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Home My WebLink AboutX2022-0701 - Permitsw,•„ City of flewport Beach - Building Division *X2022-0701 * COMB Permit: X2022-0701 100 Civic Center Drive, Newport Beach, CA 92660 Project No : 0619-2022 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combinati n Type - CIP ELEC Issued Date : Inspection Arearea :2022 7 PERMIT EX IRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY OR PERMIT WILL BE INVALID Construction 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 (CS) BIRCH ST NB Description: COMM REMOVE E)'SPRINT' CELL SITE AT ROOF 600 SF. REMOVE ALL EQUIPMENT. Legal Desc.: Owner: JOHN HANCOCK LIFE INSURANCE COMPANY USA Contractor: TELCOM ENGINEERING GROUP LLC . ,. Architect: Address: 865 S FIGUEROA T #3320 Address: 473 US HWY 46 Address: LOS ANGELES, CA 90017 CLIFTON NJ 07011 ' • y -. Phone: Phone: 480-334-6991 Phone: State Lic: Applicant: COVINGTON ALMAJ ISAIAH Con State Lic: 1075291 Engineer: KITSTEINER ROBERT ' Address: 7575 CARROLL RD Lic Expire: 04/3012023 Address: 1270 RUTLAND RD #4 _ SAN DIEGO, CA 9 121 Bus Lic: BT30075484 NEWPORT BEACH CA 92660 • - - Phone: 619-455-5955 Lic Exp Date: 06/3012022 Phone: State Lic:C-086713 • - - . - , , Code Edit: 2019 Workers Compensation Insurance Designer: Type of Construction: I-A-S R Carrier: TRAVELERS PROP & CASUALTY CO Address: Occupancy Group: U Policy No: UB9R6469822226G - Added /New sq.ft. Bldg: 3 Expire: 0410112023 Phone: Added /New sq. ft. Garage: ' No of Stories: 10 Building Setbacks Rear: / Special Conditions: No of Units : 0 Front: / Bldg Height: 0 Left: / Bldg Sprinklers: Y Right: / Flood Zone: x Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $15,000.00 Building Permit Fee: $334. 0 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $290.58 Additional Fee : $0.00 Plan check Fee : $52.00 Fire Inspection: $0.00 Overtime Plan Ck: $0. 0 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $48.50 Investigation Fee: $0. 0 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee Record Management : $16. 0 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $0. 0 Grading PC Fee: $0.00 Public Works Department - General Service $0.00 CA Seismic Safety: $0. 0 WQ Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access : $0. o PAN Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0. 0 Electrical %: $87.44 San Dist: $0.00 Building Green Fee : $1. 0 Mechanical %: $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FE : $829.52 Plan Check Fee : $431.76 Fee Due at Permit Issuance : $397.76 PROCESSED BY: 13-7 PUBLIC WORKS APPROVAL: PLAN CHECK BY: ZONING APPROVAL: .YT V" GRADING APPROVAL: 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 Iicensure 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 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). ❑ 1 am exempt from Iicensure under the Contractors' State License Law for the following reason: By my signatura bc,ow 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 legal) sell a structure. t. Lt 1 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 Cod= is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.govlcalaw.htm]. Signa,ure of Froperry Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hQr=by affirm under penalty of erjury that I am licensed under provisions of C apter 9 (commencing with Section 7000) of D�,ivJ'�iPn 3 of the Business and Professions �jo e, F d¢y I tense is in full force and effect License Class License No t0 i ZD1 ( Date �r�(Z(p f1Yil_^ Contractor Signature iC �L� 1/l r'I�\ WOPKERS' COMPENSATION DECLARATION T�1 IWARNW G: FAILUnE SC UECU RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS IE100,000I, IN ADDITION TO THE �I COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. �I hereby affirm under penalty of perjury one of the following declarations: )❑ I hPve and will mcintain 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 IN performance of the work for which this permit is issued. Policy No. 1- h, ve and will n,aii.tain 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' compensator ins ante carrier and policy number are: Carrier k,Lo) Policy Number U%-f"+Atgr 9)7-- 2.2-Vo'(Z Expiration Date 0" Name of Agent 45(k, jg-L-F i 4-'Z— Phone #1nZC>'-�`[,�-� Z e2 ❑l certify that, in the performance of the work for which this permit is issued, I shall net employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre that, if I should become �subject (to�the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant /��-1, 3� (" Date DECLARATION REGARDING CONSTTIRL�TION L DING AGENCY I 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). Lender's Name Lender's Address By 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 an the apse I ified property for inspection purposes. K Signature of Property Owner or Authorized Agent �� ff Print Property Owner's or Authorized Agent's Name xzfp, f k ( Ti L Date 6fo 2 ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED LJEPA PERMITEXTENDED OMD CERMITFIITEOF jS�L(i l.. NAL SBESTOS NOTIFICATION IS NOT �APPLICABLE PTO n / SIGNATURE: PROPOSED EX IT. c 21/1 OCCUPANCYISSUED � /�/ ,