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Home My WebLink AboutB2001-3424 - PermitsCity of Newport Beach Building Department CIP Permit No: B2001-3424 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Floor: Inspector Area: 7 Owner: Address: Phone: Applicant: Address: Phone: HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH CA 92658 Suite: VILLANUEVA MIGUEL 4850 BARRANCA PKWY #203 IRVINE CA 92604 949/552-2061 Code Edition : 97 Type of Construction: II-1 HR Occupancy Group: B Added/New sq.ft. Bldg: Added/New sq. ft. Garage: No of Stories: 3 No of Units: Issued: Receipt # Bldg: 1 Legal Desc: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: WATSON INVES 18182 SERRANO AVENUE VILLA PARK CA 714/974-6421 436023 03/31/2003 BT98038807 10/31/2001 Workers' Compensation Insurance - - Carrier: STATE FUND Policy No: 229-0019928 Expire: 01/01/2002 Description of Work: T.I./3RD FLOOR/PHASE 2 & 3/EAST OFFICES 2095-2031 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: JACK WOOD s� 4850 BARRANCA #203 IRVINE CA 949/552-2061 State Lic: C015130 Building Setbacks Rear: / Special Conditions: Front: / Left: / Right: / Use Zone: PC Parking Spaces: FEES Construction Valuation: $0.00 Building Permit Fee: $0.00 Plan Check Fee: $0.00 Supplemental: $0.00 Investigation Fee: $0.00 Clean Up Deposit: $0.00 Energy Compliance: 50.00 Fair Share: $0.00 PROCESSED BY: ZONING APPROVAL: • ea • • • •• •• • • •• • • •• • • FIRE APPROVAL: - . • • • . : . i• • • Microfilm: Excise Tax : Park Ded: SJH Trans: San Dist: Ca Seismic Safety: Disabled Review: $0.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 State Lic: PHASE 1 PERMT B2001-2616 $1100 CLEAN UP DEPOSIT $20.45 ISSUANCE FEE Hazardous Mat: Add Fire Dep HMQ: Other Fee: TOTAL FEE, : 1 120. 5 TOTAL PAYMENT :$0.00 rr� • • • • • GRADING APPROVAL: PUBLIC WORKS: • •• ••• :•• :•• :•: :• = • • • •• • •• • •• •. "•• • •• ••. ..- $0.00 $0.00 $1,120.45 Fire Department: Plan Review Fee: Inspection Fee: Planning Department: Counter Review : Zoning Plan Check: OverTime Plan Check Fee: TOTAL DUE: $1,120 95 OTHER DEPARTMENT: PLAN CHECK BY: APPROVAL TO ISSUE: $0.00 $0.00 $0.00 $0.00 $0.00 WORK MUST BE STARTED WITH A PERIOD qF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOl VI APPROVALS FOUNDATION: DATE BY COMMENTS OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC. 1031.5, BUSINESS AND PROFESSIONS CODE ANY CITY I ROUGH GRADE LINE & GRADE CERT/SETBACKS ERECTION PADS FOOTINGS SLAB ON GRADE FRAMING: DECK SLAB SUBFLOOR ROOF & BUILDING HT EXT. SHEAR/HOLD DOWNS GENERAL FRAMING FIREPLACE THROAT GNEDSTAT,- STATEMENTSHE 1-LIEE PURSUANT CNED STS LICE THAT HE AR IS MENCIND ASEC.0O THE PROVISIONS HE SIF THE ANCONTRACTORS LICENSE CO LAW))OR THAT BOR (COMMENCING EX PATH THE EFRO7000) OF DIVAS OF THE BUSINESS AND PROFESSIONS CODE)) THAT HE OR SHE IS EXEMPT THEREFROM AND THE &1513 FOR THE 3 APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500)'. COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE AN O MER 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 ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS PATH A CONTRACTOR(S) LICENSED OATE OVMER INTERIOR & EXTERIOR INSULATION DRYWALL SUSPENDED CEILING SHOWER LATH EXTERIOR LATH SCRATCH (PLASTER) (2 DAY) MASONRY PRE -GROUT LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 1000) OF DIVISION 1 OF THE BUSINESS AND PROFESSIONS /v-III' Of CONTRACTOR /A �(0" WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEOUWATONS', I HAVE AND IMLL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MISC. INSPECTIONS: SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER ANO POLICY NUMBER PRE'. CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT 15 FOR ONE HUNDRED DOLLARS I CERTIFY THAT IN 111E PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN PJW MANNER SO AS TO BECOME SUBJECT 10 THE PERMIT EXTENSION 1ST EXP. LETTER 2ND EXP. LETTER BUILDING FINAL CERTIFICATE OF OCCUPANCY 1- TENANT NAME: TYPE OF BUSINESS USE: B2001-3424 Date Paid: 7/9/04 $1100 Hoag Memorial Hospital PO Box 6100 Newport Beach, CA 92658-6100 EFUNDED WARNI SUBJE SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF$ECTION 3700 OF THE LABOR E -St v) APPLICANT'. 1AlokSaT AN EMPLOY R TOCRI•INAL SENfillQS_AND CIVIL FINES UP TO ONE HUNDRED THOUSAND A • • CENSTRUC•TIQWI LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE 15 A CONSTRUCTION LENDING AGENCY � • •- �� ••• •_• • o•ue• • • • -ti • • • L aER%ALARE•S • • • • • • • I CERTIFY THA}I HAVE•READ THISimPL�l.'ATION .{ATE AT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY W TH &L CIA's() COLW4Y ORDIAES AND STATE LAWS RELATING TO BUILOING.CONSTRUCTION, AND HEREBY AUTHORIZE REPRESEN TIVES OF THIS COUNTY TO ENTER • City of Newport Beach Building Department CIP Permit No: B2001-3424 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644.3288 Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Floor: Suite: Inspector Area: 7 HOAG MEMORIAL HOSPITAL 1 HOAG DR REIMPORT BEACH CA 92658 Owner: Address: Phone: Applicant: Address: Phone: VILLANUEVA MIGUEL 4850 BARRANCA PKWY #203 IRVINE CA92604 9491552.2061 Code Edition : Type of Construction: Occupancy Group: AddedlNew sq.ft. Bldg: AddedlNew sq. ft. Garage: No of Stories: 3 No of Units: Issued: Receipt # 97 II-1HR B Bldg: 1 Legal Desc: Contractor: Address: Phone: Con State Lic Lic Expire: Bus Lic: Lic Exp Date: WATSON INVES 18182 SERRANO AVENUE VILLA PARK CA 714/974-6421 436023 03/31/2003 0T98038807 10/31/2001 Workers' Compensation Insurance -- Cartier: STATE FUND Policy No: 229-0019928 Expire: 0110112002 Building Setbacks Rear: 1 Front: / Left: Right: 1 Use Zone: PC Parking Spaces: Construction Valuation: $0.00 Building Permit Fee: $0.00 Plan Check Fee: $0.00 Supplemental: $0.00 Investigation Fee: $0.00 Clean Up Deposit: $0.00 Energy Compliance: $0.00 Fair Share: $0.00 PROCESSED BY: ZONING APPROVAL. FIRE APPROVAL- ".___..- GRADING APPROVAL: PUBLIC WORKS: Microfilm: Excise Tax : Park Ded: SJH Trans: San Dist: Ca Seismic Safety: Disabled Review: $0.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Description of Work: T.I.13R0 FLOORIPHASE 2 & 3/EAST OFFICES 2095-2001 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: JACK WOOD 4850 BARRANCA#203 IRVINE CA 949/552-2061 State Lic: C015130 State Lic: Special Conditions: PHASE 1 PERMT B2001.2616 $1100 CLEAN UP DEPOSIT $20.45 ISSUANCE FEE FEES Hazardous Mat: Add Fire Dep HMQ: Other Fee: TOTAL FEE, : 120.' 5 TOTAL PAYMENT :$0.00 $0.00 $0.00 $1,120A5 Fire Department: Plan Review Fee: Inspection Fee: Planning Department: Counter Review : Zoning Plan Check: OverTime Plan Check Fee: TOTAL DUE: $1.120 95 OTHER DEPARTMENT' PLAN CHECK BY: APPROVAL TO ISSUE: $0.00 $0.00 $0.00 $0.00 $0.00 -"—--"-"-- - WORK MUST BE STARTEDWITHA PERIOD f # 160 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOl . APPROVALS DATE BY COMMENTS FOUNDATION: ROUGH GRADE LINE & GRADE CERT/SETBACKS ERECTION PADS FOOTINGS SLAB ON GRADE FRAMING: DECK SLAB SUBFLOOR ROOF & BUILDING HT EXT. SHEAR/HOLD DOWNS GENERAL FRAMING FIREPLACE THROAT OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I PM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC. 70315. BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT. ALTER, IMPROVE, OEMOUSH, 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 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING WTH SEC. 700a) OF TALI OF THE BUSINESS AND PROFESSIONS CODED OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031,5 BY ANY APPLICANT FOR A PERMIT SUBJELT3 THE PPPUCANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5503): ❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WLL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE (SEC. 7344, 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 MS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE • NOT INTENDED CR 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 HE CR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.). O I. AS OWNER OF THE PROPERTY, MI EXCLUSIVELY CONTRACTING WITH UCENSEO CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7344, BUSINESS AND PROFESSIONS CODE: 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 PURSUPNTTO THE CONTRACTORS LICENSE LAW). ❑ I AM EXEMPT UNDER SEC. B6 P.C. FOR THIS REASON DATE OWNER INTERIOR & EXTERIOR INSULATION DRYWALL SUSPENDED CEILING SHOWER LATH EXTERIOR LATH SCRATCH (PLASTER) (2 DAY) MASONRY PRE -GROUT LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I PM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WTH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE ANC EFFECT. LICENSE CLASS - LTC. NO. R I I b • 31 o) CONTRACTOR DATE WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WLL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE°. MISC. INSPECTIONS: PERMIT EXTENSION 1ST EXP. LETTER 2ND EXP. LETTER BUILDING FINAL CERTIFICATE OF OCCUPANCY TENANT NAME: TYPE OF BUSINESS USE: $ REFUNDED DATE TO: I HAVE AND PALL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR C00E, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 19 ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED WEARS (5100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH DRS PERMIT 19 ISSUED SHALL NOT EMPLOY ANY PERSON M ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF CRON 3700 OF THE LABOR CODEIS L FORTHWITH COMPLY WITH THOSE PROV151 J DATE A ✓ 3' 01 APPLICANT: W(AArn WARM P FAILURE TO ,INC IRE WORKERS' COMPENSATION COVERAGE 18 UNLAWFUL, AND SHALL GUSJEET AN EMPLOY;R TO ORR:INNL ^ENAFI IEa AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS 0100,000), IN CDOitION'TO T'IE COST Of COMPENSATION, DAMAGES AS PRONGED FOR IN SECTION 3705 OF THE IABCP COLS, INT.REST, AND'TTORNEY'S FEES. CuNSTELICTIvl LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY 1-HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (8EC3097, CP/C.)• LENDER.. NA IE LP)NDER.A PLJREG I CERTIFY THAT T HAVE READ T 03, MPH. CATION APO SATE HAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WTH ALL UT I,JA COIANW ORDINANCES AND STATE LAWS RELATING TO SNL0I09.LDNSTRUCRON AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON TII[ABOVEMENTIONED PROPERTY FOR INSPECTION PURPOSES • PERM TALI Ran 51 ��--�'GNATUISS—. /v•31-v, DATE - Cityof -Newport Beach Building Department ELECTRICAL Permit No: E2001-1805 PO Rnx 1768/3300 Newport Blvd Newport Beach. Califomia 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255 Job Address:1 HOAG DR Bldg: 1 Floor: Suite: Iti3pector Area: Owner: Address: Phone: Receipt #: Processed By: 7 Code Edit: 96 Legal Desc.: Description of Work: HOAG MEMORIAL HOSPITAL Contractor: WATSON INVESTMENT DEVELOPMENT 1 HOAG DR Address: 18182 SERRANO AVENUE NEWPORT BEACH CA 92658 VILLA PARK CA Phone: 7141974-6421 Con. State Lic.: 436023 Lic Expire: 03131/2003 Bus. Lic.: 0T98038807 Lic. Exp Date: 10/31/2001 FEE New Construction Residential Muitl-Family 1-2 Family 0 0 Service 0 to 600V up to 200A 0 $0.00 0 to 600V over 200A 0 $0.00 Over 600AH,000A 0 $0.00 ELECIT.I.I3RD FLOORIPHASE 2 & 3/EAST OFFI p $2001-3424 P./9. "!0p INSPECTOR NOTES: Receptacle/Switch/Outlets Motors/Transformers (HP/KVAI Recap/Outlets 0 $0.00 0 to 1 HP/KW/KVA $0.00 Fixtures 0 $0.00 1 to 10 HP/KW/KVA $0.00 Sep Circuit 0 $0.00 10 to 50 HP/KW/KVA 50 to 100 HP/KW/KVA Skins over 100 HP/KW/KVA Branch Clrcult 0 $0.00 each Add Circuit 0 $0.00 Piggy Back l Temp Power Time Clacks 0 $0.00 TOTAL: $20.95 PAYMENT: $0.00 Temp Power Pole 0 $0.00 $0.00 Temp Underground 0 $0.00 $0.00 Sub Panel 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 Record Managment Fee : $0.50 Investigation Fee $0.00 $0.00 Plan Check $0.00 Issuance $20.45 Supplemental Fee $0.00 BALANCE: $20.95 Ea CONTRACTORS CFO ARATION - F%ereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 loommencing with Section 7000) of Division 3 of the Business and Professions code, 5rre my license 6 in fullforce and effect. effie No:436023 Class: Contractor, WATSON INVESTMFNT DEVELOPMENT 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 campensalbn, as provided for by Section 3700 of the labor code. far the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance. as required by Section 3700 of the labor cede. for the performance of the work for which this permit is issued. My workers compensation insurance terrier and policy numbers ir Cartier. STATE FOND POBcy number: 229-D019928 Expire : e1/01/2002 This section need not be competed if the permit is for one hundred dollars ($100) or less. 1 r •, o o a I certify that in the performance of the work for which this permit is issued. I stall not employ any Person in any manner so as i? sy co7+`; svgjecl to irje workers compensation laws of California. and agree that if 1 should become subject to the workers' compense8en provisions of Section 3700 of the tabor code, I siallfor..gw i o_n Aly '' iIh It 3Se provisions. Date: "T-T 72 Pe Of Applicant Signature: Warning: F fo secure workers compensation coverage's unlawful. and shalt subject an ernpl yen to criminal penalties and civil fines up to one hundred ($100,0001, in addition to the cost of compensotion,damages as provided for in Section 3706 of the lobar co _le in; ere t, c lid afar *Is fees. r r I hereby acknowledge that I have read fhb application: that the information given is correct: and that I am .he ow. Ter. or clay aul.lorized client 'iftt a ownrr. 1 ogre to compry with city and state laws regulating construction: and In doing the work authorized thereby, no person will be employed in vidatbn of the labor code of the slate of California relating to workmen's compensation insurance. Permittee Name (Print)," /a,u4. wtEf3o/J Signature of permittee: / 7�+—L✓r �� v` Date: Approvals Grounding Electrode Underground Underslab/Floor Rough Conduit Wails Rough Wiring Ceilings Rough Service Temp Power Utility Co. Notlfled Final Inspector/Date i WORK MUST BE STARTED WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VAL/DATION OR THIS PERMIT BECOMES NULL AND VOID. . City of Newport Beach Ead PO Box 1768/3300 Newport Blvd., Newport Beach, California 92658-891 Permit Counter Telephone (949)644-3288 Building Department MECHANICAL Permit No: H2001-1167 Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Bldg: 1 inspector Area: 7 Code Edit: 97 Owner: Address: HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH CA 92658 Phone: Issued : Processed By: Floor: Suite: Legal Desc.: Description of Work: MECHIT.I.I3RD FLOOR/PHASE 2 & 3/EAST OFFICES B2001-3424 Contractor: WATSON INVESTMENT DEVELOPMENT Address: 18182 SERRANO AVENUE VILLA PARK CA Phone: 7141974-6421 Con. State Lic.: 436023 LIc Expire: 03131/2003 Bus. LIc.: BT98038807 LIc. Exp Date: 10/31/2001 FEES HVAC Items Furnaces up to 100k Btu/hr 0 $0.00 over 100k Btu/hr 0 $0.00 Wall/Floor Heaters 0 $0.00 Heat Pumps & Package Units up to 100k Btu/hr 0 $0.00 up to 500k Btu/hr 0 $0.00 up to 1M Btu/hr 0 $0.00 up to 1.75M Btu/hr 0 $0.00 over 1.75M Btu/hr 0 $0.00 Bolters & Compressors up to 3HP over 3HP to 15HP over 15HP to 30HP over 30HP to 50HP over 50HP Misc Items Fire Dampers Gas Line Metal Fireplace ICBO App.#- 0 $0.00 O $0.00 O $0.00 0 $0.00 o $0.00 0 $0.00 0 $0.00 0 $0.00 INSPECTOR NOTES tot Ventilation Bathroom Fan 0 $0.00 Exhaust Fan 0 $0.00 Attic Fan 0 $0.00 Down -Draft Fan 0 $0.00 Residential Hood 0 $0.00 Commercial Hood 0 $0.00 Repair/Alter/Add 0 $0.00 Air Handling Units up to 10k cfm 0 $0.00 over 10k cfm 0 $0.00 TOTAL: $20.95 PAYMENT : $0.00 BALANCE: $20.95 VAV Box Other o $0.00 $0.00 $0.00 Record Management Fee: $0.50 Investigation fee $0.00. Plan Check $0.00 Issuance $20.95 Supplemental Fee $0.00 LIQ{NSEO CONTRACTORS DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provislons of Chapter 9 (commencing with Section 7000) of Division 3 of the buslness and professions code, and my license Is in full force and effect. License No: 436023 Class: Dale: Contractor: WATSON INVESTMENT DEVELOPMENT WORKERS' COMPENSATION DECLARAIION: 1 hereby affirm under penalty of perjury one of the following declarations: € have and will maintain a certificate of consent to self -Insure for walkers' compensation, as provided far by Section 3700 of the labor code, for the performance of the work for which thls permit Is Issued. I have and will maintain workers' compensation Insurance, as required by Section 3700 of the tabor code, for the performance of the work for which Ihls permit Is Issued. My worker's compensation Insurance caner and policy number Is: ; Carder. STATE FUND Policy number: 229-D019920 Expire: 01/0112002 1 (Thls section need not he completed if the permit is for one hundred dollars ($100 or Tess)., 1 certlfy that In the pe nuance of ttte work for which this permit is issued, l shall not employ any person In any manndr j-t tr hein)ne S ybiebt to the workers' compensation laws of California, a agree that if l should become subject to the workers' compensation provision Sect n37 ggt the lde, l shall forthwith comply with those provisions. Date: /Pr 31 .Of applicant Signature : �•✓a or co ;,, , , . : , :: i I ) Warning: Failure la secure workers' compensation coverage is unlawful, and shall subject an emptoye ',to cryrriral pbnadles and civil f.hes ud ta.tine :Anwed , thousand dollars ($100,000), In addition to the cost of compensatlon,damages as provided for In Sect/ A 37r1 a`, lir, Iahpr rode, intermit, and g0ornev s Mee. :; , , I hereby acknowledge that t have read thls application; that the Information given Is correct; and that 1 dm the dwner, Ur duly abthorize,1 aged ..the wider. I tiles to comply with city and state laws regulating construction and In doing the work authorized thereby, no person will be employed In violation of the labor code of the state of .. _ _ CallfatnlareialinglowarkmedEGampe_nsatlatt Insurance, Permittee Name (Print) r Address : Signature of permittee: //% A.A- ("01eA . c - Date: 1 . tt7r3/-oj Anorowars UnderslablFloor HVAC/Hood - Rough Fireplace -Rough Gas Test Fireptace - Final HVAC/Hood - Final InspectorlDate WORK MUST BE STARTED WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOID.