HomeMy WebLinkAboutF2020-0510 - PermitsCity of Newport Beach - Building Division 111p111111111p111111111111l 1111111111111111p111
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 0 0 5 1 0
Permit Counter Phone (949)644-3288
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FIRE Permit: F2020-0510
Project No : 2366-2020
Inspection Requests Phone (949)644-3255
Job Address: 393 HOSPITAL RD NB S 00 T-H)
Description: COMM- DISTRIBUTED ANTENNA SYSTEM "ATRIA SENIOR LIVING"
Inspector Area:, - FM r[.y
Legal Description:
IRVINE SUB LOT 169 BLK 2 POR OF LOT
Owner: NEWPORT BEACH PROPCO LP
Contractor:
COMMWAVE NETWORKS INC
Architect:
Address: 300 EAST MARKET ST #100
Address:
310 TWIN OAK VALLEY RD #107-360
Address:
LOUSIVILLE, KY 40202
SAN MARCOS CA 92708
Phone:
Phone:
2064784499
Phone:
State Lie:
Applicant: GAMLER JEFFREY
Con State Lic:
900801
- Engineer:
Address: 310 TWIN OAKS VALLEY RD #107
Lie Expire:
0713112021
Address:
SAN MARCOS CA 92078
Bus Lie:
BT30073620
Phone: 206.478-4499
Lie Exp Date:
11/3012021
Phone:
State Lie:
Code Edit: 2019
Worker's Compensation
Insurance
Designer:
GAMLER JEFFREY
Type of Construction: V-A- SPR
Carrier:
FALLS LAKE
Address:
310 TWIN OAKS VALLEY RD #107
Occupancy Group: R2.1,A3
Policy No:
FLA01393700
SAN MARCOS CA 92078
Added /New sq.ft. Bldg: 0
Expire:
03/19/2021
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2
Issued Date: 01113/2021 Special Conditions:
No of Units : 0
Setback- Front:
-
Flood Zone: X
Rear:
Bldg Sprinklers: Y
Left:
Right:
FEES
Construction Valuation: $19,750.00
Building PC Fee :
$0.00
Fire Residential Alarm PC Fee:
$0.00
Records Management:
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
Fire Plan Check Fee:
$387.00
Public Works PC Fee :
$0.00
Fire Permit Fee :
$161.00
Public Works Traffic Plan Check Fee;
$0.00
Building Permit Fee :
$0.00
11 TOTAL FEE : $572.00 Plan Check Fee : $190.00
PROCESSED BY: OTHER DEPARTMENT:
ZONING APPROVAL: �p _ _ n PLAN CHECKED BY::
FIRE APPROVAL: APPROVAL TO ISSUE:
Fee Due at Permit Issuance
PERMIT EXPrhES 1,90 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
7—
J
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0
$24.00
$0.00
$0.00
$382.00
OWNER -BUILDER DECLARATION -
1 hereby affirm under penalty of perjurythat 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 Cade: Any city or countythat 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 Sig ned 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 U all of or (_) 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
mprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner-Buitder will have the burden of proving that it was not built or
mproved 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 licensureunder the Contractors' State License Law for the following reason:
3y 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 legal[
;ell a structure that 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 Bus' ass and
Drofessions Code, is available upon request when this. application is submitted or at the following Web site:http:Uwww.leginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
_ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapterg (commencing with Section 7000) of Division 3 of the Business and Professions Code n m nse is in full force
and effect. C /D .scene Class License No 0Date'X. ! %/ a j ( Contractor Signature
PORKERS' COMPENSATION DECLARATION r f
EARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE
AST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNErS FEES.
hereby affirm under penalty of perjury one of the following declarations:
7 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 the
erfovnanee of the work for which thispermit is issued. Policy No.
_1
have and will maintain workers'
trance carrier CIDvolicy number^
Agent
as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
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44 01393e-OP
.ion Date Zi Jt4
# k-QD — NI/ — 9`4S-?
(certify that, in the performance Of tfta work for which t it is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
It, if I should become su -eat to the, compens rovisl of Section 3700 of the Labor Code. I shall forthwith comply with those prov)si hs.
inature of Applicant
Date 7 _ / — y
CLARATION REGARDING CONSTRUCTION LENDING AGENCY
:reby affirm under penalty of perjury that there is a construction lending agency for the performance of the workfor which this permit is issued Section 3097, Civil Code).
ider's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owneror authorized to act on the property owner's behalf.
I have read this application and the information I have provided cored- q
I agree to comply with all applicable city and coun ordinanc nd state laws relating to building construction. fl �— t 7 ,102.1
i authorize representatives of this. city or cou ty t enterthe - r inspection purposes. q % ,//
nature of Property Owner or Authorized A ent Print Property Owner's or Authorized Acenfs Name Y A4r r C YL G ,,A,
PERMIT
AC)TON I DATE
FINAL
OCCUPANCir'7SSUED
❑ I SUBMITTED ASBESTOS N077FICATION TO:
fOTNPPCC4ME TO