HomeMy WebLinkAboutF2001-0428 - PermitsCity of Newport Beach
Building Department FIREPROT Permit No: F2001-0428
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 Floor: 3 Suite: Description of Work: 3 NEW 8, RELOCATE 4 FIRE SPRNK HEADSICONF RM
2612-2001
Inspector Area:7 Legal Desc.:
Owner: HOAG HOSPITAL Contractor: ALERT FIRE PR Architect:
Address: 1 HOAG DR Address: 5200 E HUNTER AVENUE STE B Address:
NEWPORT BEACH, CA 92658 ANAHEIM CA
Phone: Phone: 7141993-2822 Phone: State Lic:
Applicant: ALERT FIRE PROTECTION Con. Stale Lic.: 316324 Engineer:
Address: 5200 E HUNTER AVENUE STE B Lic Expire: 04/30/2002 Address:
ANAHEIM CA Bus. Lic.: BT01102410
Phone: 714/993-2822 Lic Exp Date: 0913012002 Phone: State Lic:
Edit Code: 97 Workers' Compensation Insurance - - Designer: ALERT FIRE PROTECTION
Type of Construction: 1l-1HR Carrier: STATE COMPENSATION INSURANCE F Address:
Occupancy Group: B Policy No: 1589876
Added /New sq.ft. Bldg : Expire: 10/01/2002 Phone:
Added lNew sq. ft. Garage:
No of Stories.: 3 Issued :
No of Units :
Construction Valuation: $1,300.00
Fire Plan Check Fee :
Fire Permit/Inspection Fee:
Record Management :
Investigation Fee:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
$106.00
$106.00
$2.50
$0.00
Special Conditions:
FEES
$0.00
$0.00
TOTAL FEE : $214.50 TOTAL PAYMENT : $106.00 TOTAL DUE : $108.50
OTHER DEPARTMENT:
PLAN CHECK BY:
APPROVAL TO ISSUE:
WORK MUST BE STARTED WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOID.
THRUST BLOCKS EXCAVATION
UNDERGROUND PIPING FLUSH
UNDERGROUND HYDRO TEST :
UNDERGROUND/BACKFLOW APRV.)
`SPRINKLER HYDRO TEST
SPRINKLER FLOW TEST
=SPRINKLER ROUGH PIPE
STANDPIPE HYDRO TEST
-STANDPIPE FLOW TEST
-STANDPIPE ROUGH PIPE
`CHEM SYSTEM FUNCTION TEST
CHEM SYSTEM APPROVAL
--
FIRE ALARM SYSTE
ROUGH WIRING
:SYSTEM FUNCTION TEST
CENTRAL STATION MONITOR
FIRE MISC.
:TANK REMOVAL
'TANK INSTALLATION/TEST
:TANK PIPING PRESSURE TEST
:MEDICAL GAS PIPING TEST
ACROSS CONNECTION TEST
'FINAL
M
MISC INSPECTIONS:
1
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APPROVALS DATE BY COMMENTS
FIRE PROTECTION a
UNDERGROUND ROUGH PIPE vem,fur
OWNER-BUILDER DECLARATION j
"`"7777 I HEREBY AFFRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS
.._ I, LICENSED UIRESE PURSUANT TO THE SUCH
IBLE"l1' O FILE
A LICENSE LAW FOR THE FOLLOVII NO REASON EC 70315 BUSINESS ANO PROFESSIONSCODE
��� CR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, CEIAQC PAIR ANY
SIGNED STATEMENT
PROF TO ITS 15 HE OR SHE I REQUIRES THE APPLICARSUANTNT FOR SU.M ymi `IT TO FILE E
CLONED STATEMENT THAT OR SHE'1ST THE i.
11 0440PROFESSIONS
CONTRACTORS LICENSE LAW R THAT H 9 R SHE 1S EX EXHEMPT
THEREFROM
PROOF DIV 3 100 807E BUSINESS
711 00 EXMCOOE'H 10 THAT HE OR SHE IS EXEMPT THEREFROM N110 THE BAIL) CT THE
APPLICANT
T 00 A TIVIL ANY VIOLATION OF SEC AN FIVE
BY IJ0 RED DOLLT FOR 5 PERMIT SUBJECTS THE
HPPLICHNT TO ALIVIL PENALTY OF NOT M110RE THAN FIVE HUNDRED DOLLAR.5155001.
ICI I, AS OWNER OF THE PROPERTY, OP MY EMPLOYEES WITH NAGES AS THEIR SOLE
COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR DALE
(SEC TON, BUSINESS 2t40 PROFESSIONS CODE. THE CONTRACTORS LICENSE LAN.' 00ES NOT APPLY TO
All OWNER OF PROPERTY WHO EUILDS OR IMPALA/ES THEREON. AND V.HO DOES SUCH WORK HIMSELF
OR HERSELF OR THROUGH HIS OR HER CLAN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE
NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLO NITHIN
011E YEAR OF COMPLETION, THE OWNER-BUILBER WILL HAVE THE BURDEN O: PROVING THAT HE OR 911E
DID NOT BUILD OP IMPROVE FOR THE PURPOSE OF CALEJ
I, AS OWNER OF THE PROPERTY AM EXCLLSIVELY CONTRACTMG MATHLICENSED
CONTRACTORS TO CONSTRUCT 1HE PROJECT (SEC 1044, BUSINESS AND PROFESSIONS CODE THE
CONTRACTORS LICENSE LAW 00E3 WI APPLY TO AN o'MJER OF THE PROPERTY V4410 BUIL99 OR
IMPROVES THEREON, AND 4540 CONTRACTS FOR SUCH PROJECTS WITH A CONTPACTCR{31 LICENSED
PURSUANT TO THE CONTRACTORS LICENSE LAW)
17 I AM EXEMPT UNDER SEC
B 1 P C. FOR THIS REASON
.. DATE
DINNER
LICENSED CONTRACTORS DECLARATION
0EREBY AFFIRM UNDER PENOLI0 OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF 7
CHAPTER 9 /C'OMMENCING VNTH SEC CON 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS L
CODE, AND MY LICENSE IS IN FULL FORGE AND EFFECT
LICENSE CLASS LIL NO
PTE _ l_ a / CONTRACTOR
WORKERS' COMPENSATION DECLARATION
i HEREBY AFFIRM UNDER PEINALTYOF PEF:.:URYONE OF THE FOLLOWING BEC:_ARATIORS
HAVE AND WILL ).NNTNN A CERTIFICATE OF CONSENT TO SELFINSIRE FOR WORKERS'
COMPENSATION AS PROVIDED FOR BY SEOTI@J 0700 OF THE LABOR CDCE FOR THE
PERFORNANCE OF THE WORK FOR WHICH THISPERMIIT IS ISSUED
I HAVE AIJD WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY
SECTION 3100 OF Id LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS
PERMIT IS ISSUED. IIY DUPE RS' COMPENSATION INSURANCE CARRIER AND POLICY
NUMBER APE
CARRIER
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ITHI3 SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED COLLARS
F IDI Ar]f OR LESS)
' CERTIFY T'tE.T IN THE PERFORMANCE OF THE WORK FOR 1/43-11CN THIS ?ERM1IIT 13 ISEUFL: I
EMAIL NOT EMPLOY ANY PERSON 11'I ANY MANNER SO AS TO BECOME SUBJECT TO :Pt.
WORKERS ' CO4IPi0SATIOPI LAWS OF CALIFDRIJ W 4110 AGREE THAT OF I SIIOUITI HFCONI'
SUOJECi LO THE WORKERS' COMPENSATION NSATION FO ISAII0 SEC UI)F THE I?NOP
09
_GCE I SKPLL FORTHWIPHC COMPLYWITH THOSE F ROM 4-S
1113 -a , A PI IgRrT
gN.NO FAILUHL 10 SECURE WORKER) CJOINIPEI SATIC 1 OOVERA 3E IS UNLAWFUL AND SHALL
S USPECT All £1.1YLOYER TO CRIMMRL PENAL,,TyTIEL'NIL/ CMLTINES UP TO ONE HUNDRED THOUSAND
N COLLARS 131030001. - ADDITION TO THE Ctl' JF cLNPEI':SATION. -DAMAGES AS PROVIDED FOR IN 1
L HON3/06 OF THE LABOR CODE INTEREST ,A^,I1'AT ORIIE EFEFi
CONSTRUCTION LENDING AGENCY
!HEREBY AFFIRM UNICEF PENALTY OF PERJURY THAT ?MERE IS A OINRTRUCTION L ENCINC AGENCY
ECR THE PERFORIIANO J .:F THE V.9PK FOT WHO INA 3 PERMI-AS War 'S0C 24W. 41V 01
LENSES''S NAME
L ENDERS ADDRESS. •
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CERTIFY L1HAVE A0 THIS APPLICATION/ AND SIA _ A CT. THE.NICHE ... .R.._.N.13
CORRECT I AGREE TO THALL C19! AIJ0 000Ni 000ITANC
STATE
ALAWS RELATING
TO BWLOINC CONSTRICTION ANN HFRRY AUTHORIZE REPRESENTATIVES OF THIS COUNTY i0 ENTER
UPON i1E2nOVEMENTI00D PROPERTY F0RNVFCIION PUPP[SEG
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