HomeMy WebLinkAboutXC2023-0057 - Permits¢�EWaDRT City of Newport Beach 111111111111111111111111111111111111111111111111111111111COMB Permit: XC2023-0057
O @ Community Development Department - Building Division
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: PC2023-0430
U / S
Permit Counter Phone: (949) 718-1888 Issued Date : 06/08/2023
o� newportbeachca.gov/civic Inspection Area : 4
Combination Type - ELEC MECH PLUM
Work Class - Other
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: 49 OLD COURSE DR Legal Desc : N TR 15390 BILK LOT 52 TRACT 15390 LOT 52 AND TRACT 15389 LOT S D, 1, 2,
Description: COMM- REPLACE EQUIPMENT FOR HOA SWIMMING POOL
Owner : ONE FORD ROAD COMMUNITY ASSN
Contractor :
Architect
Address : 16845 VON KARMAN AVE STE200
Address :
Address
IRVINE, CA 92606
Phone
Phone : (818) 427-2212
Phone :
State Lic
Con State Lic:
Lic Expire
Applicant: ONE FORD ROAD COMMUNITY ASSN
Bus Lic:
Engineer
Address : 16845 VON KARMAN AVE STE200
Bus Lic Expire :
Address
IRVINE, CA 92606
Phone: (818) 427-2212
Workers' Compensation Insurance
Phone
Carrier :
Owner/Builder : ONE FORD ROAD COMMUNITY ASSN
Policy No:
Designer:
Address: 16845 VON KARMAN AVE STE200
W. C. Expire:
Address
IRVINE, CA 92606
Phone
Phone : (818) 427-2212
Code Edition : 2022
Fire Sprinklers :
NO
Construction Valuation :
$300,000.00
0
Type of Construction : V-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg :
Alteration sq. ft. Bldg :
Occupancy Groups : U
No of Units :
0
0
Added/New sq. ft. Garage:
0
Bldg Height:
No of Stories:
TOTAL sq. ft. :
0
Building Setbacks
Flood Zone: X
Use Zone : PC - Aeronutronic Ford
PROCESSED BY:
EC I OR
SPECIAL CONDITIONS:
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 items)
;Secllon 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
he permit to rile 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 licensum and the basis for the alleged exemption. Any. violation of Section 7031.6 by any applicant for a permit subjects the applicant to a civil penalty of
tot more than five hundred dollars (S500).
I, as owner of the property, or my employees with wages as thekr sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
3 siness and Professiarts Code: TheContrectors 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
provaments are not inl8nded or offered for sale. IL 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
proved for the. purpose of sale).
1, es owner of the property, am exclusively wntrac0ng with licensed Contractors to cornstruc[ the proJact (Section 7044, Business and Professions Code: The Contractors' State License Law does not
spply to ah owner of properly who builds Dr Improvas.iharaon, and who contracts for lha projects with a licensed Contractor pursuant to the Contractors' State License Law).
I am exempt from Ilcensureunder the Contractors' State License law for the following reason:
3y my aigneNre !slow I rcknowledge that, except for my personal residence in which i must Have resided for aI least one year prior to completion of the improvements covered by this permit, I cannot legal)
:e!I a situ^tuts the) I have built as an owner -builder if It. has not been rtstruatad in its entirety by licensed contractors. I understand that copy of the applicable law, Section 7044 of the Business and
'19ressio1I9 Code, ;& bi,ailableupon request when I I tion i ub r at the following Web siteihttpJhvwwaaginfo.ca.govicelaw.html.
Signature of Pror arty Cwner or Authorized Agent Date l � J
-;CENS=D CONTRACTOR'S DECLARATIO
thereby affirm unde, nPnaity of perjury that I am ficansed under visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force
Ino Affect. Liceuse Cla..s Lid se. No Date Contractor Signature
VORKFRS' COMPFNSATION DECLARATION
YARNING -AILURE rO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,000), IN ADDmON TO THE
:J4T EF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES.
:Ie.rJS� cfflrm under penalty of perjury one of the following declarations:
Ir e and will mah,lain 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 th
Iaduru, ,Ice of the work for which this permit is issued. Policy No.
"and vml 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'
rice carder and policy number are:
r Policy Number Expiration Date
of Agent _. DY.....a e
JI 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
iat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
ignature of Applicant Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY —
hereby affirm under penalty 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).
enders Name Lenders Address
y 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 state laws relating to building construction.
I authorize representatives of this city or county t the agree-idantified property for inspection purposes.
DATE BY rDECLARA ON OF COMPLIANCE WITH CODE OF FEDERAL I FOROFFICE.USE
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PERMIT EMENDED I UAWO.
PERMITFINAL EVASSESTOS NOTIFICATIONNOT APPLICABLE TO
CERTIFrCATEOF PROPOSED,D[NI�ON
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