HomeMy WebLinkAboutX2009-1460 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2009-1460
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Combination Type - CIR GRAD/ ELE0 r
Job Address: 1 HOAG DR NB
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL FD&C
500 SUPERIOR AVE, STE 300
NEWPORT BEACH CA 92663
BALBONA JOSEPH
10980 WILSHIRE BLVD
LOS ANGELES CA 90024
310/4734555
Code Edit:
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage
No of Stories:
No of Units:
Bldg Height:
Bldg Sprinklers:
Flood Zone:
Issued Date- 08/13/2009
Description: CHANGE OF CONTRACTOR (X2007-3018) INSTL U/G CONDUITS
Project: 2552-2007 2552-2007 (FIBEROPTIC ROUTE)
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:
DEB CONSTRUCTION INC
2230 E WINSTON ROAD
ANAHEIM CA 92806
714-632-6680
372419
03/31/2011
BT30001134
2001 Worker's Compensation Insurance
Carrier:
Policy No:
0 Expire:
0
0 Building Setbacks
0
0
Construction Valuation: $0.00
Building Permit Fee: $0.00
Plan Check Fee: $0.00
Overtime Plan Ck: $0.00
Investigation Fee: $0.00
Record Management: $1.00
Energy Compliance: $0.00
CA Seismic Safety: $0.00
Disabled Access: $0.00
Fee Increase: Fee: $0.00
Additional Fee: $32.13
Hazardous Mat: $0.00
Building Green Fee: $0.00
••
TOTAUFEEdt $33.1a• ••• •. • •
• te-b
Use Zone:
Parking Spaces'
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
• • • •
• • • 00
: • • • 0:
• •
slivvvai• • •
TRAVELERS IDEMNITY
DTEUB9072C1109
01/01/2010
Rear
Front:
Left:
Right:
FEES
$0.00
$0.00
$0.00
$0.00
Moo
$0.00
$0.00
$0.00
$0.00
Plan Check Fee:
•• • •
•
•
• • • •
• • • • • • •
• • • • • • • • •
• •
•
San Dist:
Excise Tax:
NMUSD Fee:
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee:
Electrical %:Mechanical %:
Plumbing %:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
Planning Department -
Plan check Fee:
Fair Share :
SJH Trans:
Fire Hazard Zone : N
$0.00
$0.00
$0.00
Public Works Department -
Park Dedication: $0.00
PNV Plan Check: $0.00
BALBONA JOSEPH
10980 WILSHIRE BLVD
LOS ANGELES CA 90024
310-473-3555 State Lic:C006451
State Lic:
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$0.00 Fee Due at Permit Issuance:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
• • • • APPROVAL TO ISSUE:
$0.00
Moo
$0.00
$0.00
$0.00
$0.00
$0.00
$33.13
• • ilikhlITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
fi 15-73
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 (._) 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 property who, through employees' or personal effort, builds or improves the
property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
El I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The ContractorsState 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:I 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
prior 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 bylicensed contractors. I understand that a copy of the applicable law,
Section 7044 of the Business and i Professions Code, s available upon request when this application is submitted or at the
following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Properly 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 Business and Professions Code, and my license is in full for and ffect.
Liceg,sselass License No.
Dat &ftP 2.* I Contractor Signature<
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFTHELABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I:I I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of
Industrial Relafions as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Policy No.
El I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. My workers' compens tion insurance carrier and policy number are:
Carrier PoQcy.Nuflibr p 1 Ea4ration Date
Name of Agent
El I certify that, in the perform
SO as to become subject to the
workers' compensation provisio
Signature of Applicant
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
i hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
Lender's Name
Lender's Address
e of the work for which this ermit is issued, I shafSot employ any person in any manner
rker ' compensation laws ot California, and agree that, if 1 should become subject to the
of rtiori 3700 of the Labor Code, I shall forthwith comply with those provisions.
DatoaC
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
- t 0
CERTIFICATE OF
OCCUPANCY ISSUED
DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403.
El I SUBMITTED ASBESTOS NOTIFICATION TO:
El EPA
El AQMD
El ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
By my signature below, I certify to each of the following:
I am the properly owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provi ed is correct.
I agree to comply with all applicable city and county ordin ces and state laws relating to building construction.
Signature of Property Owner or Authorized Age
authorize representatives of this city or county to enter eabov -iden fled property for inspection purposes
Date.
Zs0 ) —
Print Property Owner's or Authorized Agent's Name'
FOR OFFICE USE ONLY
O • 1" •• •
• •
•
• • •• • • • •
• • ee
ooe •• •*•
": . •.. . • "'
•• •• •• •• * •* . •
•
.•• • • • :
01/01/2009
• • •
City of Newport Beach
Building Department
PO Box 1768 Newport Beach, California 92658-8915
PLUMBING Permit No: P2010-0023
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
411/
Job Address: 1 HOAG DR Bldg: 1 Floor:
Suite:
Inspector Area: 7 Code Edit 2007
Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
OF LOT
Owner:
Address:
Contractor: DEB CONSTRUCTION INC
Address: 2230 E WINSTON ROAD
ANAHEIM CA 92806
Phone: Phone: 714-6324680
Con State Lic:372419
Issued Date:01/26/2010 Lic Expire: 03/31/2011
s Lic: BT30028854
Processed By: Lic Exp Date: 08/31/2010
u
HOAG HOSPITAL FD&C
500 SUPERIOR AVE, STE 300
NEWPORT BEACH CA 92663
Description of Work: PLUM/ RELOCATE GAS LINE DUE TO RELOCM.OF
OA
2552-2007 ELECT DUCT BANKS
Worker's Compensation Insurance -
Carrier : TRAVELERS IDEMNITY
Policy No:DTEUB9072C1109
Expire : 01/01/2010
Bathroom Fixtures
Toilet: 0
Bidet
Urinal
Bath Tub:
Shower Stall:
Wash Basin:
a
a
Hydro -Mass Tub:0
Floor Sink: 0
Floor Drain: 0
$0.00
$0.00
$ox()
Imo°
$0.00
$0.00
$0.00
$0.00
$0.00
Kitchen Fixtures
Kitchen Sink: 0
Garbage Disp: 0
Bar Sink: 0
Vegetable Sink: 0
Ice Maker 0
Dishwasher: 0
Lndry/Trap: 0
Regulator: 0
Lawn Sprinkler: 0
TOTAL: $104.40
$0.00
$0.00
$0.00
$oso
$0.00
$0.00
$oma
$0.00
$0.00
FEES
Misc.
Water Piping: 0
Water Softener: 0
Water Heater: 0
Gas up to 4 outlets: 1
Gas over 4 outlets: 0
Backflow up to 2": 0
Backflow over 2": 0
Hose Bibb:
Drinking Fountain: 0
Plan Check Fee:
$0.00
$0.00
Moo
$6.50
$0.00
$0.00
$0.00
$oma
$0.00
Misc.
Roof Drain: 0
Grease Trap: 0
Grease Interceptor:0
P-Trap: 0
Sewer
Sewer: 0
Sewer Alter/Repair:0
Sewer Abandon: 0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Moo
Other
Record Mgmt Fee:
Investigation:
Plan Check:
Issuance:
Supplemental Fee:
$63.75 Fee Due at Permit Issuance: $40.65
$0.00
$0.00
$1.05
$0.00
$0.00
$33.10
$0.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST ViLID, IN§PECTION
• • • • • • • • •
49 • •
• • • • •
• •
• • • •
• • 4.• •
• • •
• • • •• • • • • •
• ore
•
• • • • 4100 00
• • • • • • •
• • • • OA • •
• • • • • • •
• OS OO • • 000 00
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 pursuantto the
provisions of the Contractors' State License Law (Chapter 9 (commencinowith 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 U 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.property who, through employees or personal effort, builds or improves the
property, provided that the improvements are not intended or offered for sale. lf, however, the building or improvement is sold
within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
El 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).
CI I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below I acknowledge that, excerpt for my personal residence in which I must have resided for at least one year
prior 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 bylicensed contractors. I understand that a copy of the applicable law,
i
Section 7044 of the Business and Professions Code, s available upon request when this application is submitted or at the
following Web site:http://www.leginfo.ca.govicalaw.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 prov"ons oj Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is in4111 for and e fect.
Li e e Qass Lice
ContirZ)7 Signature
WOR ERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
El I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of
Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issj.ied.
No.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
rformance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
I:1 I certify that, in the perform ce of e work for which this permit is issued, I shall not employ an person in any manner
so as to become subject to th rke j compensation laws of California, and agree that, if I sho become subject to the
workers' c ensation s of •n 370 of the Labor Code, I shall forthwith comply with tho ision
Signature o
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature below, I certify to each of the following: ,,... • • • • • • • • • • •
I am the property owner or authorized to act on the property °win bel;alf. • • • • • •
• • • • • •
I have read this application and the information I have pr. 'ded is correct, • •: ; . • • • •
I agree to comply with all applicable city and county or ces it statt laws relating kibuildincitorVoction.
I authorize representatives of this city or coun e-ide lied property for insp purposes. ,
ent's Name' ....,27Cr-- 1 foSettine-7 F. ic . e t tediZeto
Signature of Property Owner or Au
Print Property Owner's or Aut •riz • .41. . • . A •
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
FOR OFFICE USE ONLY
01/01/2009 TYP
H®
HOSPITAL
One Hoag Drive PO Box 6100
Newport Beach CA 92658-6100
949/764-HOAG (4624)
www.hoaghospital.org
August 12, 2009
To: Paul Sobek - Building Department, City of Newport Beach
From: Gregg Zoll, Senior Project Manager Hoag Memorial Hospital Presbyterian
Project Name: Hoag Memorial Hospital Presbyterian, Ped-Link Fiber Optic Cable Re -
Route — Upper Loop
Building Permit No.: X2007-3018
Re: Change of Project General Contractor
Dear Paul Sobek,
As you may already know, OSHPD required city of Newport Beach permit for the upper
loop Ped-Link fiber optic cable reroute as part of the submittal package. RBB Architects
Inc submitted the upper loop Ped-Link fiber optic cable reroute plan to the city of
Newport Beach and received approval. The original contractor was Syska Hennessy
and they pulled the building permit no. X2007-3018 on 5/14/2008.
After receiving approval from OSHPD, Hoag Memorial Hospital Presbyterian considered
to reevaluate the project cost and sent out RFP to the interested general contractors to
bid the project. Hoag Memorial Hospital Presbyterian has selected Deb Construction as
the new general contractor for the project. The original general contractor has been
notified and Hoag has reimbursed all expenses spent up-to-date for this project by the
original general contractor. We acknowledge that Deb Construction, the new general
contractor, is subject to contractor change transfer fee.
Please use this letter as the official acknowledgement from Hoag Memorial Hospital
Presbyterian, the Senior Project Manager of the above listed project, to process the new
permit for the change of General Contractor to Deb Construction, previously Syska
Hennessy.
Thank you very much.
Sincerely,
Gregg Zoll
Senior Project Manager
Owner's Representative
A NOT -FOR -PROFIT COMMUNITY HOSPITAL ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTVICARF ORGANIZATIONS
CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
CIVIL ENGINEER'S CERTIFICATION FORM
City of Newport Beach
3300 Newport Blvd.
P.O. Box 1768
Newport Beach, CA 92658-8915
Front Mollenhauer Group
707 Wilshire Blvd., 40th Floor
Los Angeles, CA 90017
Date: March 4, 2010
ATTENTION: GRADING ENGINEER, BUILDING DEPARTMENT
COMB Permit No. X20u9-1460
GPC No.: Tract/Subdivision/Lot No.: Rough Final vi
Project Names: Description: Installation Underground Conduits (Fiberoptic Route)
Owner/Developer. Hoag Hospital FD & C
Type of Project:
- Tract - Drainage
- commercial V-"Other
- Industrial
Yardage for Project:
-Cut
- Fill
- Borrow
- Export
Utility line trenching
N/A
I hereby approve the grading for this project in accordance with my responsibilities under the City Grading Code. I
have inspected the project and hereby certify that all areas exhibit positive surface flow to public ways or City approved
drainage devices. The grading has been completed: 2/25/10 in conformance with, with
the following changes to the approved grading plan.
Description of Changes: None -- * Grading on this project was limited to trenching for
the installation of utility lines only.
RCECartfim rhl 1-90
Certificaion in accordance with Paragraph 6735.5 of the Business and Professions Code.
3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915
Telephone: (949) 644-3275 • Fax: (949) 644-3250 •Website: unvw.newport-beach.ca.usibuilding
e-mail: cnb_blacity.newport-beach.ea.us