HomeMy WebLinkAboutF2016-0636 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach: CA 92660
Permit Counter Phone (949)644-3288
*F2016-0636*
FIRE Permit : F2016-0636
Project No : 2765-2016
Inspection Requests Phone (949)644-3255
0
Job Address: 1 HOAG DR NB St: 1 FI: 1
Inspector Area:
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
FIRE
HOAG MEMORIAL HOSPITAL
1 HOAG DR
NEWPORT BEACH, CA
9497644624
BRIAN/SOUTHWEST FIRE
215 E EL SUR ST
MONROVIA CA 91750
626-359-0034
Code Edit : 2013
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage: 0
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
II-A-SPR
B
3
0
X
Y
0
Legal Description:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
Description: COMM - RELO (9) FIRE SPRINKLERS "HR OPTIMIZATION"
SOUTHWEST FIRE PROT CO
215 E EL SUR ST
MONROVIA CA 91016
626-359-0034
190173
09/30/2017
BT30045570
12/31/2016
Worker's Compensation Insurance
Carrier: ZURICH AMERICAN
Policy No: WC4376407
MONROVIA CA 91750
Expire: 01/01/2017
Issued Date: 12/06/2016
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer: SOUTHWEST FIRE
Address: 215 E EL SUR ST
Phone: 626-359-0034
Special Conditions:
�c0
State Lic:
State Lic:
a
Construction Valuation: $2,877.00
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee:
Fire Plan Check Fee:
Fire Permit Fee :
Building Permit Fee :
TOTAL FEE:
$190.00
$0.00
$0.00
$0.00
$0.00
$0.00
$225.00
$417.00
FEES
Fire Residential Alarm PC Fee :
Planning Counter Review :
Planning Zoning PC Fee :
Public Works PC Fee :
Public Works Traffic Plan Check Fee;
Plan Check Fee :
$0.00
$0.00
$0.00
$0.00
$0.00
Records Management:
$0.00 Fee Due at Permit Issuance :
$2.00
$0.00
$0.00
$417.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
56-
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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 ($500).
CI II SS s>s ner of! �e:pr erty, or my employees with wages as their sole compensation, will do U all of or Q portions of the work, and the structure is not intended or offered for sale (Section 7044,
Butrg s.a,nd Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
imlrovemeents are,ingli'S6'nded or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
improved ftr the pulpose tf sale).
❑ela%gwner of the'property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
ap ply to r rvowner: f ertp arty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
❑ l aryl gxempt frofn'ITtEnsure under the Contractors' State License Law for the following reason:
By �mjasigjSture belewi 9cknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
sell a structure that have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Proyesgrbfig, Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Propertg •Owner or Authorized Agent Date
LIOENSExD CON•T$RACT OR'S DECLARATION
I hereby alum 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 my1cense is in full force
and effect. o � c LZ�b /i Contractor Signature
dGi` ._____ Class c•License No Date
/
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 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
mance of the work for which this permit is issued. Policy No.
:�' 'lye 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
ance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent
Phone #
❑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 agre
that, if I should become subject to orkers' compensatiory pro isions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. `
Date rz—/rc / f `v
Signature of Applicant
DECLARATION REG ING CONSTRUCTION LEND!t a AGFr�CM
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 Lenders Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county to gate hove-identifie�loperty for inspection purposes.
Signature of Property Owner or Authorized Agent 2 Y- Print Property Owner's or Authorized Agent's Name
YJF- KEN& Date j2/�A4
ACTION
ELATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FEDERAL REGULATIONS PART 61 OF I I I LE 40 AND
4QMDRUL E 1403.
FOR OFFICE USE ONLY
PERMIT EXPIRED
■ 1 SUBMITTEDASFIFETOS NOTIFICATION ID:
PERMIT CANER FD
® EPA
■ AQMD
PERMIT EXTENDED
E ASBESTOS NOTIFICATION IS NOT ATPPLL `APJ E 70
PROPOSED DEMOLITION.
SM,N.4TURE:.
PERMIT FINAL
J _
y N / /7
N4a- S
CERTIFICATE OF
OCCUPANCY ISSUED
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