HomeMy WebLinkAboutF2023-0121 - Permits" ��gWPORT City of Newport Beach
0 Community Development Department - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
6 s Permit Counter Phone: (949) 644-3288
a� Inspection Requests Phone: (949) 644-3255
C'9[�FORNiP newportbeachca.gov/inspections
Combination Type -
Work Class - Tenant Improvement
F 2 0 2 3 0 1 2 1COMB Permit : F2023-0121
Plan Check No: PC2023-0564
Issued Date : 03/14/2023
Inspection Area ;"7/^ _„ f.
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 : 14 CORPORATE PLZ Legal Desc : P BK 93 PG 45 PAR 14
Description: COMM FIRE ALARM SYSTEM 6 DEVICES AND CHANGE OUT PANEL
Owner: MARY ROBBERSTAD
Address :
NEWPORT BEACH, CA 9265E
Phone
Applicant: ADT COMMERCIAL LLC
Address: 210 W BAYWOOD AV
ORANGE, CA 92765
Phone: (675) 566-3065
Owner/Builder :
Address:
Phone
Code Edition :
Type of Construction
Occupancy Groups:
Bldg Height:
Building Setbacks
Flood Zone
Use Zone :
PROCESSED BY:
2022
V-B
X
PC - Corporate Plaza
SPECIAL CONDITIONS:
Contractor: ADT COMMERCIAL LLC
Address : 210 W BAYWOOD AV
ORANGE, CA 92765
Phone :
(675) 566-3065
Con State Lie
: 1065604
Lie Expire :
05/31/2024
Bus Lie:
BT30072351
Bus Lie Expire : 07/31/2023
Workers' Compensation Insurance
Carrier: OLD REPUBLIC INSURANCE
Policy No: MWC31431722
W. C. Expire : 10/1/2023
Fire Sprinklers NO
Fire Hazard Zone : NO
No of Units : 1
No of Stories:
f�
V
Architect
Address
Phone
State Lie
Engineer:
Address
Phone:
Designer : ADT COMMERCIAL LLC
Address : 210 W BAYWOOD AV
ORANGE, CA 92765
Phone: (675)566-3065
Construction Valuation : $8,000.00
Added/New/TI sq. ft. Bldg: 0
Alteration sq. ft. Bldg :
Added/New sq. ft. Garage : 0
TOTAL sq. ft. : 0
cykay\,�o Soso
3a3 $0>-87a�(
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exemptfrom the Contractors' State -License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable ftem(s)
Section 7031.5, Business and Professions Code: Any cltyorcounty that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
is permit to file a signed statement that hear she is licensed pursuant -to the provisions of the Contractors' State License Low (Chapter 9 (commencing with Section 7000) of Division of the Business and
Irofessions Code) or that he or she is exempt from Licensers and the basis farthe alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of
of more than five hundred dollars ($500).
3 1, 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,
tusiness 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 properly, provided that the
nprovements are not intended or offered for sale. If, however, the building or impiuvement is sold within one year of completion, the Owner -Builder will have the burden of proving that Itwas not built or
nproved for the purpose of sale).
11, Be 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
only to an owner of property who builds or Improvesthereon, 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:
sy 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
all a structure that I have built as an owner-buildor if it has not been constructed in its entirely by licensed contractors. I understand that a copy of the. applicable law, Section 7044 of the Business and
'rofessions Code, isavailable upon request when this application Is submitted or at the following Web site:http:/iwww.leginfo.ca.gov/calave,htmi,
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of pert'ury that I am licensed under provisions of Chapter 9 (commencing with Sectiok��
fthe Business and Pr f sions Cod � bnd I ' 1n full force
nd effect. License Class License. No Da Contractor Signatur
VORKERS' COMPENSATION DECLARATION
ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED OUSAND DOLLARS t5100,000j, IN ADDITION TO THE
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
I 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 IN
erformance of the work for which this permit is issued. Policy No.
keve 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' compensatior
Isur ce carder and policy number are:
Policy Number
ne of Agent _
Date
certify that, in the performance of the work r which s permit is issued, I shall not employ any person in any manner sous to become subject to the workers' compensation laws of California., and
, If I should becom fect to the wor - comps lion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /� J
iature of Applicant Date /dl/ I 1 I r
areby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for whichthispermit Is issued (Section-3097, Oivll ICode).
)der's Name - Lender's Address
my signature below, I Certify to each of the following:
I am the property owner orauthonzed to act on the property owners behalf,
I have read this application and the information 1 have provided is correct,
i agree to comply with all applicable city and coun ordinances ' slat aws relating to building construction.
I authorize representatives of this city or ouur�tt7tnter the _ eve -Id a-propertpitsr Inspection purposes,
ACTION DATE BY v DE"ATICN-OF COMPLIANCE WITH CODE. OF FEDERAL FOR OFFICE USE ONLY i/� /
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PER URT EXPIRED I U I SUBMITTED ASBESTOS NOTIFICATION TO
PEamr -FINAL
CERIDRCATE OF
OCCUPANCYISSUED
NOTIFICATION]$NOT APPLICABLE TO
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