J apthbpze rep%a males of this city or cou nter the ve-identified property for inspection purposes. Si hatureof Propeqy, Owner or Authorized Agent Print Property Owner's or Auliyonzed Agent's Name fi' o ,IV '1 '✓ Gil-'� ' Date L Z� ACFION • „ ' DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART BI OF TITLE 40 AND AQMD RULE i PERMIT FINAL CERTIFICA7FOF OCCUPANCY ISSUED APPLICABLE TO