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Home My WebLink AboutX2014-2002 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Combination Type - CIP ELEC II �l�I�l��J�IIIIIIIlnlIIIIIIliIIIIIIIIIIIii��III COMB Permit : X2014-2002 Project No 1621-2014 Inspection Requests Phone (949)644-3255 Job Address: 1 HOAG DR NB Issued Date : 07/30/2014 Description:COMM TI - *BLDG 47* 550 SF - REMOVAL OF EXTERIOR WALL (PRE-EXISTING OPENING STEEL COVER) FOR EQUIPMENT ACCESS (GAMMA KNIFE) Inspector Area: 7 Legal Desc.: OF LOT Owner: Address: Phone: Applicant Address: Phone: HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH, CA 92663 WOOD RICK 1800 QUAIL ST STE 120 NEWPORT BEACH CA 92660 Code Edit : Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 0 Bldg Height: Bldg Sprinklers: Flood Zone: 2013 V -B -SPR B 0 Y X Construction Valuation: $20,000.00 Building Permit Fee: ' $369.00 Plan Check Fee: $265.68 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $16.00 Energy Compliance: $55.00 CA Seismic Safety : $0.00 Disabled Access : $81.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : " $0.00 Building Green Fee : $1.00 TOTAL FEE : $871.34 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: Address: Phone: Con State Lic Lic Expire: Bus Lic: Lic Exp Date: SOUTH COUNTY CONTRACTORS 161 EXETER WAY #87 CORONA, CA 92882 949-205-6304 988175 11/30/2015 BT30048035 07/31/2015 Worker's Compensation Insurance Carrier: EXEMPT Policy No: Expire: Building Setbacks Use Zone: Excise Tax: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee Electrical %: Mechanical %: Plumbing %: $51.66 $0.00 $0.00 Plan Check Fee : Rear: I Front: / Left: / Right: / Parking Spaces: Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: INSPLCTOR WOOD JACK FREDERICK III 1800 QUAIL ST #120 NEWPORT BEACH CA 92660 949-552-2061 State Lic:C015130 WELTON JEREMY 23441 S POINTE DR #245 LAGUNA HILLS CA 92653 949-916-3440 State Lic:S-004614 Special Conditions: 0 Fire Hazard Zone : N e•*e e 0000 ••• e . e OS 0 0 0 00 03 0000 O030 e 0 000000 0 • • • e • •e • 0 • • • • oa • *000• 000000 0 e • 0 • Planning Department - $0.00 Plan check Fee : Fair Share : $0.00 SJH Trans $0.00 In -lieu Housing Fee : $0.00 Public Works Department - $0.00 Park Dedication : $0.00 P/W Plan Check : $0.00 San Dist: $0.00 NMUSD Fee: $0.00 $32.00 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit $433.68 Fee Due at Permit Issuance : PUBLIC WORKS APPROVAL: PLAN CHECK BY: e00• $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $437.66 APPROVAL TO ISSUE: PERMITS EXPIRE 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). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and 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 improvements are not intended 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 for the purpose of sale). ❑ I, as owner 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 apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge 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 I 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http:/lwww.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm andel-penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio7000) of Division 3 of the Busin s p and Profess' i/C9de and m license is in full force and effect. Llceass Class License No :WORF(ERS'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 HUNDRLfD THOUSAND DOLLARS ($100,000), IN ADDITION TO THE 00STtF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirmunde‘penalty of perjury one of the following declarations: j�• l lave and.willl•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 the terfMRnance of t atvitork for which this permit is issued. Policy No. • ❑i�rave.and wIll•I1 inta'n 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 TrTst?ance carrier and policy number are: raver• • • e yContracto Signature Policy Number Expiration Date IS me of Agent • Phone # hat,% 'hiepperformance of the work for w 'oh 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 if I should be'wfrTe'subjectjd the workeensat'on provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of A licant DECLARATI REGAREING CONSTRUCTION LENDING AGENCY I hereby affirm Mader pd'nalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Clvil Code). Lenders Name Lender's 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 core I agree to comply with all applicable city an county q dinances pyd sta I I authorize representatives of this city o unty to er the a e-I Ifie Signature of Property Owner or Authorized la ACTION RV relating to building construction. d property for inspection purposes. Print Property Owner's or Authorized Agent' Nan-DAteO PFRMITFRPIRT-R PERMIT CCITT? PERMIT EXTENDED PERMIT r CEIZ T IIFPC4 OCCUPAN F E LC / D cry DECLARATION OF COMPLIANCE KITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE AO AND AMID RUE 1403, ❑ I SNAJrTrDASrrSTr NI-ITU—KAMM TO: ❑ EPA 4WD ASBESTOSNO1IACA r POSEDDISN EMOJTIDN. SIGNA IL* FUR UFH[:i US't Ul1R1T