HomeMy WebLinkAboutF2021-0159 - Permits§ r�$ City of Newport Beach - Building Division 11�111 11111111111111111111111111111111111111111111111 Jill
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 1 0 1 5 9
Permit Counter Phone (949)644-3288
Job Address: 506 CLUBHOUSE AVE NB
Inspector Area: 1
Owner:
GARG SUSHIL
Address:
27621 HIDDEN TRAIL RD
LAGUNA HILLS CA 92653
Phone:
949-567-7036
Applicant:
INNES ELIZABETH
Address:
9521 IRVINE CENTER DR
IRVINE CA 92618
Phone:
949-861-2244
Code Edit: 2019
Type of Construction:
V-BSPR
Occupancy Group:
R3IU
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
0
No of Units :
0
Flood Zone:
X
Bldg Sprinklers:
Y
Construction Valuation: $4,500.00
Building PC Fee
Building Overtime PC Fee:
Building Extention Fee,
Building Investigation Fee:
Fire Plan Check Fee:
Fire Permit Fee :
Building Permit Fee:
TOTALFEE:
PROCESSED BY:
FIRE APPROVAL:
FIRE Permit: F2021-0159
Project No : 0934-2021
Inspection Requests Phone (949)644-3255
Description: SFR FIRE SPRINKLERS (56) HEADS (X2019-1552)
Legal Description: CANAL SECTION LOT 1 BLK 532 ALL -INC POR OF ST ADJON S-
Contractor: FIREPROOF FIRE PROTECTION
Architect:
Address: 1101 KINGSTON DR
Address:
LA HABRA CA 90631
Phone: 714-476-5370
Phone:
State Lic:
Con State Lic: 876004
Engineer:
Lic Expire: 04/30/2022
Address:
Bus Lic: BT30040107
Lic Exp Date: 07131/2022
Phone:
State Lic:
Worker's Compensation Insurance
Designer:
CASEY MONTY
Carrier: SECURITY NATIONAL INS
Address:
1101 KINGSTON DR
Policy No: SWC1325710
LA HABRA CA 90631
Expire: 02/15/2022
Phone:
714-476-5370
Issued Date: 09/30/2021
Special Conditions:
LIQUEFACTION AREA
Setback- Front:
Rear:
Left:
Right:
FEES
$0.00
Fire Residential Alarm PC Fee :
$0.00 Records Management:
$6.00
$0.00
Planning Counter Review:
$0.00
$0.00
Planning Zoning PC Fee :
$0.00
$0.00
$0.00
$285.00
Public Works PC Fee:
$0.00
$0.00
$379.25
Public Works Traffic Plan Check Fee;
$0.00
$0.00
$670.25
Plan Check Fee:
$670.25 Fee Due at Permit Issuance :
$0.00
OTHER DEPARTMENT:
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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).
111, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions f 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 cmpletion, the Owner -Builder will have the burden of proving that it was not built or
I
improved for the purpose of sale).
LJ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 71
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contr:
❑ I 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 c
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors.
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.l
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70C
and effect.
License Class License No Date
VORKERS' COMPENSATION DECLARATION
rARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
Business and Professions Code: The Contractors' State License Law does not
pursuant to the Contractors' State License Law).
year prior to completion of the improvements covered by this permit, I cannot
iderstand that a copy of the applicable law, Section 7044 of the Business and
ifo.ca.gov/calaw.html.
Date
of Division 3 of the Business and Professions Code, and my license is in full force
Contractor Signature
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
J I 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
erformance of the work for which this permit is issued. Policy No.
JI have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for
Isurance carrier and policy number are:
Policy Number
of Agent
performance of the work for which this permit is issued. My workers'
Date
certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manrier so as to become subject to the workers' compensation laws of California, and
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 i Date
DECLARATION REGARDING CONSTRUCTION LENDING 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 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 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 county to enter the above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name Date
ACTION
DATE
BY
DECLARATION OF COMPLIANCE INITH COOEOF
FEDERAL REGULATIONS PART 61. OF TITLE40AND
AQMD RULE 1403
❑ I SUBMITTEDASBEST05 NOTIFICATION T0:'.
❑ EPA
❑ AQMD
❑ ASBESTOS NOTfRCARONISNOT APPLICABLE TO
PROPOSED DEMOLITION
SIGNATURE:
FOR OFNCEUSEONLY
PERMIT EXPIRED
PERMIT CANCELLED
PERMITEXTENDED
PERMITFINAL
Z L
c)
CERTIFICATE OF
OCCUPANCYISSUED