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Home My WebLink AboutF2023-0422 - Permits�EwPoRT City of Newport Beach COMB F Community Development Department -Building Division F 2 0 2 3 0 4 2 2 100 Civic Center Drive, Newport Beach, CA 92660 Plan Chet D ram► r Permit Counter Phone: (949) 718-1888 Issued Date %anewportbeachca.gov/civic Final Date: °gc,coaN`P Combination Type - Permit Stah Work Class - Tenant Improvement Inspection / PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YE, NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK Job Address : 4440 VON KARMAN AVE, 230 Legal Desc : N TR8762 BL, LOT 5 Description: COMM FIRE- RELOCATE SPRINKLERS 16 HEADS )(GZ02j- p05 Owner: 4440 VKA TIC 3 LLC Address : 2727 LYNDON B JOHNSON FWY DALLAS, TX 75234 Phone Applicant: PACIFIC FIRE SUPPRESSION INC Address : 249 E EMERSON #G ORANGE, CA 92865 Phone: (714)283-0211 Owner/Builder Address : Phone: Contractor: PACIFIC FIRE SUPPRESSION INC Address : 249 E EMERSON #G ORANGE, CA 92865 Phone: (714)283-0211 Con State Lic : 423418 Lic Expire : 11/30/2023 Bus Lic: BT03042109 Bus Lic Expire : 03/31/2024 Workers' Compensation Insurance Carrier: EVEREST NATIONAL Policy No: 5300004928211 W. C. Expire : 9/17/2023 Code Edition : 2022 Fire Sprinklers: NO Type of Construction : II-B Fire Hazard Zone : NO Occupancy Groups : No of Units : 1 Bldg Height : No of Stories : Building Setbacks : Flood Zone : X Use Zone : PC - Koll Center PROCESSED BY: '0M SPECIAL CONDITIONS: II rer%e N S 1_ ��01 it: F2023-0422 : No: PC2023-2137 08/31/2023 3 FROM ORIGINAL ISSUANCE DATE SUNDAY AND HOLIDAYS IN ALL AREAS ress : Lic: CHUCK HAMILTON 249 E EMERSON AV, G ORANGE, CA 92865 (714)283-0211 PACIFIC FIRE SUPPRESSION INC 249 E EMERSON #G ORANGE, CA 92865 (714)283-0211 tction Valuation : $3,200.00 New/TI sq. ft. Bldg : D on sq. ft. Bldg : New sq. ft. Garage: 0 sq. ft. : 0 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable items) (Section 7031,5. Business and Professions Code: Arty city or courtly that requires a permit to construct, alter, improve, demolish, or repair any structure, prior torts 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 lieensure 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). El 1, as owner of the property, or my employees with wegas as their sole compensation, will do (_) all of or L) 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). ❑ 1, 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 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: 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, 1 cannot legally sell a structure that I have built as an owner -builder 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 Professions Code, IS available upon request when this application is submitted or at the following `Neb site:http:ltw .leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized AgentDate LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700QV 9'm ion 3 of the Business and Pro{.e��tpps CvOde, end my license is In full force and effect. License Class License No Date `TJ S� 102y Contractor SignatureLjGJ�j WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$100.000), IN AourriON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 070E OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. I 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 parj6rmance 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 permitis issued. My workers' rance carrier and policy number are! Policy Number of Agent Date Ul 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 Calffomia, and agre that, if I should becomgj •t I e workers' compertsahfnn provisions Of Section 3700 of the Labor Code, shall forthwith comply with those provisions. Signature of Appli anpl_", _ _ _ Date DECLARATION REGI FCONSTRUCTION LENDING AGENCY �' I hereby affirm under I 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). Lenders 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 slate laws relating to building construction. I authorize renresen -lives o'thls ,: q or County v thebove-identified property for inspection purposes. _' �a/J Signature of Pro etc Owner or P ulho ized Agent Print PropertyOwner's or Authorized Agent's Name ` '� w C[�l.t ti Date ACTION OAT' 3Y CLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 51 OF TITLE 40 AND AQNID RULE 1403 PERMIT EXPIRED 4 ) I SURMITTFO ASBESTOS NOTIFICATION TO PERMIT CANCEL! ED I } �EpA .._._ L' ...... ..._.. PERivfIT EXTENDED .. .. ._.❑AQMD PER+AMT FINAL �F11•�.� �M(!��3 I IASBEST OS NO I IFICA II ON IS NOIAPPUCABLE tO CERTI9CATf OE SIGNATURE:PROPOSED DEMOLITION EMOLITION OCCUPANCY lSSUEA