HomeMy WebLinkAboutB2002-1661 - PermitsCity of Newport Beach
PO Box 1768 Newport Beach, California 92658-8915
Building Department CIP Permit No: B2002-1661
Permit Counter Telephone (949)644-3288 Inspection RequesthTelephone (949)644-3255
Job Address: 1 HOAG DR Floor:
Inspector Area: 7 Legal Desc:
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
1 HOAG OR
NEWPORT BEACH CA 92653
949-646-8600
BROWN ERIC
1 HOAG DR
NEV./PORT BEACH CA 92653
949-574-4463
Code Edition :
Type of Construction:
Occupancy Group:
Added/New sq.ft. Bldg: N
Added/New sq. ft. Garage: N
No of Stories: 1
No of Units:
Issued:
Receipt #
97
V-N
B
08/0712002
Suite: Bldg: 1
Contractor: OWNER/BUM
Address:
Phone:
Con State Lic: O/B
Lic Expire:
Bus Lic:
Lic Exp Date:
Workers' Compensation Insurance - -
Carrier:
Policy No:
Expire:
Building Setbacks Rear:
Front:
Left:
Right:
Use Zone:
Parking Spaces
Construction Valuation:
Building Permit Fee:
Plan Check Fee:
Supplemental:
Investigation Fee:
Clean Up Deposit:
Energy Compliance:
Fair Share:
$50,000.00
$524.00
$377.28
$0.00
$0.00
$750.00
$0.00
$0.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APr ROv..^iL:
GRADING APPROVAL:
PUBLIC WORKS:
Microfilm:
Excise Tax :
Park Ded:
SJH Trans:
San Dist:
Ca Seismic Safety:
Disabled Review:
$26.50
$0.00
$0.00
$0.00
$0.00
$0.00
$50.00
TOTAL FEE :$2.292.96
/
/
/
FEES
Description of Work: STATE APPROVED TEMPORARY TRAILERS
1111-2002
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
LIEBKE RAY
1340 REYNOLDS AVE #115
IRVINE CA 92614
949/7525052 State Lic: C006433
DAHMEN DAVID A
2150 BELL AVE., #145
SACRAMENTO,CA 95838
9161564-6028 State Lic: C-017918
Special Conditions:
Hazardous Mat:
Add Fire Dep HMQ:
Other Fee:
$20.45
$0.00
$0.00
Fire Department:
Ran Review Fee:
Inspection Fee:
Planning Department:
Counter Review :
Zoning Plan Check:
OverTime Plan Check Fee:
TOTAL PAYMENT :$528.19 TOTAL DUE: $1,764.77
$150.91
$366.80
$0.00
$27.02
$0.00
L) 3- 7--ck
OTHER DEPARTMENT:
PLAN CHECK BY:
APPROVAL TO ISSUE:
WORK MUST BE STARTED WITH A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION
OR THIS PERMIT BECOMES NULL AND VOID.
11.•
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11
CITY OF NEWPORT BEACH
P.O. BOX 1768, NEWPORT BEACH, CA 92658-8915
OWNER -BUILDER VERIFICATION (HSC 19831)
Attention Peoperty Owner:
Ali "owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building
permit will be issued until this verification is received. (Read information on
Page 2 prior to completion of this form.)
1. I personally plan to provide the major labor and materials for
construction of the proposed property improvement (yes or no) ko .
2. I (have/have not) ua✓E signed an application for a building
permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name
Address
Phone
City
Contractors License No.
4. I plan to provide portions of the work, but I have hired the following
person to coordinate, supervise, and provide the major work:
Name
Address
Phone
City
Contractors License No.
5. I will provide some of the work but I have contracted (hired) the
following persons to provide the work indicated:
NAME
&E Now Loa _
:4,ii'w c ki000ioom,c4 tic.
ADDRESS
PHONE TYPE OF WORK
T214a.m_ zNs74Q,AT/OAi
tax- /NJTHLCAT O,J .
Signed:��
Property wner: A;e,.r Voo_ HMRC, fins pin e_
Date: 9iVoz_
(f\ob6-93)
3300 Newport Boulevard, Newport Beach
OWNER -BUILDER INFORMATION (HSC 19830)
An application for a building permit has been submitted in your name listing
yourself as the builder of the property improvements specified on the
application.
For your protection you should be aware that as "owner -builder" you-urd the
responsible party of record on such a permit. Building permits are not 'required_.
to be signed by property owners unless they are personally performing their own -
work. If your work is being performed by someone other than yourself; poi may -
protect yourself from possible liability if that person applies for the proper
permit in his or her name. .. —
Contractors are required by law to be licensed and bonded.1y the State of
California and to have a business license from the city or county.- They are elso '
required by law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you
plan to subcontract, you should be aware of the following information ;or your
benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,
and the work (including materials and other costs) is $200 or more for the entire
project, and such persons are not licensed as contractors or subcontractors, then
you may be an employer.
If you are an employer, you must register with the state and federal government
as an employer and you are subject to several obligations including state and
federal income tax withholding, federal social security taxes, workers'
compensation insurance, disability insurance costs, and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations,
and these risks are especially serious with respect to workers' compensation
insurance.
For more specific information about your obligations under federal law, contact
the Internal Revenue Service (and, if you wish, the U.S. Small Business
Administration). For more specific information about your obligations under
state law, contact the Department of Benefit Payments and the Division of
Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed
contractors are allowed to perform their work personally or through their own
employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to
secure an "owner -builder" building permit, erroneously implying that the property
owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are
performing their own work personally.
Information about licensed contractors may be obtained by contacting the
Contractors' State License Board inyour community or at 1020 N Street,
Sacramento, California 95814
Please fill out and return this owner -builder verification form so that we can
confirm that you are aware of these matters. The building permit will not be
issued until the verification is returned.
City of Newport Beach
Building Department ELECTRICAL Permit No: E2002-0957
PO Box 1768/3300 Newport Blvd, Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255
Job Address: 1 HOAG DR
inspector Area: 7
Owner;
Address:
Phone:
Bldg: 1 Floor: Suite:
Code Edit: 96
HOAG MEMORIAL HOSPITAL
1 HOAG DR
NEWPORT BEACH CA 92653
949-646-8600
Issued Date: 07/18/2002
Processed By:
Legal Desc.:
Contractor:
Address:
Phone:
Con. State Lic
Lic Expire:
Bus. Lic.:
Lic. Exp Date:
BRIGGS ELECTRIC INC
16662 MILLIKAN AVENUE
IRVINE CA 92714
949-863-9901
297836
08/31/2003
BT01013033
12131/2002
FEE
New Construction
Residential
Multi -Family
1-2 Family
Service
0 to 600V up to 200A
0 to 600V over 200A
Over 600A/1,000A
0
0
0
0
1
Receptacle/Switch/Outlets
ReceplOutlets 0 $0.00
$0.00 Fixtures 0 $0.00
$0.00 Sep Circuit 0 $0.00
$0.00
$0.00
$94.00
Signs
Branch Circuit 0 $0.00
each Add Circuit 0 MOO
Time Clocks 0 $0.00
TOTAL: $457.68
PAYMENT: $0.00
Description of Work: ELECIMODULAR TRAILERS (12)
B2002-1661
INSPECTOR NOTES:
A/yllt� .Nu�fL7ieN up 7117 ,44
a 'DNL/ 'ter 8A@zcZ Gr,,HWt-
79
195-16
Motors/Transformers (HP/KVA) Temp Power Pole 0 $0.00
0 to 1 HP/KW/KVA 0 $0.00 Temp Underground 0 $0.00
1 to 10 HPIKW/KVA 0 $0.00 Sub Panel 14 $198.36
10 to 50 HP/KW/KVA 0 $0.00 0 $0.00
50 to 100 HP!KW/KVA 0 $0.00 0 $0.00
over 100 HP/KW/KVA 1 $57.00 Record Managment Fee : $0.50
Investigation Fee $0.00
Piggy Back / Temp Power 0 $0.00 Plan Check $87.35
Issuance $20.45
Supplemental Fee $0.00
BALANCE: $457.68
LICENSED CONTRACTORS DECLARATION
hereby affirm under penalty of perjury That l am licensed under provisions of Chapter 9 (eomrnenong with Section 7000) of Division 3 of the Business and Professions code,
and my license is in fullforce and elect.
License No: 297836 Class: Conhactar: %RIGGS ELECTRIC INC
WORKERS' 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, as provided far by Section 3700 o11he labor code, for the performance
of the work for which His permit is issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the labor code, for the performance of the work far which this permit is issued.
My workers' compensation insurance earner and policy numbers is:
Canter: US FIDELITY & GUARANTY Policy number. D123W000029 Expire : 07/01/2003
This section need not be completed if the permit is for one hundred dollars ($100) or less.
I certify That in the performance of He work for which this permit is issued, 'shot not employ any person in any
of California, and agi e that ifl should become subject to the workers' compensation provisions of Section 370
Dal r7O z
Applicant Signatur
ing: Fai to se re workers' compensation coverage is unlawful, and shall subject an1wllToyer to criminal penal f d cidf Ines up tctphe hundred
($100,000), in addisan to the cost of compensation damages as provided for in Section 3706 of the labor code, Interest, and attorney's Ides.
I hereby acknowledge thal V have read this application; that the information given is correct; and ;hall am the ovmer, er duly aulhodd0Q 4geal o, the bw.er.: aa. ee to
comply with dty and slate laws regulating construction; and in doing the work aulhonzed thereby, no person will be employed in violation of Ina labor bode ol the state Jf
California relating to workmen's conpensal insurance.
to the workers' Tampa ssati on Ia-ts
ilh canpry Vaal h,be p,bvtsions.
- Permittee Name (Print)
-00
Signature of permitte
- Address
te:
Approvals
Grounding Electrode
Underground
Underslab/Floor
Rough Conduit Walls
Rough Wiring Ceilings
Rough Service
Temp Power
Utility Co. Notified
Final
Inspector/Date
- - WORK MUST BE STARTED WITHIN A PERIOD OF 180
DAYS FROM THE DATE OF VALIDATION OR THIS
PERMIT BECOMES NULL AND VOID.
City of Newport Beach
Building Department
PLUMBING Permit No: P2002-0651
PO Box 1768/3300 Newport Blvd., Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255
Job Address:1 HOAG DR
Inspector Area: 7
Owner:
Address:
Phone:
Issued Da
Processed
Bldg: 1 Floor: Suite:
Code Edit: 97
HOAG MEMORIAL HOSPITAL
1
A
EWPOR
949-646-8
07119/200
Bathroom Fixtures
Toilet 0
Bidet 0
Urinal 0
Bath Tub 0
Shower Stall 0
Wash Basin 0
Hydro -Mass Tub 0
Floor Sink 0
R
BEACH CA 92653
00
$0.00
$0.00
$0.00
$0.00
$o.00
$0.00
$0.00
$0.00
Floor Drain
Kitchen Fixtures
Kitchen Sink:
Garbage Disp
Bar Sink
Vegetable Sink
Ice Maker
Dishwasher
Lndry/Trap
Legal Desc.:
Contractor:
Address:
Phone:
Con. State Lic.
Lic Expire:
Bus. Lic.:
Lic. Exp Date:
0 $0.03
a
a
0
0
0
0
0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL: $387.07
Description of Work: StTE SEWER SYSTEM/SEWER LATERALS FOR TRAILERS
1111-2002 In_
Pe
ctor
PAN -PACIFIC PLUMBING CO
17911 MITCHELL SOUTH
IRVINE CA 92614
949/474-9170
: 093910
10/31/2003
BT00003287
02/28/2003
FEES
INSPECTOR NOTES:
7
«�('i02 /1j7rouect 544 5ccTi' 4„iz ligr per At fC. LL.
ri- 0..Jom osr;e�77 �� �dw� Yjr"tea Ears
i, le_ . frnaer Ara a,.-e.Sy if AcCeff7t9L.e-Ay
Regulator 0 $0.00
Lawn Sprinkler 0 $0.00
Miss
Water Piping 1 $3.95
Water Softener 0 $0.00
Water Heater 0 $0.00
Gas up to 4 outlets 0 $0.00
Gas over 4 outlets 0 $0.00
Backflow up to 2" 0 $0.00
PAYMENT: $0.00
Backflow over 2"
Hose Bibb
Drinking Fountain
Roof Drain
0
0
0
0
Grease Trap 0
Grease Interceptor 0
P-Trap 0
Other
3HRS INSP
BALANCE: $387.07
$0.00 PC FEE
$0.00 Sewer
$5.81
$0.00 Sewer 1 $19.30
$0.00 Sewer Alter/Repair 0 $0.00
$0.00 Sewer Abandon 0 $0.00
Moo Record Management Fee: $2.50
$0.00 Investigation $182.06
Plan Check $0.00
$153.00 Issuance $20A5
Supplemental Fee $0.00
CONTRACTORS DECLARATION
y affirm under penalty of perjury that I am licensed under • ovisions
y license B in full farce and effect. y7 /9
License No: 093910 Class: ate: .` `
Chapter 9 (commencing wilh Section 7000j of Division 3 0l the Business and Professions code,
0
Contractor: PAN -PACIFIC PLUMBING CO
WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:
I hove and will main lain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the labor code, for the pertorrnance of the work
for whisk this permit B issued.
I have and will maintain workers compensation insurance, as required by Section 3700 of the labor code, for the performance of the work for which this permit is Issued.
My workers' compensation insurance carrier and policy number Is:
Canter: (RICO CASUALFY Policy number: WCS-11167130Q Expire :07/0i/2003
(This section need not be completed if the pe-n t is for one hundred dollars ($I 00) -ss.
I certify that In the pert can ce of the wok for which this permit is ssued, l shall nal employ any person in• renoa s(be•• esubj:y�. the ers compensation laws
oycaliforg7p47gee thhj�fyejrould become subsec, to the workers compensation provisions of Seal' • ,rr 1 �h• lfhc wit) those provisions.
/v{ote: , / `/ l ( // LJ /✓/ �6ppllcant Signature : .L '
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 I$I00,000), in uddiion t., ice col'' di compel isatlondamages ns provided for In Section 3706 of the lobo code, interest, and ottomeys tees.
I hereby acknowledge 'hat I hove 'eod'h's app'ICCion: 'hat The ink rm :tio : or en's correct; and that I am the owner. or duly authaaed agent of the owner. I agree to
comply with city and scat..- lows regulating construction: and in doing the work authorized thereby, no person will be employed in violation of th I or code of the state of
Olin
CaliFo arelating to workmen's co sal ,anc� /� ��/ `��'/, ///r�-
PF ittee Name (Prints *'�K; V - Address: -1 -(d - L�r (/s /j` cr((�/ i
o c;gv9�
Sivinofure of permittee:_
7/2t
Approvals
Inspector/Date
Solt Pipe (ground) /'/
Sewer e7/y1
Water Pipe (ground)
Gas Pipe (ground)
Plumbing (rough)
Gas Pipe (rough)
Water Heater
Gas PSI Test
Gas Co Notified
Final
WORK MUST BESTARTEDWl�/�RIOD-QE J8O
DAYS FROM THE DATE OF VALIDATION OR THIS
PERMIT BECOMES NULL AND VOID.