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Home My WebLink AboutX2010-2337 - PermitsCity of Newport Beach Building Department PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3286 Combination Type - BLDG/ ELECT r / COMB Permit No: X2010-2337 PROJECT NUMBER: 1833-2010 Inspection Requests/Telephone (949)644-3255 Job Address: 1 (CS) HOAG DR NB Description:INSTALL (N) CELL EQUIPMENT @ (E) EQUIPMENT ROOM "BLDG 22" Inspector Area: 7 OF LOT Owner: HOAG HOSPITAL FD & C Address: 500 SUPERIORAVE#300 NEWPORT BEACH CA 92663 Phone: 949-764-4486 Applicant: FREDERICK ROSIE Address: 1594 N BATAVIA ST ORANGE CA 92867 Phone: 619.244.2352 Code Edit : Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 11 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Y Flood Zone: Issued Date: 10/04/2010 2007 II•ASPR 1-2 Construction Valuation: $20 000.00 Building Permit Fee: $350.40 Plan Check Fee: $252.29 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $39.20 Energy Compliance: $0.00 CA Seismic Safety : $0.00 Disabled Access : $0.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat: $0.00 Building Green Fee : $1.00 TOTAL FEE : $844.01 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Legal Desc.: 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: X3 MANAGEMENT SERVICES INC 2780 LA M IRADA DR #A VISTA CA 92081 760.2244914 933263 06/30/2011 BT30033548 10/31/2011 Worker's Compensation Insurance Carrier: NATIONAL UNION FIRE Policy No: WC005382271 Expire: 10/01/2011 Building Setbacks Rear: I Front: I Left: I Right: I PC-38 Use Zone: Parking Spaces: Solar System PC : Excise Tax: Grading Permit Fee: Grading PC Fee: WQ Insp. Fee Electrical %: Mechanical %: Plumbing %: 0 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: State Lic: LEE SHIUH-GUANG 1594 NORTH BATAVIA ST ORANGE CA 714-685-0125 State Lic:C-061054 Special Conditions: PA2009-152 TP2009-012 Fire Hazard Zone : N $0.00 Planning Department - $0.00 Plan check Fee : Fair Share : SJH Trans : $0.00 In -lieu Housing Fee : $0.00 Public Works Department - $0.00 Park Dedication : $0.00 $30.66 $0.00 $0.00 P/W Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 Plait thetleFee;• $308.88••• • ! • • • ... • •• •• .• • • • • • PUBLIC (ARKS APPROVAL: -� $120.00 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Fee Due at Permit Issuance : $0.00 $50.46 $0.00 $0.00 $0.00 $0.00 $0.00 $535.13 ••• PLAN CHECK BY: o. • • • • • • • A�PRQV1jL TO ISSUE: PERMITS EXPIRE 180 D�'•S RFT•ER ISSIA44SCd tin {A�T 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 ['censure 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 (,j all of or ( portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: T'1e 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). 0 tam 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://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent - Date LICENSED CONTRACTOR'S 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 is in full force and effect. ice I Li se No. e/10 CrSignature WORK S' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT A PLOYER 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: 0 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 the performance of the work for which this permit is ave and will maintain workers' compensation insurance, as -required. by, Section 3700 of the Labor Code, for the _imRf:e 9f\ he wqrk for which th�i.S permit is issued. My workers' compensation insurance carrier and policy number are: Carrier I\ a1 t0na I u(\i (,v, 1-i re Policy Number ktoo5'- Expiration Date Name of Agent - Phone # ❑ I certify that, in the • :rformance of the work for which this permit is issued, -I shall not employ any person in any manner so as to become sub'- to the workers' compensation laws of California, and agree that if I should become subject to the workers' com �-a • n p V io of Section 3700 of the Labor Code, I shall forthwith comply it se pr. io Signature ofA.,• '; t __�'�' DECLARATION REGA 4NG. ZySTRUCTION LENDING AGENCY I hereby affirmunder penalty of perjury that there is a construction lending agency for the perfor ance of the work for is sued this permit is (Section 3097, Civil Code). Lender's 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 beha((! • •: • : • • : : 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 I)w4 rrltipgio building ctnstruc@tin. :- I authorize representatives pf•JFjiseity orcourrty4o..= ter the • •.ve-identified•property for insptctionpurpo Signature of Property Owner or uthorized Rgen Print Property Owner's or Authorize A i 's Name: kJ ice() -0t-c n v 01/01/2009 Da •• •• ••. • • •-• •• • • • 0 ACTION DATE: BY: PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED 11• lq-,o DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: FOR OFFICE USE ONLY