HomeMy WebLinkAboutF2022-0225 - PermitsCity of Newport Beach -Building Division *F2022-0225* FIRE Permit: F2022-0225
100 Civic Center Drive, Newport Beach, CA 92660 I n, r.-=s - ••_� Project No : 1107-21122
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
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Job Address: 20282 RIVERSIDE DR NB Description: COMM (N) FIRE SPRINKLER WET SYSTEM W/ (29) HEADS. "FRIENDS
Inspector Area: FIRE Legal Description: Aual_ 19-)DO
Owner: FRIENDS OF NEWPORT BEACHIFISCHBACHER TOM Contractor: A & D FIRE Architect:
Address: 20282 RIVERSIDE DR Address: 7130 CONVOY CT Address:
NEWPORT BEACH, CA 92660 SAN DIEGO CA 92111
Phone: 714-651-4221 Phone: 858-277-3473 Phone: State Lie:
Applicant: A&D FIRE/ CAMERON
Address: 1601 W ORANGEWOOD AVE
ORANGE, CA 92868
Phone: 714-634-3923
Code Edit: 2019
Type of Construction:
V-B-SPR
Occupancy Group:
B
Added /New sq.ft. Bldg:
0
Added /New sq. ft. Garage:
0
No of Stories:
1
No of Units :
0
Flood Zone:
X
Bldg Sprinklers:
Y
Con State Lie: 1069002
Lie Expire: 0913012022
Bus Lie:
BT30073130
Lie Exp Date:
10131/2022
Worker's Compensation
Insurance
Carrier:
ZURICH AMERICAN INS CO
Policy No:
GLO100923506
Expire:
01/0112023
Issued Date: 0412612022
Setback- Front:
Rear:
Left:
Right:
Engineer:
Address:
Phone:
Designer:
A & D FIRE
Address:
7130 CONVOY CT
7130 CONVOY CT
Phone:
714-634.3923
Special Conditions:
State Lie:
FEES
Construction Valuation:
$21,000.00
Building PC Fee:
$0.00
Fire Residential Alarm PC Fee :
$0.00 Records Management :
$6.00
Building Overtime PC Fee:
$0.00
Planning Counter Review :
$0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee :
$0.00
Building Investigation Fee:
$0.00
$0.00
Fire Plan Check Fee:
$241.00
Public Works PC Fee:
$0.00
$0.00
Fire Permit Fee :
$442.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
TOTAL FEE :
$689.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance :
$689.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
91
76
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
DWNER-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 itemjs), -
(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 (_) 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).
❑ I 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 legall,
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.htmi.
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 Section 7000) of Division 3 of the Business and Professions Code, and ense is in full force
and effect. �( ./
License Class License No Date / � 1-4 " 27 -27. Contractor Signature XL
NORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND LA $100,0001, IN ADDITION TO THE
COST 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:
❑ 1 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
Derformance of the work for which this permit is issued. Policy No.
have 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'
rance carrier and policy number are:
of Agent
Policy Number Expiration Date
Phone #
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
if I should become subjec t I)the workers' ccmpensatioqj�mvisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
of
Heby affirm under penalty of perjury that the " a 6nstruction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Ider'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 s to I� ating to building construction.
I authorize representatives of this city or count�to e�he above entified prop rty for inspection purposes. /�
Signature of Property Owner or Authorized Agent Print Property Owners or Authorized Agent's Name ate — -
AC77OON
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOROFFICEUSEONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD'
PERMIT CANCELLED
PERMIT EXTENDED
ElASBESTOS NOTIFICATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTIFICATED€
SIGNATURE:
OCCUPANCYISSUED
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