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HomeMy WebLinkAboutB2005-2938 - PermitsCity of Newport Beach Building Department CIP Permit No: B2005-2938 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Job Address: 1 HOAG DR BIdg:1 Floor: Suite: Inspector Area: 7 Owner. Address: Phone: Applicant: Address: Phone: HOAG MEM HOSP 1 HOAG DR NEWPORT BEACH CA92658 949-574-4467 RINELLA NEAL 2220 UNIVERSITY DR NEWPORT BEACH CA 92660 949-574-1325 Code Edit : 2001 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : Bldg Sprinklers: Flood Zone: Issued Date: 08/29/2005 Y X 1 VN 8 Construction Valuation: $10,000.00 Building Permit Fee : $170.20 Plan Check Fee: $122.54 Supplemental: $0.00 Investigation Fee: $0.00 Energy Compliance: $0.00 Fair Share: $0.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Legal Description: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: Description of Work: COMM ADDN PHASE 2 (BLDG 2/OUTPAT SURG 82004-0289 (0216-2004) MILES & KELLEY CONSTRUCTION COMPANY INC 1102 E VALENCIA DRIVE Address: FULLERTON CA 714-773:9272 . Phone: 312206 02/28/2007 BT00018695 12/31 /2005 `~ Workers Compensation Insurance Carder: STATE COMP Policy No: 1679210 Expire: 01/01/2006 Building Setbacks Rear. / Front 1 Left: / Right: / Use Zone: Parking Spaces: Record Mgmt: $0.50 Excise Tax: $0.00 Park Dedication: $0.00 SJH Trans: $0.00 San Dist: $0.00 CA Seismic Safety, $0.00 Disabled Access' $55.00 TOTAL FEE : FEES Architect: RINELLA NEAL 2220 UNIVERSITY DR NEWPORT BEACH CA92660 949-574-1325 State Lic:CO21102 Engineer: TAYLOR WILLIAM C Address: 2220 UNIV DR #200 NEWPORT BEACH CA 92660 Phone: 714/574-1323 State Lic:S-000702 Designer: Address: Phone: Special Conditions: Hazardous Mat: Add Fire Dep HMQ: Other Fee: Planning Department Counter Rev: Zoning Plan Ck: OT Plan Ck Fee: $23.00 $0.00 $0.00 $0.00 $0.00 $0.00 40 TOTAL PAYMENT : $0.00 TOTAL DUE : $539.40 PLAN CHECK BY: APPROVAL TO ISSUE: pi Fire Department Fire Inspection Fee: Fire Plan Review $119.14 $49.02 53� FEFMIITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION APPROVALSr1 DATE BY COMMENTS OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5. BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOURES A PERMIT TO CONSTRUCT. ALTER, IMPROVE, DEMOLISH. OR REPAIR ANY STRUCTURE. PRIOR TO ITS ISSUANCE. µ50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRCTORS LICENSE LAW (CHAPTER 9 (COMMENCING WITH SEC. 7000)0F Drv. 3 OF THE BUSINESS AND PROFESSIONS COOED OR THAT HE OR SHE I5 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031.5 BY ANY APPLICANT FOR ( PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS SSW) ❑ I. AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEW SOLE COMPENSATION. WILL DO ME WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC.}MN. BUSINESS AND PROFESSORS 000E: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS DR IMPROVES THEREON. AND WHO DOES SUCH WORK HMSELF OR HERSELF OR THROUGH HIS ORP HER OWN EMOVEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF. HOWEVER. THE BUILDING OR IMPROVEMENT 5 SOLO WITHIN ONE YEAR OF COMPLETION. THE OWNERBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.). ❑ 1nN AS OFTHEPROPER, AA EACLUSEIYCCNTRAcrwWITH LICENSED CCNIRCTORSTO CONSTRUCT THE PROJECT (SEC. TMl BUSINESS AND PROESSIONSLOOE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR 1 ROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACOHTRACTOR(S)LICENSED PURSUANT TO THE CONTRACTORS LICENSE UW.). OWNERS NAME. DATE: FOUNDATION: WATER QUALITY BMP'S ROUGH GRADE iLF�,.� LINE & GRADE CERT/SETBACKS �T S•h R1111U\ OF N'Irn 1 •..Ill CO\IPLIAN!'F ERECTION PADS RBq("I 1 r (F )� �1 1 I"I11"R 1I. 1' FOOTINGS uu r,( 111- TITLE.IO AVU.\,IL);I In 1 P T •,1, n r S SLAB ON (GRADE (' 11 1 �) (III 1 .L SI)GSTOS III II K. iIJ` 1LA 1 FP, ( FRAMING: '7 . 1I p DECK SLAB �/ - BI:S70S \nTrriC,1770� SUBFLOOR is N07 AI'1'LICA❑I.E TO PTtnPOSLD ROOF & BUILDING HT BLAIULI TION. EXT. SHEAR/HOLD DOWNS / S►GNATU L i' .' / _ �d , GENERAL FRAMING FIREPLACE THROAT / J ''(i�5 "Cemorjy1,N px - Arm /2IJdMf w /iLiv ©arIG DJAI /�(.tc:wf LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISION OF CHAPTER 9ICOMMENCING WITH SECTION )BOON OF DIVISION 9 OF THE BUSINESS AND PROFESSIONS CODE. ANO MY LICENSE IS IN FULL FORCE ANO EFFECT. 01*55 LICENSE CLASS uL. ND. /.{ INTERIOR & EXTERIOR _/ /.�c /,9 -A! C INSULATION �Ln Ra- /fra to /� toe$ IQ'� DRYWALL /l /� �,Y/,I, o f — COAT lOR 7-/ F O SUSPENDED CEILING 9/j / / J//2 / WORKERS' COMPENSATION D CLAR• ION !HEREBY A WRITUNDERPENALTY OF PERJURY ONE OF THE FOLOwING DECIMATIONS: I HAVE AND WILL WWI TAN A CERTIFICATE OF CONSENT 10 SELF -INSURE FOR WORKERS' MPENSATKIN, A5 PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 515SUE°. I HAVE AND WILL MAW TAN WORKERS COMPENSATION INSURANCE. AS REQUIRED BY SHOWER LATH �� f/f"%J2¢g7/�l(. S/X n'Ac.- Jn[1`/,y/LJ-//{/-,�/, EXTERIOR LATH ? 2 a/ (4/ s T,t/" SCRATCH (PLASTER) (2 DAY) / /% 2Z L� fi 97t e ,1.� en L MASONRY PRE -GROUT �/'!" fff///��, /T] /JAY �1L •///`� SECTION 3700 OF THE LABOR COOS. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER INSPECTIONS: POLICY NUMBER (THIS SECTION NEED NOT BE COMFLE TEO IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (51W) OR LESS). I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15ISSUED. 1 SHALL NOT EMPLOY ANY PERSON W ANY MANNER 50 AS TO BECOME SUBJECT TO THE PERMIT EXTENSION WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION MOO OF THE LABOR COOS I'H11'. FERTHW"H CO' B•.Y WITH THOSE PROVISIONS. WARNIN0. FAILURE TO SECJRE NO R4RS COMPENSATION COVERAGE IS UNLAWFLA. AND SHALL SUBJECT AN EMPLOYPR TO CRIMINAL PENAL) 1E5 AND Civil FINES UP TO ONE HUMORED THOUSAND DOLLAR5151W.W'l1. IN A DOI'ION TO THE COF1 OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION3706 OF II'S•JSOP CODE INCTIO. AND ATTORNEYS FEES 1ST EXP. LETTER 2ND EXP, LETTER (�� BUILDING FINAL L /� CONSTRUCTION LENDING AGENCY 1 HEREBY MfIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH T1115 PERMIT IS ISSUED ISECYA). CIv.0 1 LENDE(S LAME ^ ' -, CERTIFICATE OF OCCUPANCY TENANT NAME: OWNER / BUILDER AGENT INFORMATION NAME: LEx0E.KS'.001.E55' , " , 1 CET? TIE THAT 1 HAVE READ THIS AYl0G I1ON AND STATE NHA1 THE ABOVE INFON0AIION 15 CORRECT. I AGREE TO COMPLY WITH ALL CIry AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING COVSTRUCTIIJN, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER 0PQN THE A/B/OVE.M TIONEO PROPERTY FO"RINNSPECTION PURPOSES. )/)t Pt /A -fin ADDRESS: TYPE OF BUSINESS USE: DRIVERS LIC. NO. �PENMii IE�MAM //> (-J/�/j/��////1 / % 0 Shared\Permits DeplBldgPermit(Back)8/04