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Home My WebLink AboutX2022-0301 - PermitsCity Of 100 Civic Permit Cot Inspection r��c r,rilK+'�a Combinal Job Address: 2121 BRISTOL: Description: COMM REPAIR Legal Desc.: P BK 179 PG 48 Owner: CHEVRON USA II Address: PO BOX 6004 SAN RAMON, CA Phone Applicant: HOHN GREG Address: 3334 E COAST H NEWPORT BEAC Phone: 909.645.1515 Code Edit: 2019 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Building Permit Fee: $215 Plan Check Fee: $187.05 Overtime Plan Ck: $0 Investigation Fee: $0 Record Management: $2 Energy Compliance: $0 CA Seismic Safety: $0 Disabled Access : $0 Hazardous Mat $0 Building Green Fee : $1 11 TOTAL PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: ;wport Beach - Building Division `X2022-0301 ` COMB Permit : X2022-0301 Project No : 0275-2022 er Drive, Newport Beach, CA 92660 r Phone (949)644-3288 luests Phone (949)644-3255 Issued Date: 02/02/2022 Type - BLDG Inspection Area : 7 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 02/02/2025 OR PERMIT WILL BE INVALID :S 180 Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays ion Hours: Monday- IS ING IN DISPENSER "CHEVRON" R1 Contractor: PERRY WAYNE INC Architect: Address: 8281 COMMONWEALTH AVE Address: ��•••+++++�� 583 BUENA PARK CA 90621 State Lic: Phone: 714-826-0352 Phone: Con State Lic: 300345 Engineer: �. 'STE 550 Lic Expire: 09/30/2022 Address: CA 92625 Bus Lic: BT02092602 phone: State Lic: Lic Exp Date: 08/31/2022 Worker's Compensation Insurance Designer: HOHN GREG , Address: 3334 E COAST HWY STE 550 Carrier: EVEREST NEWPORT BEACH, CA 92625 Policy No: CA10003737221 Expire: 1213112022 Phone: Building Setbacks Rear: I Special Conditions: Front: I ; Left: / ' Right: I • • ' Use Zane: Parking Spaces: 0 Fire Hazard Zone : N 7,500.00 0 Excise Tax: $0.00 Planning Department - $52.00 Fire Department Fire Inspection: $0.00 Additional Fee : $0.00 Plan check Fee : $0.00 Fire Plan Rev $48.50 0 Grading Bonds Fee: $0.00 Fair Share : $0.00 Demolition Fee 0 Grading PC Consultant: $0.00 $0.00 SJH Trans : In -lieu Housing Fee : $0.00 Building DAdm 0 Grading Permit Fee: $0.00 Public Works Department- General epttice $0.00 0 Grading PC Fee: $0,00 Park Dedication Refund Deposit $0.00 p WO Insp. Fee: M Check : $50 75 Grading Bond: $0.00 0 i0 Electrical %: $0.00 San Dist: $0.00 $0.00 $0.00 i0 Mechanical %: $0.00 NMUSD Fee: $0.00 Plumbing %: $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $556.30 $556.30 PUBLIC WORKS APPROVAL: 1 PLAN CHECK BY: APPROVAL TO ISSUE: OWNER -BUILDER DECLARATION 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 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 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 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 not more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) 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' or 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 improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). I am exempt from licensure under the Contractors' State License Law for the following reason: By 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, sell 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 0 of (vision 3 of the Business and Pro,(epsions' ode, and my license is in full force and effect. Licen'.e .;lass License No Date 'L 2 Contractor Signature R'URLCERS' COMPENSATION DECLARATION NA,RNINC: 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 FORM SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm un0e-r ^enalty of perjury one of the following declarations: I have and wM 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 Ierformance of th. wo.k for which this permit is issued. Policy No. hn,'e 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' rdncp carrier and policy number are: Policy Number rf Agent Date ctr,ify that, kl 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 agre it, if I should become scut/�{ect to th/ey��orkers' compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with those provisions. ]nature of Applicant\ ( �/%- iCLARATION REGAFKDIN NSTRGCTI LENDING AGENCY r ereby 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). nder'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 city and county ordinances and state laws relating t0 building construction. I authorize representatives of this city or county to rite, a bove-identified property for inspection purposes. / (nature of Property Owner or Authorized Agent Q°�_ Print Property Owner's or Authorized Acent's Name X 6e r .,. I'Z/z A,� ACTION DATE I BY Y REGULATIONS PARTn10 TIITLE 40 AND AgMD RULECE WITH CODE OF FOR OFFICE USE ONLY PERMIT EXPIRED PERMIT CANCELLED PERMIT -EXTENDED PERMITFINAL CERTIFICATE OF OCCUPANCY ISSUED I SUBMITTED ASBESTOS NOTIFICATION TO EPA IS NOTAPPLICABLE TO