HomeMy WebLinkAboutF2019002533 FIRECITY OF HUNTINGTON BEACH
DEPARTMENT OF BUILDING & SAFETY
2000 Main St., Huntington Beach, CA 92648 Inspector:
5 / For Inspections Call: (714) 536-5241 Kho, Billy (714) 536-5408
` FIRE PERMIT
Permit Number: F201MO2533 Sprinklered? No valuation: $10.40
Date Issued: 0523/2019 Zone: RMH-A Coastal Permit? No
Building Address: 1103 England St Block No, Families:
Date Entered: 04/18/2019 Tract: A0813 No, Stories:
Building Use: SFR Lot: 1 Public Building? No
Owner Contractor
MODERN NEST LLC JA H ACCORD GROUP INC
PO BOX 1252 320 WEST CLARY AVE
AA CA 90701 SAN GABRIEL CA 91776
5625470698 6263089155
Project Description: INSTALL RESIDENTIAL FIRE SPRINKLERS & PIPING FOR NEW 3237 SF SFD W/ 440 SF GARAGE, 334 SF OPEN DECK, & 203 SF COVERED
DECK ***3 BEDROOMS & 5 BATHROOMS*** ALL WORK MUST COMPLY WITH 2O16 CFC, NFPA 13D & HBMC. SCOPE CONSISTS OF
INSTALLING 37 HEADS.
'.Oct. Group Construction Type Occupancy Load
Permit Fees: Inspection: $0.00 Park & Rao: $0.00 Microfilm: $0.00
Building Plan Review: $0.00 library: $0.00 Penalty: $0.00
Planning Plan Review: $460.55 Traffic Impact: $0.00 Extension: $0.00
Processing: $533.18 Day Impact Fees: $0.00 C/O: $0.00
SMIP: $0.00 Demolition: $0.00
Permit Total: $993.73
Outstanding Amount: $0.00
Permit Details Permit Fees: i inspection Plan Review
Ire Related Items Unit Type Quantity $533.18 $125.00
Fire Sprinkler SFR Base (up to 30 heads) Plan Check QTY 1
Fire Sprinkler SFR Base (up to 30 heads) Inspection QTY 1
Fire Sprinkler, Per Add. Head (All Types of Slogs.) Pln Chk CITY 7
Fire Sprinkler, Per Add. Head (All Types of slogs.) Insp. CITY 7
Scanning Small - 8.5" x 11" (Per Page) QTY 10
Scanning Large - 11" x 17" or Greater (Per Page) QTY 2
WORKERS' COMPENSATION DECLARATION
I hereby affirm ands penalty ofp jury one of the following declarations:
[] Ihave and will mein*anacercificate ofconsentto self-insurefotwo rkors' women sation wprovided for by Sact on3]OO ofthe Lab or Codgfor the performance of the work for which this permit is
issued.
,[.].. I have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which the permit is issued My workers compensation
policy information is Carrier STATE COMPENSATION INSURANCEF Pohry Number:1963961 Expires!0822/2019
Ag t C t %^ + 1 Ft a �C '�TG /11 i; t Phone(626) 308-9155
[ ] 1 certify that to the performance of the w k for v�i7 ich this permit is:ssuM, I shall not employ any person many manner so as to become subject to the workers compensation laws of California, and
agree that if I should become subject to the workers compensation provision of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGEIS UNLAWFULAND 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 3700 OF THE LABOR CODE,
INTEREST, AND ATTORNEYS FEES. t
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I on license d tons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
forceandeffect.Licetse No: 757675 LicenseClapC- 2��/
vrs q
Contractors Signature. Date: �� /
IF WORK ISNOTCOMMENCED 180 DAYS FRO ISSUE OF THIS PERMIT. OR IF THE WORK IS ABANDONED FOR MORETHAN I BO DAYS, THIS PERMIT SHALL BE
SUBJECT TO EXPIRATION.
OWNER -BUILDER DECLARATION (Deelarstlon Form Attached)
CONSTRUCTION LENDINGAGENCY
I hereby affirm under penalty ofperjury that there is a construction lending agencyfor the Performance of the work for which this permit is houed(Se% 3097, Civ. Q.
Lender: Address:
DECLARATION BY CONSTRUCTION PERMIT APPLICANT
By my signature below, I certify to each of the following: I am
[ I California licensed contractor, or
['I The property owner*, or
[ I Authorized to sot on the property owner's behalf
I certify coat I have read this construction application and that the information 1 have provided is correct I agree to comply with all City and County ordinates and State Laws relating to building
construction. I shall be responsible to ensure all improvements are consistent with all applicable RDA CC&Rs. I authorize representatives of this City or County to enter upon the above -identified
property for inspection purpose.
California Licensed Contractor, Property Owner or Authorized Agent"*
I understand that all refunds are subject to a p as fee as listed to the City Master Fee Schedule. s
r.Sgnature.
Requires separate verification form
**Requires separate authorization form