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Home My WebLink AboutXC2024-0103 - PermitsSEW PO/tT City of Newport Beach II IIIIII I III IIIIIII III III III I IIII II COMB Permit : XC2024-0103 C� Community Development Department- Building Division X C 2 0 2 4 0 1 0 3 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No > z Permit Counter Phone: (949) 718-1888 Issued Date : 03/14/2024 newportbeachca.gov/civic Final Date: Combination Type - Permit Status: Issued Work Class - Other Inspection Area : 7 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 : 3900 COAST HWY W, BLDG 51 Legal Desc : A TR IRVINE SUB BLK 1 LOT 172 IRVINE SUB BLK 1 LOT Description: COMM REROOF -LAY 1/4" DENS DECK 60 MIL TPO MECHANICALLY FASTENED SYSTEM OVER (E) BUR CAP SHEET. 54 SOS Owner: HOAG MEMORIAL HOSPITAL-PRESBYTERIAN Contractor: CENTIMARK CORP Architect Address : 1 HOAG DR Address : 12 GRANDVIEW CIR Address NEWPORT BEACH, CA 92663 CANONSBURG PA 15317, CA Phone : Phone : (714) 744-6964 Phone Can State Lie : 497859 State Lie: Lie Expire : 09/30/2024 Applicant : BEN MEDINA Bus Lie: BT30015096 Engineer Address : 31225 LA BAYA DR Bus Lie Expire : 05/31/2024 Address WESTLAKE VILLAGE, CA 91362 Phone: (818) 735-7876 Workers' Compensation Insurance Phone: Carrier: AMERICAN CASUALTY COMPANY OF READING PA Owner/Builder: Policy No: WC7018259101 Designer Address : W. C. Expire : 5/1/2024 Address Phone: Phone: Code Edition : 2022 Fire Sprinklers : NO Construction Valuation : $37,162.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/Ti sq. ft. Bldg : 0 Occupancy Groups : B No of Units : 0 Alteration sq. ft. Bldg : Bldg Height : No of Stories : Added/New sq. ft. Garage: 0 TOTAL sq. ft. 0 Building Setbacks Flood Zone : X Use Zone : PC - Hoag Hospital JeAf PROCESSED BY: SPECIAL CONDITIONS: I hereby affirm under penalty of perjury that f 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) 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 is permit to file a signedstatement that no 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 Tofessions Code) or that he or she is exempt from lcensure 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).. 3 1, 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). 7 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 ppiy 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). D I am exempt from licensureunder the Contractors' State License Law for the following reason. Iy 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 legalit all a structure that I have built as an ommor-buildor if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law. Section 7044 of tho Business and 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http:!lwww.leginfo.ca.gov/calaw.html. tignature 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 ouon 70brQ i 'o 3 of the Business and Professions C my license is in full force Ed effect. License Class License No i ete.j L3 Contractor Signature VORKERS' COMPENSATION DECLARATION rARNING; FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNOR USAND DOLLARS t6100,000t, IN AUDITION TO THE OST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 1706. OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: I I have end 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 th erformance of the work for which this permit is issued. Policy No. ays 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' compensatior lsurance carrier and policy number are: 'ter Policy Number Expiration Date rie of Agent -Phone . certify that, in the performance of the Wert for which th permit is issued. I shall notemploy any person in any manner so as to become subject to the workers' compensation laws of Cafffomia, and agre if I should become subject to thh"orker ' ensatlon provisions of Section 3700 of the Labor Code, Ishall forthwith comply with those provisions. �L lature of. Applicant,____: _ _ _ - Date iAr :RATION REGAL G STRUCTIDN LENDING AGENCY areby affirm undel�p`ena�f perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). idar'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 Ihave provided is correct. I agree to comply with all applicable city and county ordinances and state Paws relating to building construction. I authorize representatives of this city or count. enterthe ab clan ifled property for inspection purposes. mAHlep, of pronPnv Clwnor or Aulhnn7erl Anent Print Prooerty Owners or Authorized Apart's Nam ACTION DATE DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE O N LY REGULATIONS PART 61 OF TITLE 40 AND ACIPA D RULE 1403 PERMiT EXPLiED l , U I SUBMITTED ASBESTOS NOT] FICATION TO PERMIT FINAL LJASBESTOSNOTIFICA OTAPPLICABLE IQ CE.S rIFICA TE O'F I � PROPOSED DE OCCUPANCYISSJrt, I SIGNATURE: