HomeMy WebLinkAboutF2021-0620 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII FIRE Permit: F2021-0620
100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 1 0 6 2 0 Project No : 2919-2021
(9)
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 8 SURFSPRAY BLUFF NB
Description: SFR FIRE SPRINKLER SYSTEM 4 HEADS (X2021.2509)
Inspector Area: 5
Legal Description:
Owner: ZIMMERMAN KENT
Contractor:
MCCULLOUGH ENGINEERING Architect: KOLLIN MICHAEL
Address: 8 SURFSPRAY BLUFF
Address:
2050 WACO RD Address: 4265 E CONANT STREET #101
NEWPORT BEACH, CA
APPLE VALLEY CA 92308 LONG BEACH CA 90808
Phone:
Phone:
760.403-4875 Phone: 562-597-8760 State Lic: CO21173
Applicant: POP JOAN
Con State Lic:
958381 Engineer:
Address: 2027 HUNTER RD
Lic Expire:
03/31/2023 Address:
CHINO HILLS, CA 91709
Bus Lic:
BT30077493
Phone: 714-213-2559
Lic Exp Date:
1213112022 Phone: State Lic:
Code Edit : 2019
Worker's Compensation
Insurance Designer:
Type of Construction: V-B-SPR
Carrier:
NO EMPLOYEES Address:
Occupancy Group: R3/U
Policy No:
Added /New sq.ft. Bldg: 0
Expire:
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 2
Issued Date: 1211612021 Special Conditions:
No of Units : 0
Setback- Front:
Flood Zone:
Rear:
Bldg Sprinklers: N
Left:
Right:
FEES
Construction Valuation:
$1,000.00
Building PC Fee :
$222.00
Fire Residential Alarm PC Fee : $0.00 Records Management:
$2.00
Building Overtime PC Fee:
$0.00
Planning Counter Review: $0.00
Building Extention Fee :
$0.00
Planning Zoning PC Fee : $0.00
$0.00
Building Investigation Fee :
Fire Plan Check Fee:
$0.00
$0.00
Public Works PC Fee: $0.00
$0.00
Fire Permit as :
$0.00
Public Works Traffic Plan Check Fee; $0.00
Building Permit Fee :
$269.00
TOTAL FEE :
$493.00
Plan Check Fee : $222.00 Fee Due at Permit Issuance :
$271.00
PROCESSED BY:
OTHER DEPARTMENT:
ZONING APPROVAL:
_
_ _ =: PLAN -CHECKED BY::
FIRE APPROVAL: r
- _ oAPPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
)WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law forthe 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
ie 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
'rofessions 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
of 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 U portions of the work, and the structure is not intended or offered for sale (Section 7044,
Usiness 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
nprovements 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
nproved 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
pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractor_%State License Law).
D I am exempt from licensure under the Contractors' State License Law for the following reason:
ly 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
ell 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
'rofessions 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
.ICENSED CONTRACTOR'S DECLARATION
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 Profess'ns Code, an li se Is in full force
nd effect.1
.!cerise Class [� License No �S n Date` Z ^ 16 — Z./Contractor Signatu
VORKERS' COMPENSATION DECLARATION
IARNING: 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
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
3%j 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 thl
y rnnance of the work for which this permit is issued. Policy No.
have and will marital 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'
"ante carrier and posit number are:
jer Policy Number Expiration Date
of Agent
in the performance of the work for whicVhis 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
become subject to Wwork%,; _gpmposatigwO( rovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ,
nature of Applicant Date �6
CLARATION REGA TRUCTIO ING AGENCY
areby affirm under pyhalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued ( action 3097, Civil Code).
Ider's Name Lender's Address
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 t ant - ifi property for inspection purposes.
nature of Property Owner or Authorized Agents Print Property Owner's or Authorized
AC77ON
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF T17LE40 AND
AQMD ROLE 1403.
PERMITEXPIRED
❑ 1 SCI8MITTEBASBESTOS NOTIFICATION TO:
[" EPA
C: AW40
PERM7TCANCELLED
PERMITEXTENDED
❑ AiBEiTOSNGI.RCi TIONISYCTtO9UCABLETO
PROPOSED DEMOLITION.
PERMIT FINAL
lo—
—
CERTIFICATE OF
OCCUPANCYISSUED
SIGNATURE: