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Home My WebLink AboutX2020-0230 - Permitsw1°r City of Newport Beach - Building Division *X2020-0230* COMB Permit: X2020-0230 100 Civic Center Drive, Newport Beach, CA 92660 Project No : 0193-2020 :< Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type Inspection Area e - CIP ELEC MECH PLUM Issued Date : Area : 2020 °+tiautiE+e : 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: 4440 VON KARMAN AVE NB St: 1 Ft: 2 Unit: 201 Description: COMM TI "DR. GROSSMAN" 882 SF (CHANGE OF USE) Legal Desc.: N TR 8762 LOT 5 R Owner: SHOPOFF REALTY INVESTMENTS Contractor: STELLRECHT }r- g^, COMPANY INCORPORATED THE Architect: INS 1rµ� L VT® Address: 2 PARK PLAZA STE 700 Address: 15261 TRANSISTOR LANE Address: IRVINE, CA 92814 HUNTINGTON BEACH CA 92649 Phone: 949-417-1396 Phone: 714-898-7557 Phone: State Lic: Applicant: PILKERTON TRICIA Con State Lic: 497453 Engineer: .- Address: 3150 BRISTOL ST STE 205 Lic Expire: 0813112020 Address: COSTA MESA, CA 92626 Bus Lic: BT30062909 Phone: 949.724.1499 Lic Exp Date: 01131/2021 Phone: State Lic: Code Edit : 2019 Worker's Compensation Insurance Designer: PILKERTON TRICIA - Type of Construction: I-B-SPR Carrier: STATE FUND Address: 3150 BRISTOL ST STE 205 Occupancy Group: B Policy No: 9017146 COSTA MESA, CA 92626 ., Added /New sq.ft. Bldg: 882 Expire: 0710112020 Phone: 949-724-1499 , Added /New sq. ft. Garage: 0 Special Conditions: , No of Stories: 3 Building Setbacks Rear: I rShu^•--�`eE.1,� No of Units : 0 Front: I l� Bldg Height: 0 Left: / • - , Bldg Sprinklers: Y Right: / . . Flood Zone: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Construction Valuation: $42,000.00 Building Permit Fee: $658.00 Excise Tax: $0.00 Planning Department - Fire Department Plan Check Fee: $572.46 Additional Fee: $0.00 Plan check Fee : $40.00 Fire Inspection: $0.00 Overtime Plan Ck: $0.00 Grading Bonds Fee: $0.00 Fair Share : $0.00 Fire Plan Rev $0.03 Investigation Fee: $0.00 Grading PC Consultant : $0.00 SJH Trans : $0.00 Demolition Fee Record Management: $38.00 Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Building Dept Adm $0.00 Energy Compliance: $56.00 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 "'Ali Disabled Access : $87.00 PAN Plan Check: $0.00 Grading Bond: $0.00 Hazardous Mat $0.00 Electrical %: $172.26 San Dist: $0.00 Building Green Fee : $2.00 Mechanical %: $135.35 NMUSD Fee: $0.00 $0.00 Plumbing %: $110.74 $0.00 TOTAL FEE: $1,871.81 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Plan Check Fee $950.09 Fee Due at Permit Issuance : $921.72 PUBLIC WORKS APPROVAL: PLAN CHECK BY: Y✓ 1 APPROVAL TO ISSUE: _��N� 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 (_) 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 propprty_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 1 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. 1 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.htm]. 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 Sectigqn,j7000) I sio f the Busin ss and Profess s C nd m ense is in full force and effect. License Class License No Dap�.dContrac Signature WORKERS' COMPENSATION DECLARATION // WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO O HUNDRED THO NO DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under: dLnalty of perjury one of the following declarations: ❑ I 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 g; µMgcal ice of th& worn, 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 Expiration Date Agent iii 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 Calif mia, and oecome subject to the vgcker�mpens bn provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ; / 7 of oereby affirm under venal of perju there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil er,da,'6 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 pounty to ente bove-identified property for inspection purposes. ACTION DATE BY 9,. OF COMPLIANCE WITH CODE OF FEDERAL FO FFICE USE ONLY IONS PART 61 OF TITLE 40 AND AQMD RULE PERMITEXPIRED i i 11-1 1 U SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EpA PERMIT FINAL /Z- Z. /- Z 0 jt ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO CERTIFICATE OF ' it PROPOSED DEMOLITION ^--� OCCUPANCY ISSUED SIGNATURE: