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Home My WebLink AboutXC2024-0104 - Permits�Ew, oar, City of Newport Beach II IIII III I II I I IIIIIIIIIII IIII III II COMB Permit : XC2024-0104 Community Development Department- Building Division X C 2 0 2 4 0 1 0 4 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No ~ Permit Counter Phone: 949 718-1888 i ) 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 50 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. 72 SOS Owner: HOAG MEMORIAL HOSPITAL-PRESBYTERIAN Address : 1 HOAG DR NEWPORT BEACH, CA 92663 Phone : Applicant: BEN MEDINA Address : 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362 Phone: (818)735-7876 Owner/Builder : Address : Phone Contractor: CENTIMARK CORP Architect Address : 12 GRANDVIEW CIR Address CANONSBURG PA 15317, CA Phone: (714)744-6964 Phone: Con State Lie : 497859 State Lie Lie Expire : 09/30/2024 Bus Lie: BT30015096 Engineer: Bus Lie Expire : 05/31/2024 Address Workers' Compensation Insurance Phone: Carrier: AMERICAN CASUALTY COMPANY OF READING PA Policy No: WC7018259101 Designer W. C. Expire : 5/1/2024 Address Phone: Code Edition : 2022 Fire Sprinklers : Type of Construction : V-B Fire Hazard Zone Occupancy Groups : B No of Units : Bldg Height: No of Stories Building Setbacks : Flood Zone : X Use Zone: PC - Hoag Hospital PROCESSED BY: 461 SPECIAL CONDITIONS: NO Construction Valuation : $37,162.00 NO Added/New/Ti sq. ft. Bldg: 0 0 Alteration sq. ft. Bldg : Added/New sq. ft. Garage: 0 TOTAL 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: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior toils 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 licensum 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 U 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' nr 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). ❑ 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 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). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below t 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 legall+ sell a structure that I have built as an owner -builder if it has not boon constructed in its entirety 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 Web site:http:fiwww.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 700 f D" f the Business and Professions, ande� my license is In full force and effect. License Class License No Date io Contractor Signature WORKERS' COMPENSATION DECLARATION tj� 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 1$100A00l, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORi FEES. I hereby affirm under penalty of perjury one of the following declarations: 0 (have and will maintain a certificate of consent to self -insure for workers' compensation, Issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for lh per(prmance of the work for which this permit Is issued. Policy No. and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' carrier and policy number are: Policy Number Date Te of Agent Phone # certify that, in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compen$,ation I ws of California, and ague if I should become subject to the workers' compensation provi Helton 3700 of the Labor Code I shall forthwith comply with those provisions. �!� iature of Applicant :1 ARATinN RFC.A*rNNr3 rnNATPII�t rwrri Ur An FNrV =_reby affirm under penalty ofg'ar that a Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). lders Name Lenders Address _. 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 ordina s and state la I authorize representatives of this city or county to ente. he bove-idaPn _c rs r Gilding construction. property for inspection purposes. ACTION DATE BY LWeO RATION OF COMPLIANCE vVrrH CODE OF Ff Df RAL { REGULATIONS PART 51 OF TITLE 40 AND AQNID RLI LE. 1403 PERMIT EXP.4ED 1 SUBMITTED ASBESTOS NOTIFICATION TO PERMiTCAwCrLL€L1 -- jLJEPA �— P€RMITEXlENOE`1 QMD PEAANPFINAL 7 (.� Z �M OS NO] IFICAI'ION I APPLICABLE TO CERTIFICATE OF ,/ PROPOSED DEMOLi OCCUPANCYY55Jd1, SIGNATURE: FOR OFFICE USE ONLY &Lxlc,�