HomeMy WebLinkAboutF2002-0409 - PermitsCity of Newport Beach
Building Department FIREPROT Permit No: F2002-0409
PO Box 1768/3300 Newport Blvd., Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288/3289 Inspection RequestsTelephone (949)644-3255
Job Address: 1 HOAG DR Bldg: 1
inspector Area:7
Owner: HOAG HOSPITAL
Address: 1 NOAG DR
NEWPORT BEACH CA 92660
Phone:
Applicant:
Address;
Phone:
Edit Code:
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg :
Added /New sq. ft. Garage:
No of Stories. :
No of Units :
Floor: 3
Suite: 315
Legal Desc.:
Contractor:
Address:
Phone:
Con. State Lic.
tic Expire:
Bus. Lic.:
Lic Exp Date:
Description of Work: RELOC (7) FIRE SPRINKLERS/ADD (5) NEW
2669-2002 (82001-35501
ALERT FIRE PR
5200 E HUNTER AVENUE STE B
ANAHEIM CA 92807
714/993-2822
316324
04/30/2004
BT02112004
10131/2003
2001 Workers' Compensation Insurance - -
It-1HR Carrier: STATE FUND
B Policy No: 1589876-02
Expire: 10101/2003
3
Issued : 12/12/2002
Construction Valuation: $2,200.00
Fire Plan Check Fee :
Fire Permit/ Inspection Fee:
Record Management :
Investigation Fee:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
T
$110.00
$110.00
$3.00
c
Architect
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
State Lic:
ALERT FIRE PROTECTION
5200 E HUNTER AVE, STE B
ANAHEIM CA 92807
714/993-2822
4,1,070
FEES
$0.00
$0.00
FEE : $223.00 TOTAL PAYMENT : $110.00 TOTAL DUE : $113.00
OTHER DEPARTMENT:
PLAN CHECK BY:
APPROVAL TO ISSUE'
WORK MUST 5tE STARTED W 111N A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOID.
(3-L cfell
APPROVALS
DATE
BY
COMMENTS
OWNER-BUILOER 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 ANO PROFESSORS COCE: ANY
CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR
REPAIR ANY STRUCTURE, PRIOR TO RS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH
PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PRONSrONS
OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING WITH SEC. 7000) OF DIV. 3 OF THE
BUSINESS AND PROFESSIONS CODE)) OR THAT HE CR SHE IS EXEMPT THEREFROM AND THE BASIS
FOR THE ALLEGEO EXEMPTION ANY VIOLATION OF SEC. 7031.5 BY ANY APPUCANT FOR A PERMIT
SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED COLLIRS(EGW):
I,AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
COMPENSATION, WILL CO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE
(SEC 7044, BUSINESS ANC PROFESSIONS CODE: THE CONTRACTORS UCENSE LAW DOES NOT APPLY
TO AN OWNER OF PROPERTY WHO BUILDS 0R IMPROVES THEREON, AND WHO DOES SUCH WORK
FIRE PROTECTION
UNDERGROUND ROUGH PIPE
THRUST BLOCKS EXCAVATION
UNDERGROUND PfPING FLUSH
UNDERGRO YDRO TEST
N,
UNDERGR. UAIb/EACKFLOW APRV.
SPRjiNk[ P7 HYDRO TEST
IkLER FLOW TEST
HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH
IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER, THE BUILDING OR
IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION. THE OWNWI ER -BUILDER LL HAVE THE
BURDEN OF PROVING THAT HE 0R SHE DID NOT SURD OR IMPROVE FOR THE PURPOSE OF SALE
I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7054, BUSINESS ANC PROFESSIONS CODE: THE
CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR
IMPROVES THEREON, ANO WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED
PURSUANT TO THE CONTRACTORS UCENSE LAW.)
I AN EXEMPT UNDER SEC. B.A P.C. FOR THIS REASON
SP INKLER ROUGH PIPE�
/�b/A
STANDPIPE HYDRO TEST
`
STANDPIPE FLOW TEST
STANDPIPE ROUGH PIPE
CHEM SYSTEM FUNCTION TEST
CHEM SYSTEM APPROVAL
DATE OWNER
FIRE ALARM SYSTEM
LICENSED CONTRACTORS 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, AND MY LICENSE IS IN FULL FORCE AND EFFECT.
UCENSE/CLASS LIE NO '
ROUGH WIRING
SYSTEM FUNCTION TEST
CENTRAL STATION MONITOR
0A9 7Z/�C/ o 2 CONTRACTOR.%
WORMERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, A5 PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE FOR THE
FIRE MISC.
TANK REMOVAL
TANK INSTALLATION/TEST
PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND'MLL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY
TANK PIPING PRESSURE TEST
MEDICAL GAS PIPING TEST
SECTION 3700 OF INC LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WNICN
THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY
NUMBER ARE.
CARRIER
CROSS CONNECTION TEST
POLICY NUMBER
MISC. INSPECTIONS:
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED COLLARS
(11001 OR LESS)
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 5O AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CAUFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37030F THE TABOR
CODE, I SHALL FORTHWITH COMPLY WTH THOSE ISIO
DATE Z//2 /y) 2 APP ANT: ��-
WPP.�RNING: FAILURE TO/ SECURE WOR,ERC 'EN iATIOP, COVERAGE IS UNLAWFUL AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL TIENALT1ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (E100,000), IN ADDITION TO THE LAST GP OOMPEAJATION, DAMAGES AS PROVIDED FOR IN
SECTION3706 OF THE LABOR COD:, 'NrERrST AP'0AITORN=YS FEES
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING
AGENCY FLT T)E PERFORMANCE OF THE WORK FOR WHICH THIS PERMFT IS ISSUED (SEC.3097.
CNOQ.
LENDER'S NAME
LENOER'SAD: RESS '
I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND 0TATE THAT THE A"OVE INFORMATION IS
CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, ANC HERESY AUTHORIZE REPRESENTATIVES OF THIS
COUNTY TO R UPCY'HE APOVEUENTIONED PROPERTY FOR INSPECTION PURPOSES.
FINAL
IAA
PERMITTEE E ?RIFT) T
, ,l� - 3y
RE OF PERMITTE DATE