HomeMy WebLinkAboutF2004-0109 - PermitsCity of Newport Beach
Building Department FIRE PROTECTION Permit No: F2004-0109
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR Bldg:1 Floor: 3 Suite:
Inspector Area: 7
Owner: HOAG MEMORIAL HOSPITAL
Address: ONE HOAG DR
NEWPORT BEACH CA 92658
Phone: 949-574-4477
Applicant: ALERT FIRE PROTECTION
Address: 5200 E HUNTER AVE
ANAHEIM CA 92807
Phone: 714-993-2822
Code Edit : 1999
Type of Construction: II.1HR
Occupancy Group: B
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 0
No of Units :
Legal Description:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
ALERT FIRE PROTECTION
5200 E HUNTER AVENUE STE B
ANAHEIM CA 92807
714/993-2822
316324
04/30/2004
BT02112004
10/31/2004
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 1589876
Expire: 10/01/2004
Issued Date: 03/25/2004
Description of Work: FIRE SPRINKLERS/TI (3RD FL) RELO 5 HEADS
0672-2004 (62004.0130)
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
State Lic:
INSPECTOR
Construction Valuation: $500.00
PROCESSED BY:
ZONING APPROVAL:
• •
FIRE APPROIMU: •
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• u•
Fire Plan Check Fee :
Fire Permit/Inspection Fee:
Records Management:
Investigation Fee:
$114.00
$114.00
$3.50
$0.00
TOTALFEE : $231.50
FEES
TOTAL PAYMENT : $114.00 TOTAL DUE : $117.50
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OTHER DEPARTMENT:
PLAN CHECK BY::
APPROVAL TO ISSUE:
PERMIITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
$0.00
$0.00
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APPROVALS
DATE
BY
OMMENTS
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS
LICENSE LAW FOR THE FOLLOWING REASON (SEC. 70315. BUSINESS AND PROFESSIONS COLS: ANY
CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE. DEMOLISH, OR
REPAIR ANY STRUCTURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH
PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT i0 THE PROVISIONS
OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING WITH SEC. 7000) OF DN. 3 OF THE
BUSINESS AND PROFESSIONS CODEII OR THAT HE OR SHE 15 EXEMPT THEREFROM AND THE BASIS
FOR THE ALLEGED EXEMPTION. ANY VIOLATION OF SEC 7031.5 BY ANY APPLICANT FOR A PERMIT
THAN FIVE HUNDRED DOLLARS (E50C)'.
FIRE PROTECTION
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UNDERGROUND ROUGH PIPE
THRUST BLOCKS EXCAVATION
UNDERGROUND PIPING FLUSH
UNDERGROUND HYDRO TEST
SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE
I. AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE
(SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY
TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK
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
WILL HAVE THE
BURDEN OF PROVING THAT HE OR SHE YEAR NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.I.
BURDEEOF PR IS SOLD WITHIN ONE OF BUILDC COMPLETION, THE OWN HE PURPOSE
I. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS COOS. THE
CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR
IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED
PURSUANT TO THE CONTRACTORS LICENSE LAW)
1 AM EXEMPT UNDER SEC. B.& Pt. FOR THIS REASON
UNDERGROUND/BACKFLOW APRV.
SPRINKLER HYDRO TEST
SPRINKLER FLOW TEST
SPRINKLER ROUGH PIPE
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STANDPIPE HYDRO TEST
STANDPIPE FLOW TEST
STANDPIPE ROUGH PIPE
CHEM SYSTEM FUNCTION TEST
CHEM SYSTEM APPROVAL
DATE OWNER
FIRE ALARM SYSTEM
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF
CHAPTER 8 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS
CODE. AND MY LICENSE IS IN FULL FORCE ANO EFFECT.
LICENSE CLASS UC NO
ROUGH WIRING
SYSTEM FUNCTION TEST
CENTRAL STATION MONITOR
1 ATE 5-1S CONTRACTOR
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS 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.
1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY
SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH
TANK PIPING PRESSURE TEST
MEDICAL GAS PIPING TEST
THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY
NUMBER ARE:
CARRIER
CROSS CONNECTION TEST
POLICY NUMBER
MISC. INSPECTIONS:
NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS
(THIS SECTION NEED
(S100) 0R LESS).
IS ISSUED, I
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTOR 3700 OF THE LABOR
CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIO S.
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)6TE: Z•7.'s ••• PLI.ANT:•• W
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C0MEENZATOR COVERAGE 15 UNLAWFUL. AND SHALL
WARNING: FAILURE TO SECURE*JORK�ts
SUBJECT AN EMPLOYER TO CRIMIIW MENALyEStND CIVIL INES UP TO ONE HUNDRED THOUSAND
ODSTa C MPE ATION, DAMAGES A5 PROVIDED FOR IN
DOLLARS ($I0 ,0001, IN ADDITOMTO TIRE
SECTION 3706 OF THE LABOR CODE•IRIEREST, me ATTSEY'S FEES.
CONSTRUCTION LENDING AGENCY
UNDER PENALTY OF PERJURY THAT THERE I5 A CONSTRUCTOR LENDING
1 HEREBYJ)AFFIRM
AGENCY FOry THE PE_I$I RMANEE OP1M• WORK•FOR Oft THISERMIT•IS ISSUED (SE0.3097.
LENDER'SNAFAE• • • .• • •
_ • • • • • •
•• •••
•�" • ••: • • •
LENDERS ADORESS •
READ THIS APPLICATION AND STATE THAT THE AZOVE INFORMATION IS
1 CERTIFY THAT I HAVE
CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING ONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS
E lM •ROPERIY#0%INSPECTION PURPOSES.
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COUNTY TO ENTER UP
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