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Home My WebLink AboutX2021-1213 - Permits�,8'4•noyT City of Newport Beach - Building Division G� 100 Civic Center Drive, Newport Beach, CA 92660 } `• 3, Permit Counter Phone (949)644-3288 L yw fi "�r`arPs Inspection Requests Phone (949)644-3255 e'r Combination Type - CIP ELEC IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit: X2021-1213 Project No : 1070-2021 Issued Date : 1010612021 Inspection Area : 7 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 10/06/2024 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 H I YS. Job Address: 2744 (CS) E COAST HWY NB Description: COMM - CELL SITE MOD (ROOF TOP) ADD BATTERIES "T-MOBILE" Legal Desc.: TR 323 LOT 4 BLK M ALL -EX HWY-(AND NWLY 35.47 FT -EX HWY- LOT 5 B LK M Owner: SHOKRIAN SIMONA & ROSSANA Contractor: QUALTEK WIRELESS LLC Architect: SANTILLAN MICHAEL �r Address: 904 N BEDFORD OR Address: 475 SENTRY PKWY E #200 Address: 30 THOMAS if BEVERLY HILLS, CA 90210 BLUE BELL PA 19422-2320 IRVINE CA 92618 Phone: Phone: 484-804-4500 Phone: 949-714-9990 State Lic:CO23337 Applicant: NATIONAL ENG/JUSTIN Con State Lic: 1042849 Engineer: ' Address: 30 THOMAS Lic Expire: 08/31/2022 Address: IRVINE CA 92618 Bus Lic: BT30074344 Phone: 949-716-9990 Lic Exp Date: 02/28/2022 Phone: State Lic: Code Edit : 2019 Worker's Compensation Insurance Designer: Type of Construction: V-B Carrier: FIRST LIBERTY INS CO Address: Occupancy Group: U Policy No: WC6631510650028 Added /New sq.ft. Bldg: 0 Expire: 11/30/2021 Phone: Added /New sq. ft. Garage: 0 No of Stories: 0 Building Setbacks Rear: / Special Conditions: - No of Units : 0 Front: I - Bldg Height: 0 Left: / Bldg Sprinklers: Right: / Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $15,000.00 Building Permit Fee: $334.00 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: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $48.50 Investigation Fee: $0.00 Grading PC Consultant: $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $42.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: $0.00 Building Dept Adm $0.00 Energy Compliance: $0.00 Grading PC Fee: $0.00 Public Works Department - General Service $0.00 CA Seismic Safety, $0.00 WO Insp. Fee: $0.00 Park Dedication : $0.00 Refund Deposit $0.00 Disabled Access: $0.00 P/W Plan Check : $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $87.44 San Dist : $0.00 Building Green Fee : $1.00 Mechanical W $0.00 NMUSD Fee: $0.00 $0.00 Plumbing %: $0.00 $0.00 TOTAL FEE : $855.52 Plan Check Fee : $355.63 Fee Due at Permit Issuance : $499.89 PROCESSED BY: PUBLIC WORKS APPROVAL: ZONING APPROVAL: PLAN CHECK BY: 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) mc:.cateu aelow 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 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). ❑ 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 Prnperty C.wner or Authorized Agent Date %ICENSED CONTRACTOR'S DECLARATION ) hereby affirm ui 6s. Penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) D'gis'on 3 of the Business and Profess iofi o e, an rry 'tense full force and effect. Liceicc Mass License No Date l4 Contractor Signature 1 WORKERS' COMPENSATION DECLARATION WARNING: FAILURE rJ 3-CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ARS ($100,000), IN ADDITION TO THE :O"T OF, COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 11 hereby affirm under penalty of perjury one of the following declarations: 1V I have and will r,aintain 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 thi �pe�rmance of thn work for which this permit is issued. Policy No. " hai,e and will mai:ltain 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' compensatio f insurance came. ,.nd Folicy number are: ICarrier - - - - - Policy Number Expiration Date Name of Agent Phone # ❑I certify that, in the performance of the work for which t,4 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 that, if I should become subje o orke s' co ens n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant - Date lJ/Tl DECLARATION REG DING C NS R TION LENDI AGENCY I hereby affirm under penalty of perju at 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 stat ws relating to building construction. I authorize representatives of this city or county a the bo -!den d property for inspection purposes. Signature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Nam �Q,VI �(`J Date ACTION DATE B D C ATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY R LATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED OEPA PERMIT EXTENDED qM D PERMITFINAL ✓ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF 2 P/3�� C PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: _ \ Ln s ; §}[ $( I \) a _ -Fa § \§ \/ �� - ) )} > Z )}} /( § /) _ mId /\/§ _ !§0 - 0\ k\\u � \ ) ®� 8 �> \\)} } § ( k 0 �\ §&}k { )�<< ) j/ \ k \: ! / \kf\ 1' \ \!.. )§ § G")\0 vu ,_ , u C) / \