HomeMy WebLinkAboutX2021-0375 - Permits><mo4 City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II COMB Permit: X2021-0375
r¢ 100 Civic Center Drive, Newport Beach, CA 92660 x 2 0 2 1 0 3 7 5 Project No : 0371-2021
Permit Counter Phone (949)644-3288
i3 yam. Inspection Requests Phone (949)644-3255
�* Combination Type - CIP MECH Issued Date : Area
: 2021
r��ruwa YP
Inspection Area 7
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 02/23/2024 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 Holidays
Job Address: 361 HOSPITAL RD NB St: 1 FI: 1 Unit: 124 e
Description: COMM TI "NBSC PROCEDURE" 250 SF
Legal Desc.: IRVINE SUB LOT 169 BLK 2 POR OF LOT
Owner NEWPORT LIDO MEDICAL CTR
Address: 351 HOSPITAL RD #307
NEWPORT BEACH, CA 92663
Phone
Applicant: VARISCO ROBERT
Address: 30 CORPORATE PARK #201
IRVINE CA 92606
Phone: 714-642-5966
Code Edit: 2019
Type of Construction: I-A-SPR
Occupancy Group: 12.2
Added /New sq.ft. Bldg: 250
Added /New sq. ft. Garage: 0
No of Stories: 5
No of Units : 0
Bldg Height: 0
Bldg Sprinklers: Y
Flood Zone: X _
Construction Valuation: $25 000.00
Building Permit Fee: $501.00
Plan Check Fee: $435.87
Overtime Plan Ck:
$0.00
Investigation Fee:
$0.00
Record Management:
$16.00
Energy Compliance:
$0.00
CA Seismic Safety:
$0.00
Disabled Access :
$91.00
Hazardous Mat
$0.00
Building Green Fee :
$1.00
TOTAL FEE: $1,241.68
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Contractor:
VARISCO DESIGN BUILD GROUP
Architect:
NISBET JEFF
Address:
30 CORPORATE PARK #201
Address:
30 CORPORATE PARK #201
IRVINE, CA 92606
IRVINE CA 92606y
Phone:
949-679-6300
Phone:
714-642-5966 State Lic:CO20170
(1'
Con State Lic:
494166
Engineer:
0
Lic Expire:
03131/2021
Address:
Bus Lic:
BT30073992
0
Lic Exp Date:
01/3112022
Phone:
State Lic:
Workers Compensation Insurance
Designer:
Carrier:
STATE COMP. INS
Address:
Policy No:
9232563
Expire:
05131/2021
Phone:
Building Setbacks
Rear: I
Special Conditions:
Front: I
Left: I
Right: I
Use Zone: Parking Spaces: 0
Fire Hazard Zone : N
Excise Tax:
$0.00 Planning Department -
Fire Department
Additional Fee :
$47.50 Plan check Fee:
$46.26 Fire Inspection:
$0.00
Grading Bonds Fee:
$0.00 Fair Share :
$0.00 Fire Plan Rev
$0.00
Grading PC Consultant :
$0.00 SJH Trans :
$0.00 Demolition Fee
Grading Permit Fee:
$0.00 In -lieu Housing Fee:
$0.00 Building Dept Adm
$0.00
Grading PC Fee:
$0.00 Public Works Department -
General Service
$0.00
WQ Insp. Fee:
$0.00 Park Dedication :
$0.00
Refund Deposit
$0.00
PAN Plan Check:
$0.00
Grading Bond:
$0.00
Electrical %:
$0.00 San Dist:
$0.00
$0.00
Mechanical W
$103.06 NMUSD Fee:
$0.00
Plumbing W
$0.00
$0.00
Plan Check Fee
$529.62 Fee Due at Permit Issuance : $712.06
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
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 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 (_) 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
�m roved 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 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.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 Section 7noCl) ppf ivisi n 3 of the Business and Prco �;iv e, and my I ns �n II force
and effect. License Class License No Date 'C Contractor Si natur
NORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under 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,
)eyformance 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'
'ance carrier an licy number i/1/-��1
ier n Po)icyNluAer Expiration Date
of Agent
certify that, in the performance of the'vork 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
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant
CLARATION RE ARDIN CONSTRUCT I LENDING AGENCY
veby affirm u peq f pe jury th he is a construction lending agency for the performance
Ider's Name Lender's Address
my signature reloW, I certify to each of -the following:
I am the pr erty owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
Date
for which this permit is issued (Section 3097, Civil Code).
I agree to comply with all applicable city and county ordinances and state s relating to building construction.
I authorize representatives of this city or cou ty en rty for inspection purposes.
signature of PropertyOwner or Authorized Agent t above-i tif' ropePrint Property Owner's or Authorized A
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403 _
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
TO
NOTAPPLICABLE TO