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Home My WebLink AboutX2022-0425 - Permits�anu4 City of Newport a 100 Civic Car H ,• � Permit Counter " Inspection RE Combination Beach - Building Division ter Drive, Newport Beach, CA 92660 Phone (949)644-3288 quests Phone (949)644-3255 Type - CIP ELEC MECH PLUM IIIIIIIIIIIIIIIII�lllllllllllllllllllu II COMB Permit: X2022-0425 X 2 0 2 2 0 4 2 5 Project No : 0378-2022 Issued Date : 0512612022 Inspection Area : 7 PERMIT EXPIR S 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, PROJECTS MUST BE COMPLETED BY 0512612025 OR PERMIT WILL BE INVALID Construc ion Hours: Monday- 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 Job Address: 5000 BIRCH ST NB St: 1 FI: 4 Unit: 420 Description: COMM TI - 2298 SF SPEC SUITE Legal Desc.: P BK 181 PG 13 PAR 5 Owner: JOHN HANCOCK LIFE INS CO Contractor: CREW BUILDERS INC Architect: ALGAZE NELSON Address: 6083 BRISTOL PKWY Address: 5000 BIRCH ST Address: 6191 CORNERSTONE STE 101 CULVER CITY CA 90230 NEWPORT BEACH A 92660 Phone: SAN DIEGO CA 92121 619-587-2033 Phone: 213-929.1400 State Lic:CO21090 Phone: Applicant: GRAVES HOLLY Con State Lic: 753428 Engineer: Address: 18600 MACARTHU BLVD STE 100 Lic Expire: 0413012023 Address: IRVINE CA 92612 Bus Lic: BT30049124 Phone: State Lic: Phone: 949-608-3723 Lic Exp Date: 1113012022 Code Edit : 2019 Worker's Compensation Insurance Designer: Type of Construction: I-A-SPR Carrier: AMERICAN ZURICH Address: Occupancy Group: B Policy No: WC551373107 Added /New sq.ft. Bldg: 22 8 Expire: 10/01/2022 Phone: Added /New sq. ft. Garage: 10 Building Setbacks Rear: / Special Conditions: No of Stories: Front: / No of Units : 0 Left: I Bldg Height: 0 Right: I e"�`r'� •s Bldg Sprinklers: Y X Use Zone: Parking S aces: 0 Fire Hazard Zone : N Flood Zone: Construction Valuation: 1,920.00 Building Permit Fee: $1,1 62.0 0 Excise Tax: $0.00 Planning Department - Fire Department $52.00 Fire Inspection: $0.00 Plan Check Fee: $1,010.94 Additional Fee : $48.50 $0.00 Plan check Fee : Fair Share : $0.00 Fire Plan Rev $0.00 Overtime Plan Ck: $0. $0. 0 Grading Bonds Fee: 0 Grading PC Consultant : $0.00 SJH Trans : $0.00 _Demolition Fee Investigation Fee: Record Management: $50. 0 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 General Service $0.00 Energy Compliance: $64. 4 Grading PC Fee: $0.00 $0.00 Public Works Department - Park Dedication : $0.00 Refund Deposit $0.00 fety : $0. 0 WO Insp. Fee : P/W Plan Check: $0.00 Grading Bond: $0.00 ss : $91. $0. 2 0 Electrical %: $304.21 San Dist; $0.00 t Fee : $4. 0 Mechanical %: $239.02 $0.00 NMUSD Fee: $0.00Plumbing "GreenFee %:$195.56$0.00 TOTAL FEE: $3,222.49 Plan Check Fee i : $3,222.49 Fee Due at Permit Issuance : $0.00 ��'' PUBLIC WORKS APPROVAL: : __ A1� �w`✓ PLAN CHECK BY: ZONING APPROVAL: APPROVAL TO ISSUE: GRADING APPROVAL: _ 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 U 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' 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.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perju at I am licensed under provisions of Chapter 9 (coarcing with Section 7000) f Div' 3 of the Business and Professions C my license is in full force and effect. License Class License No �`�' aiZi� Date Q� Contractor Signature NORKERS' COMPENSATION DECLARATION NARNING: 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 FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 th ormance of the work for which this permit is issued. Policy No. • ave 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' compensatiol n angf arrier nd polifc-y,,nu-mber are: t / 'anner url TTl✓K✓I �Ai� Policy Number w L 3g0 `Iq% ski Expiration Date 11311 /22 Jame of Agent Phone # certify that, in the performance cf 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 agree if I should become subject to the I rkmpensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 'I Au of Applicc .— s .........._...... Dat�L Jr�%-(P l �Z 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). -ender's Name Lender's Address 3y 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 to ante identified property for inspection purposes. ,,,,,,'�'�,�,�"" Signature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Nam GfC-/Crn2l At.teff Date ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED IS UBMITTED ASBESTOS NOTIFICATION TO PERMIT EXTENDED LJAQMD ASBESTOS eLE TO NOTIFICATION�T\ PROPOSED DEMOLITION G-.i ar.NATDRFA 7 PERMIT FINAL �I �� G CERTIFICATE OF r l7 ! OCCUPANCYISSUED A.•-