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Home My WebLink AboutF2005-0053 - PermitsCity of Newport Beach Building Department FIRE COMBO Permit No: F2005-0053 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 Bldg:1 Floor: Suite: Inspector Area: 7 Owner: Address: Phone: Applicant: Address: Phone: HOAG MEM HOSP 1 HOAG DR NEWPORT BEACH CA92658 949-574-4467 METRO FIRE PROT 7520 DEERING AVE CANOGA PARK CA 91303 818-710-6050 Code Edit : 2001 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : Flood Zone: Bldg Sprinklers: VN-SPR B 1 X Y Legal Description: Contractor: Address: Phone: METRO FIRE PROTECTION INC 7520 DEERING AVENUE CANOGA PARK CA 91303 818-769-7887 Con State Uc: 578097 Lic Expire: 09/30/2005 Bus Lic: BT01060804 Lic Exp Date: Workers Compensation Insurance Cartier. EMPLOYEE SERVICE GROUP Policy No: 280650 Expire: 07/01/2005 Issued Date: 05/27/2005 Description of Work: FIRE SPRK (13) HEADS (BLDG 21OUTPAT SURG CTR) 0282-2005 (B2004-0289) /kaA„ .. CjP Architect: Address: Phone: Engineer: Address: State Uc: Phone: State Lic: Designer: SCHIRMER ENGINEERING Address: 21221 S WESTERN AVE #100 TORRANCE CA 90501 Phone: 310.782.1970 Special Conditions: Construction Valuation: $2,300.00 Fire Plan Check Fee : Fire Permit/Inspection Fee: Records Management: Investigation Fee: Residential Issuance Fee _v _) , )JJ PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL l J }J TOTAL F J J ) ..)a)J -) -' 3 �) JJ FEES $120.00 $0.00 $120.00 $0.00 $24.00 Counter Review: $0.00 $0.00 Zoning Plan Check Fee: $0.00 $0.00j-4 tS/1/ COL( f ' $264.00 TOTAL PAYMENT : 5120.00 TOTAL DUE : $144.00 / )� J. 3 4 J J OTHER DEPARTMENT: PLAN CHECK BY:: APPROVAL TO ISSUE: PERMIT EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION APPROVALS DATE BY COMMENTS OWNER•BUILDERDECLARATION FIRE PROTECTION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTACTORS UCENSE LAW FOR THE FOLLOWING UNDERGROUND ROUGH PIPE REASON (SEC. 7031.5, BUSINESSMO PROFESSIONSCODE: MNYCITY OR COUNTY WHICH REQUIRES PERMrt TO CONSTRUCT. ALTER, IMPROVE.DEMOUSH,OR REPAIR ANY THRUST BLOCKS EXCAVATION STRUCTURE, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE ARPUCAN TFOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS D THE UNDERGROUND PIPING FLUSH CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING WITH SEC. T000) OF DIV. 3 OF THE BUSINESS AND PROFESSIONS CODE)) OR THAT HE OR SHE IS EXEMPT THEREFROM Alt THE BASIS FOR THE UNDERGROUND HYDRO TEST ALLEGED EXEMPTION. ANYVIOLATIONOF SEC.701.S BY ANY APPLICANTFOR A PERMITSUBJECTSTHE APPLICANT TO A CALL PENALTY OF NOT MORE THAN FIVE HANORED DOLLARS D599T UNDERGROUNDBACKFLOW APRV. I, AS OWNER OF E PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COSWENSATION,WILL DOTE WORN, AND WE STRUCTURE SPRINKLER HYDRO TEST (� 2 /04r 15 NOT INTENDED OR OFFERED FOR SALE (SEC 704. BUSINESSAD PROFESSIONSCODE: THE CONRCTORS UCENSELAW DOES NOT APPLY TO AN OWNER OF PROPERTYWHIO BUILDS SPRINKLER FLOW TEST OR IMPROVESTEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF CR THROUGH MS OR HER OWN EMPLOYEES,PROVIDEO THAT SUCH IMPROVEMENTSARE NOT INTENDED CR OFFERED FOR SPRINKLER ROUGH PIPE SALE. IF, HO WEVE R, THE BUILDING CR IMPROVEME NTIS SOD WITHIN ONE YEAR OF COLIPLETION.THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING MAT HE OR SHE DID NOT BUILD OR IMPROVE STANDPIPE HYDRO TEST FOR THE PURPOSE OF SALE.). I, As OWNER OF THE PROPERTY. AM E)(CLUSWELY CONTRACTING WITH LICENSED CONRACTOK TO STANDPIPE FLOW TEST CONSTRUCT THE PROJECT (SEC. TUNA, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY AAAO BUILDS OR IMPROVESTHEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW.). I AM EXEMPT DOER SEC. BE P.C. FOR THIS REASON STANDPIPE ROUGH PIPE CHEM SYSTEM FUNCTION TEST CHEM SYSTEM APPROVAL CO2 SYSTEM APPROVAL DATE OWNER FM 200 FUNCTION LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY O PERJURY THAT I AM LWFMCFD UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WIT. SECTION T000) O DIVISION S OF THE BUSINESS AND PROESSICO S CODE, MO MY LICENSE IS N FULL FORCE AND EFFECT. LICENSEcuss LIc.No. DRY CHEM SYS FUNCTION TEST DRY CHEN SYS FUNCTION APRV. HALON SYS FUNCTION TEST HALON SYS FUNCTION APPROVAL 7 cj _ A7_ 05 HOOD SYSTEM APPROVAL WORKERS' CDMPENSATI DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE DTE FOLLOW NG DECLARATIONS: I HAVE AND WILL MMNTANA CERTIFICATED CONSENT TO SELF INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SECTION 5703 O THE LABOR C. FOR THE PERFORMANCE O THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY DOCK PROTECTION ROUGH DOCK PROTECTION HYDRO DOCK PROTECTION FLOW FIRE ALARM SYSTEM SECTION 3700 OFTHE LABOR CODE, FORTE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: uaRER ROUGH WIRING SYSTEM FUNCTION TEST CENTRAL STATION MONITOR POLICY NUMBER (INS au11c1N NW.) NU i et cWYLE I w R Hit Yt1041I IS &Ut UNt MMIXRD WLW(x (5100) OR LESS). 1 CERTIFY THAT N THE PERFORMANCE O THE WORT( FOR WHICH THIS PERMIT IS ISSUED, I FIRE MISC. SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 A5 TO BECOME SUBJECT TO THE WOU(ERSCOIPENSATION LAWS D CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TOTE WORKERS•COMPENSATIONPROVISIONSOF SECTION 3700 D THE LABOR COOS, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. CUTE: 3 , , ) A.RU. CAA TANK REMOVAL TANK INSTALLATION/TEST TANK PIPING PRESSURE TEST 1 WARNING: FAILURE To SECL45 Wry+K&IS CjMPENSAIfH UNLAWFUL. JN COVERAGE IS UAWF, AND SHALL SUBJECT AN EMPLOYER TO OCLLL P.>LLi,]S ANO CIA FINES UP TO ONE HUNDRED THOUSAND CaI APS (5103000), IN AD011A61 O TVTHi CIA: 'C01SIN£NSATION. DAMAGES AS PROVIDED FOR SECTION 3706O THE LABOR MetFIR(REST. AND ATIIRNEYs FEES. FUEL MODIFICATION O I HER CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PEN.LLTYOF PERJLRYTHAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PEI-FORWJ.GE OfTAE WT.A2.OYItJ .ER wHICI.MIT SSSUEDD(EC.T09T, CN.0). RENDERS RII -J J .)� J J J J J J J .n--J--L-.>-'_ 1,1.- LENOERS^F7PESs?• . -- J 'J tLJ J 1 3 I ) I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCESARD STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBYAUTHORIZE REPRE SENTATNE SOF THIS COUNTY TO ENTER UPON THE ABOVEIMErysNErnry n."0R IFI ECTITN gWPOSES. FINAL / ` // iXi 4� fRMIEE NAM ) „ANC For,nsIBIAFIEPeoTl(aFJ( 51 NATURE F�F MITT F RATE