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Home My WebLink AboutXC2023-0063 - PermitsCity of mCommunity CQ�"a 100 Civic C nPermit SnewporeeE Cou Combinati Work Cla: PERMITS EXF NO CONSTRUCTI Job Address: 4023 BIRCF Description : COMM INS Owner: HERTZ CORP Address : 225 BRAE BL\ PARK RIDGE, Phone: (239)301-700( Applicant: CHRISTOPHE Address: 17 WOODCRE ALISO VIEJO, Phone: (917)710-861: OwnerlBuilder Address : Phone Code Edition : Type of Construction Occupancy Groups: Bldg Height: Building Setbacks: Flood Zone Use Zone: PROCESSED BY: mport Beach II IIIIII I IIIIIIIIIIIIIIIIII III IIIIIIIIIII II II COMB Permit : XC2023-0063 velopment Department- Building Division X C 2 0 2 3 0 0 6 3 er Drive, Newport Beach, CA 92660 Plan Check No: PC2023-0473 Phone: (949) 718-1888 Issued Date : 08/15/2023 :a.gov/civic Final Date: Type - ELEC Permit Status: Issued Other Inspection Area :7 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS ;T Legal Desc : N TR 3201 BLK LOT 46 LL TESLA EV CHARGERS "HERTZ" Contractor: AMBIENT ELECTRIC INC Architect: Address : 2363 TELLER RD UNIT #112 Address J 7656 NEWBURYT PARK, CA 91320 ' Phone: (805)262-0428 Phone: Con State Lie : 995928 State Lie Lie Expire : 08/31/2024 ARROYO Bus Lie: BT30082373 Engineer : GARY SOMMERFIELD i LANE Bus Lie Expire : 08/31/2024 Address : 19307 W 63RD TERRACE ' " SHAWNEE KS 66218, CA 0,92656 Workers' Compensation Insurance Phone: (313) 458-9319 Carrier: EMPLOYEE SERV GRP ' Policy No : C5130911A Designer W. C. Expire : 3/1/2024 Address 20 g Fire Sprinklers : V_ Fire Hazard Zone U No of Units : No of Stories X SPECIAL CONDITIONS: Office --Airport Phone: NO Construction Valuation : $200,000.00 NO Added/New/TI sq. ft. Bldg : 0 0 Alteration sq. ft. Bldg : Added/New sq. ft. Garage: 0 TOTAL sq. ft. : 0 i � �3�•,yV; 'gym" � `�..�`a._;� OWNER -BUILDER DECLARATION 1 hereby afilmt under penalty of perjury that I am exempt from the Contractors' Slate License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable items) (Section 7031 "5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish,. or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that no or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7001 Division 3 of the Business and Professions Code} or that he or she is exempt from licensues and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more Ihan five hundred dollars ($w500). 0 1, 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). ❑ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Slate 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 1lcensure under the Contractors' State License Law for the following reason: _ _.._....... prior to completion __.......annot..._._ 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 legalt, sell a structure that I hava built as an owner -builder if it has not been constructed in its entiroly 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:htlp:gwww,leginfo.ca.gov/colaw.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 Sectio Do f Divia" n 3 of the Business and Pro sions Code, and my license is In full force and effect, License Class License No Daf Contractor Signature WORKERS' _CMPENSATION DECLARATION ✓YARNING FAILPrs TJ SECURE WORKERS' COMPENSATION COVERAGE IS UNLAwFUL, AND SHALL SUBJECT AN EMPLOYER TO GRIM AL PENALTIES AND CIVIL PINES UP TO ONE "Real THOUSAND DOLLARS JSt00,000), IN AD OITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEE& ear^by affir.-n .,n le, 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 romance of the work for which this permit is issued. Policy No. _.. have 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' :jZp carrier arid policy number are: Policy Number na of Agent Date ce-lify that. ,n the .n rformance 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 I. II I should 'It tothe workers' nature of Af'plf:ant__ comation provisions of Section 3700 of the Labor CodeI shall forthwith comply with those pens, ply provisions. Lucome j .._ T.._�___...,_ ,__ _�__._.. Date_,_, o L/-7Lrae� CLARATION REGA OI CONSTRUCTION LENDING AGENCY ireby affirm under p natty o rjury that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097, Civil ode). Idler's Name _ Lenders Address my signature below, Denffy to each of the following: _ '-� I am the property owner orautherized 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 c unty rdinances and state lases relating to building construction. I authorize representatives of this city or count o mer t e a/b�Dve�-id/party for inspection purposes. nature of Property Owner or Authorized Agami �!/ A✓ Pent Property Owner's or Authorized Aaenrs Namr% �l. e//1, ACTION BY I/, DEL°EARATIONOFCOMPLIANCEWITIi COOEOFFEDEI RFGWAI"IONS PART fit OF TITLE 40 AND AQMD RLILE FOR OFFICE USE ONLY PERMIT EXPIRED j LJ I StJ WITTED ASBESTOS NOTI FICATION TO PERIL11T CslNCEfl ED MIA PERMiT ENTENDED ❑ t Q M D MIT �aSBesl(0 NOTIFICAIIONISNOIAYPLICABLE TO CERTIFICATE OF FICATEL CERTIFICATE OCCUPANCY ISSUED / PROPO.,F.O MOLITION