The URL can be used to link to this page

Home My WebLink AboutX2010-2078 - PermitsCity of Newport Beach Building Department COMB Permit No: X2010-2078 PROJECT NUMBER: 1651.2010 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Combination Type - BLDG/ r r / Job Address: 1 HOAG DR NB Desaiption:INSTL 2 REPLACEMENT SIGN FACES "HOAG HEALTH CENTER" Inspector Area: 7 OF LOT Owner: HOAG HOSPITAL FD & C Address: 500 SUPERIOR AVE NEWPORT BEACH, CA 92663 Phone: Applicant: OUTDOOR DIMENSIONS Address: 5325 E HUNTER AVE ANAHEIM CA 92807 Phone: 714-342-0920 Code Edit : 2007 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: - 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Issued Date: 09103/2010 Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: OUTDOOR DIMENSIONS 5325 E HUNTER AVE ANAHEIM CA 92807 714-459-6695 532856 06/30/2012 BT00007018 06/30/2011 Worker's Compensation Insurance Carrier. STATE FUND Policy No: 478-000012 Expire: 04/01/2011 Building Setbacks Rear. 1 Front I Left: / Right / Use Zone: Parking Spaces: Architect Address: Phone: Engineer: Address: Phone: INSPECTOR State Lic: State Lic: Designer: HEYER ROBERT Address: 5325 E HUNTER AVE ANAHEIM CA 92807 Phone: 714-342-0920 Special Conditions: Fire Hazard Zone : N Construction Valuation: $3,000.00 Building Permit Fee: $107.30 Plan Check Fee: $77.26 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $7.20 Energy Compliance: $0.00 CA Seismic Safety : $0.00 Disabled Amass : $0.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : $0.00 Building Green Fee : $1.00 TOTAL FEE : $312.76 Solar System PC : Excise Tax: Grading Permit Fee: Grading PC Fee: WO Insp. Fee: Electrical %: Mechanical %: Plumbing %: • •• • • • • • •• $0.00 Planning Department - $0.00 Plan check Fee : Fair Share : SJH Trans : $0.00 In -lieu Housing Fee : $0.00 Public Works Department - $0.00 Park Dedication : $0.00 $0.00 $0.00 $0.00 • •• • N•en Citeckfae • * • P/W Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $120.00 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit $0.00 Fee Due at Permit Issuance : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $312.76 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: • • • ••• •• • • PUBLIC WORKS APPROVAL: ••• • • • ••• •• PLAN CHECK BY: • • •• •• • • •• • • APPROVAL TO ISSUE: •PERMFA6 ENRI4 'f6Qa3VSA1=TER ISSUANCE OR LAST VALID INSPECTION. �� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or () portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of properltlyy who, through employees' or personal effort, builds or improves the property, provided ofthe the Owner are will haver he burd densofe provinge building built orr pimprovedt fors the purpose of yearale). completion,p gp ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors State License Law). ❑ I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year pnor to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner - builder if: it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S 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 Busine s and Professions Code, an• y license is in full force anc.2jfect. License Class License N - ate Co_a' • al��' Signature ERS' C"MP 7 NSATION DECLAR d•N WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO WFUL, AN SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLCAS ($100 ), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INr Hest, AND ATTORNEY'S FEES. 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, issued by the Director of Ind u , ' elations as provided for by Section 3700 of the Labor Code; for the performance, of the work for which this permit is ve and will maintai workers' compensation insurance, as required by_ Section. 3700 of the Labggqqqqr Code, for the e of the =r for is this permit is issued. My wor erg' compensation insurece carrier and popc! la are: W . ' 7 . Policy NUmberPhl'1 rt' 1 INC 104 OI: lion Datell 11 ll Agent B.SY12 Phone # 0 I ' edify that, in the performanceof the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the w.I. - . .ensation . of.Califomia, and agree that if I should become subject to the workers' compensation :�yy. .] `I!!�i�.1'iTf'' 00 of th .. • Code, I shall forthwith comply wit hose Signatur DECLA•— a REG I hereby at'rmand is su this permit is Lende 's Name Lender's Address nstruction lending agency for the performance of the work for By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's beh I have read this application and the information I . ,. - :. vided is I agree to comply with all applicable city and co I authorize representatives of this city or county t Signature of Property Owner or Autho Print Property Owner's or Authorized • ••• • • • • • • • • • • •• ating to building construction purposes ACTION PERMIT EXPIRED DATE: BY: PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL �,- t 7- 1.1 d.,_ CERTIFICATE OF OCCUPANCY ISSUED DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403: ❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AOMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED. DEMOLITION. SIGNATURE: • • •• • • • . • • • • • • • • • • • ••• • • • • • ••• • • • • v. FOR OFFICE USE ONLY 01/01/2009