HomeMy WebLinkAboutF2024-0155 - PermitsCOMB Permit: F2024 0155
EWPo City of Newport Beach
C�a i ,w�r@^- Community Development Department- Building Division F 2 0 2 4 0 1 5 5
W y,, 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No : PC2024-0622
p' Permit Counter Phone: (949) 718-1888 Issued Date : 03/27/2024
U e"`.. newportbeachca.gov/civic Final Date:
°94FORT"P Combination Type - Permit Status: Issued
Work Class - Tenant Improvement - Inspection Area : FIRE
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 : 853 NEWPORT CENTER DR Legal Desc : P BK 221 PG 30 PAR 6 P.M. 221-30 PAR 6 FOR OF PAR
Description: COMM FIRE ALARM TI WITH (22) DEVICES FOR "SWEETGREEN" (XC2023-0372)
Owner: IRVINE COMPANY
Address : 110 INNOVATION DRIVE
IRVINE, CA 92617
Phone: (949)720-2000
Applicant:
RICHARD JOHNSON
Address :
3750 SCHAUFELE AV, 200
LONG BEACH, CA 90808
Phone:
(562)353-4680
Owner/Builder
:
Address :
Phone
Contractor: INTERFACE SYSTEMS
Address : 3750 SCHAUFELE AV, 200
LONG BEACH, CA 90808
Phone:
(562)353-4680
Con State Lic
: 469046
Lic Expire :
08/31/2025
Bus Lic:
BT30046473
Bus Lic Expire : 03/31/2024
Workers' Compensation Insurance
Carrier: TRAVELERS PROPERTY CASUALTY CO OF
AMERICA
Policy No: UBOK0634482243G
W. C. Expire : 10/1/2024
Architect
Address
Phone:
State Lic
Engineer:
Address :
Phone
Designer: INTERFACE SYSTEMS
Address : 3750 SCHAUFELE AV, 200
LONG BEACH, CA 90808
Phone: (562)353-4680
Code Edition :
2022
Fire Sprinklers :
YES
Construction Valuation :
$2,200.00
Type of Construction :
III-B
Fire Hazard Zone :
NO
Added/New/TI sq. ft. Bldg:
0
Occupancy Groups :
A2;B;U
No of Units :
0
Alteration sq. ft. Bldg :
0
Bldg Height:
No of Stories :
1
Added/New sq. ft. Garage:
TOTAL sq. ft.
0
Building Setbacks
Flood Zone :
X
Use Zone :
PC - North Newport Center
PROCESSED BY
SPECIAL CONDITIONS:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty or 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 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 ficensure 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 (_) 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).
❑ 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 ficensure under the Contractors' Slate 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:httpJ/www.leginfo.ca.govlcalaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION /J �
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 ProfeCode,.? d my license is in full force
and effect. License Class License No Date 3- 7-7- z4 Contractor Signature Rf U�-
NORKERS' COMPENSATION DECLARATION^�
NANNING: 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
)erformance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the performance of the w rk forwhich 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
1, if I should become subject to the wq rspenssaabonn pgv' Ions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
[nature of Applicant ice-{ - Date 3 - Z 7- 2-V
CLARATION REGARDING CONSTRUCTION LENDING A ENCY
=reby 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 Code).
lder s Name Lenders Address
my signature bo'c'v. I certify to each of the following:
I am the properly owner or authorized to act on the property owner's behalf.
L.ca read 'his application and the information I have provided is correct.
I agree to cvmpP ,udh all applicable city and county r inances nd slate laws relating to building construction,
f au"torize representatives of this city or county F n�y(d(rt ove-identified property for inspection purposes. I J
nature of Property Owner or Authorized Agent /� /I (� Print Property Owner's or Authorized Agent's Name �r�hwco ri - � a P1'
AC, ION'
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE
1403
PERMIT EXPIRED
SUBMITTEO ASBESTOS NOTIFICATION TO
MI PE7TCANCELLFD
EPA
PERMIT EXTENDED
UACIMO
PERMIT FINAL
7�C y
P'i �L�.(S
ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO
CERTIFICATEOF
PROPOSED DEMOLITION
OCCUPANCY ISSUED
SIGNATURE:
Date 3- 77 -