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Home My WebLink AboutX2021-2034 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 E• Permit Counter Phone (949)644-3288 y fi Inspection Requests Phone (949)644-3255 n> Combination Type - BLDG 111111p1111111111111p111111111p11111111p11111lililCOMB Permit:X2021-2034 x 2 0 2 1 2 e 3 4 Project No: 1764-2021 Issued Date : 12123/2021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 1212312024 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: 11 HOAG OR NB Description: COMM R/R 6' TRASH ENCLOSURE W/ ROOF Legal Desc.: Owner: HOAG MEMORIAL HOSPITAL Contractor: SLATER BUILDERS INC Architect: NOUIZILI ILYES M Address: 510 SUPERIOR AV STE 290 Address: 3100 - B PULLMAN STREET Address: 10 EDELMAN NEWPORT BEACH CA 92663 COSTA MESA CA 92626 IRVINE CA 92618 Phone: 949-355-9268 Phone: 714-615-6108 Phone: 949-788-4054 State Lic:C032135 Applicant: DIONNE CHRISTOPHER Con State Lic: 675832 Engineer: BISHOFF RYAN WILLIAM Address: 10 EDELMAN Lic Expire: 08/31/2023 Address: 3300 IRVINE AVE #245 IRVINE CA 92603 Bus Lic: BT30025319 NEWPORT BEACH CA 92660 Phone: 949-660-9178 X 1157 Lic Exp Date: 02128/2022 Phone: 949-862-8510 State Lic:S-006250 Code Edit : 2019 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Construction Valuation: Building Permit Fee: $249.00 Plan Check Fee: $216.63 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $0.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee : $1.00 Worker's Compensation Insurance Carrier: CYPRESS INS COMPANY Policy No: SLWC245302 Expire: 02/16/2022 Building Setbacks Excise Tax: Additional Fee Grading Bonds Fee: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: Rear: / Front: / Left: / Right: I $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL FEE: $617.88 Plan Check Fee PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: O�1 Designer: Address: Phone: Special Conditions: Fire Hazard Zone : N Planning Department - Plan check Fee Fair Share SJH Trans In -lieu Housing Fee Public Works Department - Park Dedication : $0.00 PAN Plan Check: $50.75 San Dist: $0.00 NMUSD Fee: $0.00 a+ Fire Departmentf $52.00 Fire Inspection: $0.00 $0.00 Fire Plan Rev $48.50 $0.00 Demolition Fee $0.00 Building Dept Adm $0.00 General Service $0.00 Refund Deposit $0.00 Grading Bond: $0.00 $0.00 $0.00 $0.00 Fee Due at Permit Issuance : $617.88 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: qro��-V 0,- r"J 10 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 (_) 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 perjug that I am licensed under provisions of C apter (Commencing with Section 70 ) of Di sign of the Business and Pro essions�e, a m icense is in full force and effect. License Class License No % ��J 77Z Date Contractor Signatur NORKERS' COMPENSATION DECLARATION 1 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 OOL/11$1 66,600), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION a766 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: ❑ 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 the Der(ormance of the work for which this permit is issued. Policy No. JI 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 ermit i issued. My workers' compen nsu ante carrier an polic number are: ' � / U 1mer ( e •�"�Ir Policy Number 5 L (/t/ r� /%L Expiration Date A � 9P,2 Z— Name of Agent Phone # ❑1 certify that, in the performance of thework for which th permit is issued, I shall not employ any person in any manner so as to become subject t0 the workers' compensation aws of California, and :hat, if should become subject t0 the we ers' comp s Ion provisions of Ion 3700 of the Labor Code, shall forthwith comply with those provisions. �L 01 Signature of Applicante DECLARATION REGAR I G C TRUCTIO ENDIN P ENCY lll/// ��I hereby affirm under penalty of perjury that there is a C uction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). -ender's Name Lender's Address 3y my signature below, I certify to each of the follow g: 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 ordinan 'es and sta laws relating to building construction. I authorize representatives of this city or county to enter above-i tifed property for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name �` />�G Date % ACTION DATE BY ECLARATION OF C LIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONSP 61 OF TITLE 40 AND ACiMD RULE PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED DEPA PERMIT EXTENDED ❑ACIMD PERMITFINAL CERTIFICATE OF OCCUPANCY155UED // D/-(Q-� / ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION SIGNATURE: