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Home My WebLink AboutX2022-0908 - Permits,0"%rozr City of Newport Beach - Building Division II IIII IIIII IIIII IIII II IIIII IIII I II COMB Permit: X2022-0908 100 Civic Center Drive, Newport Beach, CA 92660 x 2 e 2 2 8 9 e a Project No : 0839-2022 I { ••k Permit Counter Phone (949)644-3288 `u fi Inspection Requests Phone (949)644-3255 Issued Date : 06/09/2022 Combination Type - CIP MECH ELEC PLUM Inspection Area : 7 PERMIT EXPIRES 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: 5020 CAMPUS DR NB St: 1 FI: 1 Unit: 230 Description: COMM TI FOR SLEEP CENTER MEDICAL CLINIC 1,247 SF Legal Desc.: N TR 9626 LOT 9 ' Owner: NEWPORT CAMPUS LLC Contractor: COLUMN 4 CONSTRUCTION CO. Architect: SCHAFER MICHAEL K Address: 4701 VON KARMAN AVE STE100 Address: 4701 VON KARMAN AVE STE 100 Address: 23112 ALCALDE DR STE#B _ •- - NEWPORT BEACH, CA 92660 NEWPORT BEACH, CA 92660 LAGUNA HILLS CA 92653 , Phone: 949-263-1920 Phone: 949-420-1601 Phone: 949-584-5426 State Lic:C013366 Applicant: SCHAFER MICHAEL K Con State Lic: 992770 Engineer: - ' Address: 23112 ALCALDE DR STE#B Lic Expire: 05/31/2024 Address: LAGUNA HILLS CA 92653 Bus Lic: ST30067755 .. • , ' ' " Phone: 949-584-5426 Lic Exp Date: 06/30/2022 Phone: State Lic: Code Edit : 2019 Worker's Compensation Insurance Designer: , Type of Construction: V-B-SPR Carrier: STATE COMP Address: . - • , Occupancy Group: B Policy No: 9099527 Added /New sq.ft. Bldg: 0 Expire: 05/14/2023 Phone: Added /New sq. ft. Garage: 0 No of Stories: 1 Building Setbacks Rear: I Special Conditions: No of Units : 0 Bldg Height: 0 Front: / Left: I• Bldg Sprinklers: Y Right: / `v a Flood Zone: X Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $150,000.00 Building Permit Fee: $1,564.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $1,360.68 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 $97.00 Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $54.00 Grading Permit Fee: $0.00 In -lieu Housing Fee: $0.00 Building Dept Adm $26.00 Energy Compliance: $105.00 Grading PC Fee: $0.00 Public Works Department - General Service $219.00 CA Seismic Safety: $0.00 WQ Insp. Fee : $0.00 Park Dedication : $0.00 Refund Deposit $564.00 Disabled Access : $150.00 PNV Plan Check : $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $409.46 San Dist : $0.00 Building Green Fee : $6.00 Mechanical %: $321.71 NMUSD Fee: $0.00 $0.00 Plumbing %: $263.22 $0.00 TOTAL FEE : $5,192.07 Plan Check Fee : $2,130.31 Fee Due at Permit Issuance : $3,061.76 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) 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 :he 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). 1, 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 owrer 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 arr. exempt from licensure under the Contractors' State License Law for the following reason: Hy my s,gnatur? Dr1owI 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 iiave 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 :'rc.`ess;cns Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo,ca.gov/calaw.htmf. Signature of ProFe^ty 'Owner or Authorized Agent Date LICENSED CONITPACTOR'S DECLARATION I hereby affirm urder penalty of perju that I am licensed under provisions of C�hay�ter 9 commencing with Section 7 0) ivisi n 3 of the Business and Profes on s C , and my license is in full force ..oC Ef;ect. LICdnSE Class License No Li '/ % y 7 Date Contractor Signature vv6KKERS' COMPENSATION DECLARATION ,JHHN,NO FAILURE TO SE IRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUe.IECT AN EMPLOYER TO CRIMIN L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO SAND DOLLARS 1$100,000), IN ADDITION TO THE rOST OF ^OMPEWATICV, CAMAGES 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: , oave 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 oerformance of the work for which this permit is issued. Policy No. 1�4 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' compensatiol insi ante carrier and, policy number are: of Policy Number .q[) 'I 9 n L Expiration Date � � ¢LZ— 3 Phone # I certify that, in 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 t, if I should become sub' t to theporkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant' Date lz 2 CLARATION REGAIRQ.CONSTRLICTION LENDING AGENCY 3reby affirm under Mnalty o 'uuW that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). ider'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 c unty ordinances land state laws relating to building construction. I authorize representatives of this city or county nter th a e-identified property for inspection purposes. signature of PropertyOwner or Authorized Agent Print Property Owner's or Authorized Ag ACTION DATE BY DEM7ATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA PERMIT EXTENDED AQM D PERMITFINAL _ t SBESTO�N9PTIFICATION 15 NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEfpnOLITION Q OCCUPANCYISSUED SIGNATURE:I N