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Home My WebLink AboutXC2023-0280 - Permits�cWr°or City of Newport Beach o� ', e Community Development Department - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 - n Permit Counter Phone: 949 718-1888 newportbeachca.gov/civic unN� • Combination Type - ELEC Work Class - Other X C 2 0 2 3 0 2 8 0II COMB Permit : XC2O23-0280 Plan Check No: PC2023-1812 Issued Date : 0210112024 _ Final Date: Permit Status: Issued Inspection Area : 7 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 : 4000 MACARTHUR BLVD Legal Desc : P BK 114 PG 22 PAR 1 Description: COMM - INSTALL 10 LEVEL 2 EV CHARGERS Owner: HG NEWPORT OWNER LLC Address : 101 CALIFORNIA ST STE1000 SAN FRANCISCO, CA 94111 Phone : (858) 435-4026 Applicant: ANDYSKYWAK Address : 1700 E. WALNUT EL SEGUNDO, CA 90245 Phone : (310) 612-3617 Owner/Builder : Address : Phone Contractor: RENEWAGE CONSTRUCTION Address : 1700 E. WALNUT EL SEGUNDO, CA 90245 Phone: (310)612-3617 Con State Lic : 995853 Lic Expire : 08/31/2024 Bus Lic : BT30OB2220 Bus Lic Expire : 07131/2024 Workers' Compensation Insurance Carrier: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Policy No: UBOX118548 W. C. Expire : 10/112024 Architect Address Phone : State Lid Engineer : xtP x10kaPeo 1 Address: $joys( Law«lbord WAY, D41r1011 ON 43016 Phone : (610}Ze2- 1119 Designer: MAURICIO NORIEGA Address : 1700 E. WALNUT EL SEGUNDO, CA 90245 Phone : (213) 376-8853 Code Edition: 2022 Fire Sprinklers : NO Construction Valuation : $120,000.00 Type of Construction : V-B Fire Hazard Zone : NO Added/New/TI sq. ft. Bldg: 0 Occupancy Groups : U No of Units : 0 Alteration sq. ft. Bldg : Bldg Height: No of Stories : Added/New sq. ft. Garage: 0 TOTAL sq. ft. 0 Building Setbacks Flood Zone : X Use Zone: PC - Koll Center PROCESSED BY: SPECIAL CONDITIONS: OWNER -BUILDER DECLARATION I thereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmarl I have placed next to the applicable. Tennis) (Section 7031.5, Business and Professions Code: Any city or County (hat 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). 0 I, as owner of the property, or my employees With wages as their sole compensation, will do U 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-Builderwili have the burden of proving that it was not built or Improved for the purpose of sale). 0 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 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). B m signature a below I acknowlcd e that, except form personal residence in which I must have resided for at least one year prior to 0 I am exempt from licensure under the Contractors' State License Law for the following reason y y g g y p y completion of the improvements covered by this permit, i cannot lagalil sell a structure that I have built as an ov.mor-buildor 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 prat the following Web site:http:liwww.leginfo.ca.govicalaw.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 7000) of Division 3 of the Business and Professions Code, is In full force and effect. License Class e7 - 1 U License No !Z S 'L. 5`3 Date OZ-- O i - 2 Ll Contractor 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' TOONE HUNDRED THOUSAND DOLLARS 15100,000j, IN ADDITION T07HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penaltyof perjury one of the following declarations: ❑ I have and wilt 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 Ih performance of the work for which this secant Is issued. Policy No. LI 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' eompensatio Insurance carrier and policy number are/: Col„r "17 P Carrier (t•, vl }iwr=�Ju! CR5bc, IFJ Policy Number (o U �� r 1 �- ZC! Expiration Date O'b/3t/2" Name of Agent I Phone It ❑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 that, if I should become subject to the worker ' ompensatl , w,vtsions of Section 3700 of the Labor Code, I shall forthwith comply Win those provisions. Signature of Applicant _ Date U Z DECLARATION REGARDING CON ION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction tending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By 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 aoniicalion and the information I have provided is correct. I agree to comply will, all applicable city and county ordinances and state laws relating to building. construction. I authorize representatives of this city or county to enter the entitled property for inspection purposes. // / Signature of Pro arty Owl,ar or Authorized Ageall Pont PropertyOwner's or Authorized Agent's Name Cr 3' (� t H c r ,J e't Date ACTIC`N DATE BY DECLARATION. OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY 1 REG ULATIONS PART 61 OF TITLE 40 AND AQMD RU LE 1403 PfRMi, EXPIRED I SUBMITTEDASBESTOS NOTIFICATION TO PEkNdI CANCELLED-- PERMiErXTENDED PERA'IT FI VA 3 ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CE7f1IFICA rC OF -2U1' PROPOSED DEMOLITION D':LL,I AN, Y ISSUED SIGNATURE: / /�