HomeMy WebLinkAboutB2001-3549 - PermitsX
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City of Newport Beach
Building Department CIP Permit No: B2001-3549
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 Legal Desc:
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL
1 HOAG DRIVE
NEWPORT BEACH CA 92663
WEAVER EMILY
4850 BARRANCA #203
IRVINE CA
949/552-2061
Code Edition :
Type of Construction:
Occupancy Group:
Added/New sq.ft. Bldg:
Added/New sq. ft. Garage
No of Stories:
No of Units:
Issued:
Receipt #
Suite: Bldg: 1
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
WATSON INVES
18182 SERRANO AVENUE
VILLA PARK CA 92667
714/974-6421
436023
03/31/2003
BT98038807
10/31/2002
97 Workers' Compensation Insurance - -
II-1HR Carrier: STATE FUND
B Policy No: 229-0019928
Expire: 01/01/2003
3
05/01/2002
Building Setbacks Rear:
Front:
Left:
Right:
Use Zone:
Parking Spaces:
Construction Valuation: $70.000.00
Building Permit Fee: $638.00
Plan Check Fee: $459.36
Supplemental: $0.00
Investigation Fee: $0.00
Clean Up Deposit: $1,100.00
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:
a Seismic Safety:
isabled Review:
$0.50
$0.00
$0.00
$0.00
$0.00
$0.00
$70.00
TOTAL FEE :$2.918.65
• •
•. ••
•
•••
•
•
••
000
•
•
•
Description of Work: TII2ND FLOOR (NO PLUM)
2739-2001
Architect:
Address:
Phone:
Engineer:
Address:
Phone:1
Designer:
Address:
Phone:
Special Conditions:
tnsndo'
WOOD III JACK F
4850 BARRANCA #203
IRVINE CA 92604
949-552-2061 State Lic: C015130
State Lic:
FEES
Hazardous Mat:
Add Fire Dep HMQ:
Other Fee:
$20.45
$0.00
$0.00
Fire Department:
Plan Review Fee:
Inspection Fee:
Planning Department:
Counter Review :
Zoning Plan Check:
OverTime Plan Check Fee:
TOTAL PAYMENT :$0.00 TOTAL DUE: $2.918.65
OTHER DEPARTMEN
PLAN CHECK
APPROVAL TO
$183.74
$446.60
$0.00
$0.00
$0.00
WORK MUST BE START' D TH + PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION
OR THIS PERMIT BEC • + NU AND VOID.
CDolaWO
APPROVALS
FOUNDATION:
ROUGH GRADE
LINE & GRADE CERT/SETBACKS
ERECTION PADS
"FOOTINGS
R
)SLAB ON GRADE
FRAMING:
DECK SLAB
SUBFLOOR
DATE _I BY i COMMENTS
-(3)111a./ 717/4 /
OWNER -BUILDER DECLARATION
/1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS 14/✓i9 I LICENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5, BUSINESS AND PROFESSIONS CODE. ANY CITY 1
OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMTOUSH, OR REPAIR ANY ,1
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 WITH SEC. 7000) de DN. 3 OF THE BUSINESS
AND PROFESSIONS CODE)) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE
ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 703).5 BY ANY A➢PUCANT FOR A PERMIT SUBJECTS THE
APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED COLLARS (5500):
1. AS O`MIER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
COMPENSATION. WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE
(SEC. TOH, 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 I
OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE
__j1 NOT INTENDED OR OFFERED FOR SALE. IF. HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN j,
a ONE YEAR OF COMPLETION. THE OWNER•BUILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR 19
.— — -- 111 SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.).
— JF51 0 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED �.
CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE
ROOF & A BUILDING D
HT
EXT. SHEAR/HOLD DOWNS
GENERAL FRAMING
irFIREPLACE THROAT
INTERIOR & EXTERIOR
INSULATION
(DRYWALL
SUSPENDED CEILING
iSHOWER LATH
EXTERIOR LATH
9,
•
SCRATCH (PLASTER) (2 DAY)
MASONRY PRE -GROUT
MISC. INSPECTIONS
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 ).
111;I AM EXEMPT UNDER SEC. . 0 S PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS 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 I3 IN FULL FORCE AND EFFECT.
LICENSE CLASS UO. NO. 1-' \\��
OA - t - 01. ONTRACTOR l•A••)
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
it I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
O MPENSATION, AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE, FOR THE
IyJy PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
p x I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY
'1 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 ME:
PERMIT EXTENSION
1ST EXP. LETTER
2ND EXP. LETTER
BUILDING FINAL
CARRIER
POUCY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS
(310010R LESS).
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
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 SECTION 3700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
1
DAT_ S-I-C'). 1: i`^"'^1J
RNING' FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL
SUBJECT AN EMPLOYER Ty"RIAy:INAN PENATIES CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (3100,000), IN'•.•!YR'ITIOI�TO:HE ST.OF 0 PENSATION, DAMAGES A5 PROVIDED FOR IN
SECTION 310e OFTHELPBORCGGE.RQNLEW'. AND A RNEY'S FEES.
• Adt4S:20t073.14 CING AGENCY
CERTIFICATE OF OCCUPANCY
TENANT NAME:
TYPE OF BUSINESS USE:
B2001-3459
Date Paid: 7/9/04
$1100
Hoag Memorial Hospital
PO Box 6100
. Newport Beach, CA 92658-6100
L .
1EFUNDED
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 (SEC 3007, GV.0).
LENDER'N NAME .......•• • •
• • • • • • • • • • •
•
LENDE•RSAODNES# • • • • • • ••
1 CiRTI Y'MAT•I FIVE (SEAN TESL a1 APPIO AI4 STATEy1FL4T� H •ABOVE INFORMATION IS
CORREC(. I AGREE TO COMPLY NTH ALL CIT*AND COUNTY ORDWJJICES ONO STATE LAWS RELATING
TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATVES OF THIS COUNTY TO ENTER
I UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES.
74kN4 NA%JP9S0154 • ..
ITTEE NtE:FLINT)• • • .
PIT;
I-o�
SharecABldgPermit(Back)9101
City of Newport Beach
PO Box 1768 Newport Beach, Califomia 92658-8915
Job Address: 1 HOAG DR Floor:
Inspector Area: 7 Legal Desc:
Owner.
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL
1 HOAG DRIVE
NEWPORT BEACH CA 92663
WEAVER EMILY
4850 BARRANCA #203
IRVINE CA
9491552-2061
Code Edition :
Type of Construction:
Occupancy Group:
Added/New sq ft. Bldg:
Added/New sq. ft. Garage:
No of Stories: 3
No of Units:
97
II-1 HR
B
Issued: 05/01/2002
Receipt #
Suite: Bldg: 1
Building Department
Permit Counter Telephone (949)644-3288
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date.
WATSON INVES
18162 SERRANO AVENUE
VILLA PARK CA 92667
714/974-6421
436023
03/31/2003
BT98038807
10/31/2002
Workers' Compensation Insurance - -
Carrier: STATE FUND
Policy No: 229-0019928
Expire: 01/01/2003
Building Setbacks Rear:
Front:
Left:
Right:
Use Zone.
Parking Spaces
Construction Valuation: $70,000.00
Building Permit Fee: $638.00
Plan Check Fee: $459.36
Supplemental: $0.00
Investigation Fee: $0.00
Clean Up Deposit: $1,100.00
Energy Compliance: $0.00
Fair Share: $0.0
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL
GRADING APPROVAL:
PUBLIC WORKS:
Microfilm:
Excise Tax :
Park Ded:
SJH Trans:
San Dist:
a Seismic Safety:
isabled Review:
$0.50
$0.00
$0.00
$0.00
$0.00
$0.00
$70.00
TOTAL FEE :$2,918.65
CIP Permit No: B2001-3549
Inspection RequestsTelephone (949)644-3255
Description of Work: TI/2ND FLOOR (NO PLUM)
2739-2001
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
InsnCtGf
WOOD III JACK F
4850 BARRANCA#203
IRVINE CA 92604
949-552-2061 State Lic: C015130
State Lic:
FEES
Hazardous Mat.
Add Fire Dep HMO:
Other Fee:
TOTAL PAYMENT :$0.00
$20.45
$0.00
$0.00
Fire Department:
Plan Review Fee:
Inspection Fee:
Planning Department:
Counter Review :
Zoning Plan Check:
OverTime Plan Check Fee:
TOTAL DUE: $2,918.65
OTHER DEPARTMEN
PLAN CHECK
APPROVAL TO abl+E.
WORK MUST BE START 0
OR THIS PERMIT BEC
$183.74
$446.60
5o.00
$0.00
$0.00
PERIOD OF I BS DAYS FROM THE DATE OF VALIDATION" —
AND VOID.
APPROVALS TT DATE BY ; COMMENTS
FOUNDATION:
ROUGH GRADE
CLINE & GRADE CERT/SETBACKS
ERECTION PADS
FOOTINGS
SLAB ON GRADE
_ FRAMING:
pDECK SLAB
ISUBFLOOR
IROOF & BUILDING HT
EXT. SHEAR/HOLD DOWNS
GENERAL FRAMING
.FIREPLACE THROAT
INTERIOR & EXTERIOR
INSULATION
DRYWALL
!SUSPENDED CEILING
SHOWER LATH
[EXTERIOR LATH
!SCRATCH (PLASTER) (2 DAY)
MASONRY PRE -GROUT
(yMISC. INSPECTIONS:
PERMIT EXTENSION
1ST EXP LETTER
2ND EXP LETTER
BUILDING FINAL
?CERTIFICATE OF OCCUPANCY
TENANT NAME:
TYPE OF BUSINESS USE:
r
$
DATE
TO:
REFUNDED
OWNER.BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTACTORS
LICENSE LAW FOR THE FOLLOWING REASON (SEC 70315, BUSINESS AND PROFESSIONS CODE 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 15 UCENSEO PURSUANT TO THE PROVISIONS OF THE
CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING WITH SEC 7000) Or' DIV 3 OF THE BUSINESS
AND PROFESSIONS CODE)) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE Bl515 FOR THE
ALLEGED EXEMPTION. ANY VIOLATION OF SEC 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE
APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500)
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 OFFERED 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 DR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE
E NOT INTENDED OR OFFERED FOR SALE IF,HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN
0 ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR
p SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE)
hU 1, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED a
CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044, BUSINESS AND PROFESSIONS CODE THE EE5
CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY 19510 BUILDS OR
IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED
PURSUANT TO THE CONTRACTORS LICENSE LAW )
__ I AM EXEMPT UNDER SEC B B P C FOR THIS REASON
DATE OWNER
LJCENSED CONTRACTORS DECLARATION
1 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 FORCE AND EFFECT
4 LICENSE CLASS
!D
of
L)0 NO. t �` -
ONTRACTOR iZA✓l (A yKF
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
--COMPENSATION. COMPENSATION. AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE. FOR THE
PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED
x 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 ARE:
OAT
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS
(5100) 0R LESS)
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
-. - SHALL NOT EMPLOY ANY PERSON IN 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 SECTION 3700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS
S-1-ol -„� 7t•-"-A)...iW�.�
RNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO Cn1MINA4' PEW-LTIES A60 CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN AD'ITION 7TO (HE CdST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3709 OF THE LABOR O'175INTFREP AT ND ATTARNEY'S FEES
CQAS1RULLON LENLiNG 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 (SEC 3097. CIV C
LENDEA'a LAME
LENDER' a ADOHESS'
I C'RTI'W' THAT 1 W VE SEAS TRIP APPLI 5ATIONI ANC STATE THAT THE ABOVE INFORMATION IS
CORREC-. 1 AGREE TO CCIPLY WI-H ALL OJT" AND CC'INTY OR31 JP)ICES WD STATE LAWS RELATING
TO BUILDING CONSTRUCTION AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER
UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES
imtr�.71J, ,
MITTEE NAME PEINT)T)
Shared\BIDgPetmll(Back)9101
City of Newport Beach
Building Department ELECTRICAL Permit No: E2001-1868
P.O 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 Bldg: 1 Floor: Suite: Description of Work: TI/2ND FLOOR (NO PLUM)
B2001-3549
Inspector Area: 7
Legal Dose.:
N PECTOR N TES: /j
Owner: HOAG HOSP Contractor: WATSON INVESTMENT DEVELOPMENT �� AqL S: cti1/r cf/T
Address: 1 HOAG . E Address: 18182 SERRANO AVENUE
NEWP • RT BEACH A 92663 VILLA PARK CA 92667 i /b/a` I911 ///MD( 4lD
Phone:.State 714/974-6421 67(4- O,C /te jrr l
Con. Uc.: 436023 i 4C,%
Phone:
Issued Date: 0
Processed By:
Code Edit: 96
Lic Expire: 03/31/2003
Bus. Lic.: BT98038807
Lic. Exp Date: 10/31/2002
New Construction Receotacle/Swltch/Outlets Motors/Transformers (HP/KVAI
Residential ReceplOutlets 16 $15.52 0 to 1 HP/KW/KVA
Multi -Family 0 $0.00 Fixtures 0 $0.00 1 to 10 HP/KW/KVA
1-2 Family 0 $0.00 Sep Circuit 0 $0.00 10 to 50 HP/KW/KVA
50 to 100 HP/KW/KVA
Service Slans over 100 HP/KW/KVA
0 to 600V up to 200 0 $0.00 Branch Circuit 0 $0.00
0 to 600V over 200A 0 $0.00 each Add Circuit 0 $0.00
Over 600A/1,000A 0 $0.00 Time Clocks 0 $0.00
(TON
ar
liva eby firm under
p natty o1 perjury
bSFD �m penalty of pe Nry Ihat I am licensed under provisions of Chapter 9 (commencing with Section 7030) of Division 3 of the Business and Rofes ons code, Approvals IOSDEC10r/Date
TOTAL: $40.35
Piggy Back / Temp Power
PAYMENT: $0.00
tnsptct(g
FEE
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 $3.88
Issuance $20.45
Supplemental Fee $0.00
BALANCE: $40.35
and license is in fullforce and effect.
Lice e: 434023 Class: Contractor: WATSON INVESTMENT DEVELOPMENT
Grounding Electrode
WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations Underground
I 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 performance
of the work for which Ihis permit is Issued. Underslab/Floor
I hove 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 compensaton insurance earner and policy numbers is- Rough Conduit Walls
Cartier STATE FUND Polley number. 229-0019924 Expire :91/01/2003
This section need not be completed if the permit is for one hundred dollars ($100) or less. Rough Wiring Ceilings
I certify that in the performance of ff e wc.k fur whk1.h tuts permit is issued, I s000halllll not employ any person in any manner so as to become subject to the workers' compensation laws Rough Service
of� ia, and agree that if should become sunter h tM ",leers' compensaL ovisions of Section 3700�of the labor code, I shall forthwith comply vnth those provisions
Date: S-I - 0 2. Applicant�00
Signature: 1 '. -
Temp Power
Warning. Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to onminal penalties and civil fines up to one hundred
jy100,W01, in addition to the cost of compbhsotion,pamagPs q- previd,tl :.xin Section 3706 of the labor code, interest, and attorney's fees.
I hereby acknowle dge thOi. have Ieaa thl` oppliocifion, the t 1h, in -am .atlUn given Is correct: and that I am the owner, or duly authanzed agent of the owner I agree lo
comply with city and /late lows regulating ccnstructio,,: andln doing the work authoezed thereby, no person will be employed in violaton of the labor code of the slate of
Califorrya relating to workmen's compensation insurance.
F�ermittee Name (Print) Ra &TCr 1 rv,RTSci J Address :
c c
Sign
Utility Co. Notified
Final
WORK MUST BE STARTED WITHIN A PERIOD OF 180
DAYS FROM THE DATE OF VALIDATION OR THIS
PERMIT BECOMES NULL AND VOID.
c-aaa(w-)
City of Newport Beach
Building Department MECHANICAL Permit No: H2001-1202
PO Box 1768/3300 Newport Blvd., Newport Beach, California 92658-891 Permit Counter Telephone (949)644-3288
Inspection RequestsTelephone (949)644-3255
Job Address: 1 HOAG DR Bldg: 1
Inspector Area: 7 Code Edit: 97
Owner:
Address:
Phone:
Issued Date:
Processed By:
HVAC Items
Furnaces
up to 100k Btu/ 0 $0.00
over 100k Btu/• 0 $0.00
Wall/Floor H=- rs 0 $0.00
Heat Pumps : ackage 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
over 1.75M Btu/hr 0
$0.00
$0.00
D CONTRACTORS DECLARATION
Floor: Suite:
Legal Desc.:
Contractor:
Address:
Phone:
Con. State Lic. :
Lic Expire:
Bus. Lic.:
Lic. Exp Date:
Boilers & Compressors
up to 3HP
over 3HP to 15HP
over 15HP to 30HP
aver 30HP to SOAP
over 50HP
Misc Items
Fire Dampers
Gas Line
Metal Fireplace
ICBO App.B-
0
0
0
0
0
0
0
0
Description of Work: T1/2ND FLOOR (NO PLUM)
B2001-3549
INSPECTOR NOTES
WATSON INVESTMENT DEVELOPMENT
18182 SERRANO AVENUE
VILLA PARK CA 92667 '/s/4 C Alf j
714/974.6421
436023
03/31/2003
BT98038807
10/31/2002
FEES
Ventilation
$0.00 Bathroom Fan 0 $0.00
$0.00 Exhaust Fan 0 $0.00
$0.00 Attic Fan 0 $0.00
$0.00 Down -Draft Fan 0 $0.00
$0.00 Residential Hood 0 $0.00
Commercial Hood 0 $0.00
$0.00 Repair/Alter/Add 2 $22.70
$0.00 Air Handling Units
$0.00 up to 10k cfm 0 $0.00
over 10k cfm 0 $0.00
TOTAL: $49.33 PAYMENT : $0.00
BALANCE: $49.33
by affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the business and professions code,
nd my license Is In full force and effect.
License No: 436023 Class:
pets:
Contractor: WATSON INVESTMENT 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 setidnsure 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.
I have and will maintain workers' compensation Insurance, as required by Section 3700 of the labor code, for the perlomance of the work for which this penult Is issued.
My worker compensation Insurance canter and policy number Is :
Carder STATE FUND Policy number: 229-001992a Expire: 01/01/2003
(Thls section need not he coLTple.ed if tha permit is for one hundred dollars ($100 or less).
1 certify that in the perfoman_e of the work ex which this permit Is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws
of IHonda, and agree that r I should'nrcone subject to the workers' compe Ion provisions of SS ion3700 of tpe Tibor code, I shall forthwith comply with those provisions.
a -I-&_. pplicanfSignature : n/0.APini--
thousand Failure t($1secure 0workers' s010 the
coverage.sant ni,dr ands as rsovidet foempbyeono70101 l tpenalties lane civil fines p to one hundred
[thousand dollars IS100,0001 In addlPvl'o the test of corpesabori,tlrmages as provided for In Section 3]Os of the labor code, interest, and ahomey's fees.
I hereby ack:ow.edge that a Irve .ead tnis application! this th- Iry.3matlon given Is correct; and that I am the owner, or duly authorized agent of the owner. I agree to
comply with ally and rate laws requlrt''g construction rnd In doing the work authorized thereby, no person will be employed In violation of the labor code of the state of
Califomla rekt1n- to nrohmen'e camPe.dsagon Insurance. - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .. -
P rmittee Name )Print) R10e, wafotA Address :
Snature of permlrtee:_ ' �' o. > r' /gate: 5- I -o)-
VAV Box
Other
Insptctor
Record Management Feez
Investigation fee
Plan Check
Issuance
Supplemental Fee
Approvals
Underslab/Floor
HVAC/Hood - Rough
Fireplace -Rough
Gas Test
Fireplace - Final
HVAC/Hood - Final
0 $0.00
$0.00
$0.00
$0.50
$0.00
$5.68
$20.45
$0.00
Inspector/Date
7
WORK MUST BE STARTED WITHIN A PERIOD OF 180
DAYS FROM THE DATE OF VALIDATION OR THIS
PERMIT BECOMES NULL AND VOID.