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Home My WebLink AboutX2022-1499 - PermitsEW PO City of Newport Beach COMB Permit : X2U22-1499 II II I II I III I II I I II Community Development Department -Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No : 1386-2022 Permit Counter Phone: (949) 644-3288 Issued Date : U tea.. Inspection Requests Phone: (949) 644-3255 Inspection Area : 7 9(1FO0.T�`P newportbeachca.gov/inspections Combination Type - ELEC MECH PLUM Work Class - Tenant Improvement PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS Job Address : 5020 CAMPUS DR Legal Desc : N TR 9626 ELK LOT 9 Description: COMM TI: FOR ORTHOPEDIC SPORTS & SPINE MEDICAL CLINIC 2295 SF (STE # 210) Owner: NEWPORT CAMPUS II LLC Contractor: COLUMN 4 CONSTRUCTION CO. Address : 4701 VON KARMAN AVE NEWPORT BEACH, Address : 5020 CAMPUS DRIVE, 250 NEWPORT CA 92660 BEACH, CA 92660 Phone : (949) 263-1920 Phone : (949) 420-1601 Con State Lie : 992770 Applicant: SCHAFER MICHAEL K Lie Expire : 05/31/2024 Address : 23112 ALCALDE DR STE#B LAGUNA HILLS, Bus Lie : BT30067755 CA 92653 Phone: (949) 584-5426 Bus Lie Expire : 06/30/2023 Workers' Compensation Insurance Carrier: STATE COMPENSATION INSURANCE FUND Policy No : 9099527 W. C. Expire : 5/14/2023 Code Edition : 2019 Fire Sprinklers : YES Type of Construction : V-B Fire Hazard Zone : Y Occupancy Groups : B,U No of Units : 0 Bldg Height : No of Stories : 1 Building Setbacks Flood Zone: X Use Zone : PC - Kollll Center PROCESSED BY: '✓ 7S SPECIAL CONDITIONS: Architect Address Phone: State Lie Engineer: Address Phone: Designer: Address Phone: SCHAFER MICHAEL K 23112 ALCALDE DR STE#B LAGUNA HILLS, CA 92653 (949)584-5426 Construction Valuation : $270,066.90 . Added/NewfTI sq. ft. Bldg: 2,295 Added/New sq. ft. Garage: 0 OWNER -BUILDER DECLARATION I hereby afllnn under penalty of perjury that I am exempt from the Contractors' State License Law for the reasom(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 fife 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). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure Is no( 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 sate). ❑ 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 rffa ly 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 Licensee Law). LI 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 legally sell a structure that I have built as an owner-buildar 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:llwvw.leginfo.ca.gov/calaw.html, Signature of Property Owner or Authorized Agent Data LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions i and my license is in full force and effect. License Class License No Date 1�� ntraclor Signature ��// WORKERS'. C0M.PENSATION DECLARATION/- WARNING: FAILURP Tr` SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS i5100,0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370C OF THE LABOR CODE, INTEREST'. AND ATTORNEYS FEES. I hereby affirm ender penalty of perjury one of the following declarations: 0 4 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 pc�xmance of the work for which this permit Is issued, Policy No. FI have and will mnintain workers' compensation insurance, as required by Section 370D of the Labor Code, for the performance of the work for which this permit is issued, My workers' compensation irill,ance carrier and policy number are: er-- ,e of Agent Policy Number Date 11 certify that, in tl,s 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 at, IF I should t�corie subject to the workers' Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. u ia,ure of Apptirart_-<,,,-,_,„_ _ Date- 7��. — — — ECLARATION REGARDING CONSTRUCTION LENDING AGENCY 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 Cade). finder's Name , Lender's Address y 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 eoterihe ab ve-identified property for Inspection purposes. %1C ignature of Properly Owner or Authorized Agent Ix Print Property Owner's or Authorized Agent's Name j__� Date ,CTION i DATE By DECLARA710N OF COMPLIANCE VVITHl CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 51 OF TITLE 40 AND AOMD RUlF PERMITCANCELLED UEPA All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall PERMIT EXTENDED QMD be In place prior to approval to fill pool/spa & shall remain in place & be maintained for the PERMIT ANAL. i�(r ASBESTOS NOTIPICAFION IS NDT APPLICABLE TO life of the pool. CERTIFICATE Of ' I �' r1G/ L / , PROPOSED DEMOLITION,/ // OCCUPANCYISSUED i Aol 5 1 SIGNATURE: x A/ d _