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Home My WebLink AboutF2023-0185 - Permits�EWPORT City of Newport Beach IIIIIIIIIIII IIIIIIIIIIIIIII IIIIIIIIIIIII II COMB Permit : F2023-0185 4 d Community Development Department - Building Division F 2 0 2 3 0 1 8 5 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No : 1522-2022 = Permit Counter Phone: (949) 718-1888 Issued Date : a newportbeachca.gov/civic Inspection Area : FIRE Cq�rFOF�,P Combination Type - 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 1�IKD15G *l N$ {--TII,I1 Y CLINIC. Job Address : 4321 BIRCH ST ttK f(-/ Legal Desc : N TR 5169 BILK LOT 5 Description : COMM MEDICAL GAS (X2022-1677) Owner: 4321 BIRCH PARTNERS LTD Address: 668 N COAST HWY #1370 LAGUNA BEACH, CA 92651 Phone: Applicant: JARED TAYLOR Address: 5847 BRACE RD LOOMIS, CA 95650 Phone: (805)440-7537 Owner/Builder: Address : Contractor: GRAY WEST CONSTRUCTION INC Address : 421 E CERRITOS AVENUE ANAHEIM, CA 92805 Phone: (714)491-1317 Con State Lie : 775947 Lie Expire : 03/31/2024 Bus Lie: BT30080560 Bus Lie Expire : 01/31/2024 Workers' Compensation Insurance Carrier: AMERICAN GUARENTEE Policy No: WC8085995 W. C. Expire: 1/2/2024 Architect : LIM GEOFFREY BUENAVISTA Address : 218 THE PROMENADE NORTH LONG BEACH, CA 90802 Phone: (562)206-7720 State Lie Engineer Address Phone: Designer: Address Phone: Phone Code Edition : 2022 Fire Sprinklers : NO Construction Valuation : Type of Construction : Fire Hazard Zone : NO Added/New/TI sq. ft. Bldg Occupancy Groups : B No of Units : 1 Alteration sq. ft. Bldg : Bldg Height: No of Stories : 1 Added/New sq. ft. Garage: TOTAL sq. ft. Building Setbacks Flood Zone : X Use Zone : OA - Office —Airport PROCESSED BY SPECIAL CONDITIONS: N 0 0 I hereby affirm under penally 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 applicableitem(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 bass 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). 1 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, lusiness 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 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 pply 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 I am exempt from licensure under the Contractors' State License Law for the fallowing 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 legall) ell a structure that I have built as an owner -builder if It has not been constructed in its entirely 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 sitaihttp:/NAvw.leginfo.ca.govlcalaw.html. Ignature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION J�J hereby affirm under penalty of perjury that. I am licensed under provisions of Chapter 9(commencing with Section ) of Division 3 of the Business and Prof e is o and my 1' iise is In full force ndeffect. License Class License No Dat 0. �' < Contractor Signature VORKERS' COMPENSATION DECLARATION rARNING: FAILURE TO SECURE WORRERW COMPENSATION COVERAGE 19 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,900), IN ADDRION TO THE DST OF COMPENSATION, DAMAGES AS PROVIDEP FOR IN SECTION 0700 OF THE LABOR COPE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one or the fallowing declarations: I I 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, forth L)rformance 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 Expiration Date of Agent certify that, in the performance oft work for F h 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 agie t, if I should beco subject t workers' ensatio provisions of Section 3700 of the Labor Code;. I shall forthwith comply with those provisions. 'HIV nature ofApplica t I ; -S'-7_ — CLARATION RE(*RCHNIG-64ONSTRUCTICIN LE DING AGENCY YYYY \ areby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for whichthispermit is issued (Section 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 owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable ctty and county Droll an nd state relating to building construction. i authorize representatives of this city or countyVenter t}t bove-idenodd pro arty for inspection purposes. it / ,t ACTION CANCELLED CERTIFICATE OF OCCUPANCVI53UED DATE. BY Y DECrAffAPQI+OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61: OF TITLE 40 AND AOMD RULE ASBESTOS U ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO PROPOSED DEMOLITION