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HomeMy WebLinkAboutX2019-0271 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Combination Type - CIP II 18IDIPIIU PIIIIIIIUI101PIllIIII 111 COMB Permit: X2019-0271 Project No : 2292-2018 Issued Date : 02/06/2019 Inspection Area : 7 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00. am. to 6:00 p.m. No Job Address: 1 HOAG DR NB. Description. COMM =R/R SKYLIGHT @ HOAG MEDICAL CENTER Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR OF LOT Owner Address: Phone: Applicant: Address: Phone: HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH, CA 92663 DEAN/HARWOOD CONSTRUCTION 1695 CURTISS CT LA VERNE CA 91750 909-593-6555 Code Edit : 2016 Type of Construction: V-A- SPR Occupancy Group: B Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 3 No of Units :. 0 Bldg Height: 0 Bldg Sprinklers: Y = Flood Zone: Construction Valuation: $246.000.00 Building Permit Fee: $2,044.00 Plan Check Fee: $0.00. Overtime Plan Ck: $0.00. Investigation Fee:- $0.00. Record Management: $8.00 Energy Compliance:. $172.20 CA Seismic Safety: $0.00 Disabled Access : $0.00 Hazardous Mat $0.00 Building Green Fee: $10.00. TOTAL FEE : $3,019.20 Contractor: Address: Phone: HARW00D CONSTRUCTION INC 1695 CURTISS COURT LA VERNE CA 91750 909-593-6555 Con State Lic: 561049 Lic Expire: 03/31/2019 Bus Lic: BT30051371 Lic Exp Date: 06130/2019 Worker's Compensation Insurance Carrier: SECURITY NATIONAL Policy No: SWC1211416 Expire: 10/01/2019 Building Setbacks Use Zone: Excise Tax: Additional Fee : Grading Bonds Fee: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : `.. Electrical %:. Mechanical %: Plumbing %: Rear: / Front: / Left: / Right:, / Parking Spaces: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: Planning Department - Plan check Fee : Fair Share: ortr on Sundays or Holidays LIEBKE, STEVEN S 4922 PERSIMMON LANE IRVINE CA 92612 State Lic:CO28341 SCHROEDER MARK 16969 VON KARMAN #240 IRVINE CA 92606 949-474-0502 State Lic:S-004110 Fire Hazard Zone : N $0.00 $0.00 SJH Trans ; $0.00 In -lieu Housing Fee :$0.00 Public Works Department - Park Dedication : ` $0.00 PNV Plan Check $0.00 San Dist: $0.00 `. NMUSD Fee: $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Grading Bond: $2,234.20 Fee Due at Permit Issuance 0000 0o00 00 a 9 0 0 a 00 0 0 2 m o 0 0 00 r O u 0 0 0 a •6 O 00094 0 00000 0 Q03 a o aa J 0i.0 O 0 O C0 0 D O 0 0 a000 0000 $0.00 $0.00 $24.00 $197.00 $564.00 $0.00 $0.00 $0.00 $785.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: 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 (_) 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: Bymy 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. 1 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://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent - Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm unite rpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing wit on 7000) f Division 3 of the ss and Profe ode d e i ull force and effect. License Class License No De �� Wig �`ontra r gnature Mk V79 MMP,RS' COJAPOSATION DECLARATION VMRNING:4AILURPro SECIORE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1'0,000), ADDITION TO THE COOT OF•COMPENSAtIUN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I jle21iy 2ffirm under penalty of perjury one of the following declarations: .• I have and will ma..intain 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 perf;•-:• of the work for which this permit is issued. Policy No. rllgigt'ain 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 ranee carrier and policy number are: • Td{ • • [Same ofMgent Policy Number Expiration Date Phone # IIIT Mgr that, intpe performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become s a wo rs' compensation laws of California, and agree th4t,•irrshould b 9Qi iQ%ubject a workers' compe rovi ' • ns of Section 3700 of the Labor Code, I shall forthwith comply with Signature cLiVIVIKant + DECLARAN-REGARDING CONSTRUCTION LEND G AG Y I hereby affirmNu t er penalty of perjury that there is a co struction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name — -"- Lender's Address By my signature below, 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 e city and county ordinances and state laws relatin• to building construction. I authorize rep sentatives of thisity or county s - e art�,w den -d pr• , - y for inspection purposes. Signature of Pro erty Owner orgufhored Agent y '� / Print Property Owner's or Authorized RATION OF COM LIAN iiih H CODE OF FEDERAL REGULATIONS PART 61 • F TITLE 40 AND AQMD RULE 1403 ACTION PERMIT EXPIRED DATE BY ❑ I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED ❑EPA PERMIT EXTENDED DAQMD PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED 3-1-S-\y S NOT ' CATION IS NOT APPLICAB12"TO gents Name ©RAJ a 0/2(4(7 Dat % t FOR OFFICE USE O Y