HomeMy WebLinkAboutF2020-0356 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIII FIRE Permit: F2020-0356
(9)
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 0 0 3 5 6 Project No : 1585-2020
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 1022 WEST WIND WAY NB Description: NEW SFR FIRE SPRINKLERS (62 HEADS) X2019-2523
Inspector Area: 3
Owner: LEVINSON RONNI
Address: 1902 SUVA CIR
COSTA MESA CA 92626
Phone:
Applicant:
GRISSOM DAVE
Address:
645 NORTH ECKHOFF ST
ORANGE CA 92686
Phone:
714-933-0089
Code Edit: 2019
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units
Flood Zone:
Bldg Sprinklers:
Construction Valuation
V-B-SPR
R31U
0
0
Legal Description:
N TR 4224 LOT 184
Contractor:
KELLY FIRE PROT INC
Address:
10141 THESEUS DR
HUNTINGTON BCH CA 92646
Phone:
714-907-7586
Con State Lic: 878823
Lic Expire: 08131/2021
Bus Lic: BT30070761
Lic Exp Date: 01131/2022
Worker's Compensation Insurance
Carrier: AMERICAN FAM HOM INS
Policy No: 2EA5WC000024603
Expire: 04/11/2021
1 Issued Date: 02/09/2021
0 Setback- Front:
Rear:
Y Left:
Right:
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee:
Fire Plan Check Fee:
Fire Permit Fee :
Building Permit Fee:
TOTALFEE:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
$6,200.00
FEES
$217.00
Fire Residential Alarm PC Fee
$0.00
Planning Counter Review:
$0.00
Planning Zoning PC Fee
$0.00
$0.00
Public Works PC Fee:
$0.00
Public Works Traffic Plan Check Fee;
$263.00
$482.00
Plan Check Fee:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
$0.00
$0.00
$0.00
$0.00
$0.00
State Lic:
State Lic:
KELLY SEAN
10141 THESEUS DR
HUNTINGTON BEACH CA 92646
Records Management
$0.00 Fee Due at Permit Issuance
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIREC 130 JAYS AFTER ISSUANCE OR LAST VALID INSPECTION
$2.00
$0.00
$0.00
$482.00
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 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, priorto 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 L) 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
im roved 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
ap ly 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 legally
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 1 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 perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect. /
License Class License No Date Contractor Signa a !4
WORKERS' COMPENSATION DECLARATION TTT
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 DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 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
e�o(mance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
Policy Number
of Agent
Date
I 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 agre
that, if I should become subject to the workers' omc-nsation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions.
Signature of Applicant fin/'- Date
DECLARATION REGA DING CO TRUCTION LENOTNrkAGENCY
I hereby affirm under penalty of perjury that there is a t- tion lending agency for the performance of the work for which this permit is issue (Section 3097, Civil Code).
Lender'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 owners 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 state laws relating to building construction.
I authorize representatives of this city or county o e,pler the above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent 6v _ Print Property Owners or Authorized Agent's Na &Lf )�—G Date ,�' 7 "Zl
ACTION
DATE
BY
DECLARATION OF COMPLIANCE V#7TN CODE OF
FOR OFFICE USE ONLY
FEDERAL RFGULA I IONS PART 61 JF TITLEfOltT
AQMD RULE 140.
PERMIT EXPIRED
❑ I SUBMI'TEV AS}tESTt 6 40 AF-CARONTO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMIT EXTENDED
❑ ASBESTOS NOTfflCATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITIOnl.
PERMIT FINAL
20 2
��, TAM
CERTIRCATEOF
SIGNATURE:
OCCOPAPJCYISSUED