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HomeMy WebLinkAboutX2015-2512 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach; CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - GRAD II IIIIIIIIZI IIIIIII COMB Permit : X2015-2512 Project No : 1896-2015 Issued Date : 09/01/2015 Inspection Area : 7 PERMITS EXPIRE 180 [JAYS AFTER ISSUANCE OR LAST VALID IN Job Address: 1 HOAG DR NB Description: Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR OF LOT COMM - MINOR GRADING AND LANDSCAPE @ LOWER CAMPUS ENTRANCE BEHIND ATP Owner HOAG MEMORIAL HOSPITAL Address: 1 HOAG DR NEWPORT BEACH, CA 92663 Phone: Applicant: KINDNESS GENERAL CONTRACTORS INC Address: 12891 NELSON STREET GARDEN GROVE CA 92840 Phone: 714-636-4542 Code Edit : 2013 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Construction Valuation: $0.00 Building Permit Fee: Plan Check Fee: Overtime Plan Ck: Investigation Fee: Record Management: Energy Compliance: CA Seismic Safety : Disabled Access : Hazardous Mat Building Green Fee : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL FEE : $640.50 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Contractor: KINDNESS GENERAL CONTRACTORS INC Address: 12891 NELSON STREET GARDEN GROVE CA 92840 Phone: 714-636-4542 Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: 780044 04/30/2017 BT30047746 07/31/2016 Worker's Compensation Insurance Carrier: HDI-GERLING INSURANCE CO Policy No: EWGCC0001580 Expire: 01/01/2016 Building Setbacks Use Zone Excise Tax: Additional Fee : Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: Rear: / Front: / Left: / Right: / Parking Spaces: Address: Phone: Engineer: Address: Phone: PECTION. Architect: State Lic: State Lic: Designer: RABBEN/HERMAN Address: 833 DOVER DR, STE 9 NEWPORT BEACH CA 92663 Phone: 949-548-3459 Special Conditions: Fire Hazard Zone $0.00 Planning Department - $0.00 Plan check Fee : Fair Share : $0.00 SJH Trans : $287.80 In -lieu Housing Fee: $253.00 Public Works Department - $23.20 Park Dedication : $0.00 PNV Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $0.00 $0.00 $o.00 Plan Check Fee : $32.00 $0.00 $0.00 $0.00 N Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit $0.00 Fee Due at Permit Issuance : PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: $0.00 $44.50 $0.00 $0.00 $0.00 $0.00 $0.00 $640.50 OWNER -BUILDER DECLARATION r - 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 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 property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 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 ave 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. $ignatuw of Pro{5er (Owner or Authorized Agent , Date rjCEFI$ED COtR4CTOR'S DECLARATION I Fteregy affirm ulaltenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000a} of,,ivision 3 of the Business and Pro cense is in full force andbeffect. License Class License No Date �t r Contractor Signatu W,ORVERS' eWiPENSATION DECLARATION WARNING'. FAILURE SC $@CURE 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 tOST•O.F COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. PlTet tTy affirm Cr de?'penalty of perjury one of the following declarations: ®h� ... I:ve and wile 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 the mance of the work for which this permit is issued. Policy No. k 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' compensation ura ree carrii-ty d pglicy number are: Carrier • • • Policy Number Expiration Date Name of Agent Phone # ❑ I certify that, in the perfo rri ante 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 su ' c to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant ' Date DECLARATION REG DI ONSTRUCTION LENDING AGENCY I hereby affirm under penal y 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). 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 application and the information I je provided is correct. I agree to comply with all applicable city and cou ty o#dinances and state laws relating to building construction. I authorize representatives of this city or county ;a thaalaskeezittentified property for inspection purposes. f1�� Signature of Property Owner or Authorized Agen - Print Property Owner's or Authorized Agent's Name tis P,NDNESS Date TK Arnim DATF Ai^ fIECLARAMON OF FEDERAL REGULATIONS PART&t 4WDRULE 4403.. CODE OF OF TITLE46 AND TTI: T LICAELE FtBti [R-NLt t U,NT► - PFRIAIT XPlPR) ■ I SINVIRTrnASTY STOS wmirMaTfON © EPA 0 MIND r"CfiM/ TL;AICCLII,D PEnM.?TETFMDED ■ ASBESTOS NONHCATIPN PREIPOSEDDEAItJLTWA- Sf( A I LtlA=: PERMIT FINAL CERTIF!CATEO'F OCCUPAIJCYiSSUE�D 5 • 5 - \Ca �. ^ p_ S-c sNO�