HomeMy WebLinkAboutF2010-0450 - PermitsCity of Newport Beach
Building Department FIRE COMBO Permit No: F2010-0450
PO Box 1768 Newport Beach, California 92658.8915 Permit Counter Telephone (949)6443288
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB
Inspector Area: FIRE
OF LOT
Owner.
Address:
Phone:
Applicant:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
301 N NEWPORT BLVD
ORANGE CA 92869
SOUTHWEST FIRE PROTECTION
215E EL SUR ST
MONROVIA CA 91016
626359-0034
Code Edit : 2007
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
U
0
0
0
0
Description: RELOCATE FIRE LINE TO FIRE HYDRANT
SEE 1064-2010 -
Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Contractor: SOUTHWEST FIRE PROTECTION COMPANY
Address: 215 E EL SUR STREET -
MONROVIA CA 91016
626-359-0034 - - Phone:
Con State Lic:. 190173 - Engineer:
Lic Expire: 09/30/2011 Address:
Bus Lic: BT300001854
Lic Exp Date: 01/31/2011 Phone:
Phone:
Worker's Compensation Insurance
Carrier: ZURICH AMERICAN INS CO
Policy No: 437640706
Expire: 01/01/2011
Issued Date: 12/02/2010
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Designer: Address:
Phone:
Special Conditions:
State Lic:
State Lic:
SOUTHEST FIRE PROTECTION
215E EL SURST
MONROVIA CA 91016
626-359-0034
Construction Valuation:
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee :
Fire Commercial PC Fee:
Fire Commercial Permit Fee :
Fire Residential Permit Fee :
Fire Residential Alarm Fee :
TOTAL FEE:
PROCESSEQ,Y:.•• •• IC • ••
• • • •
•ZONING APPROVAL.. ' • • •
FIRE APPROVAL
$16,900.00
$0.00
$0.00
$0.00
$0.00
$79.70
$221.40
$0.10
$30 0
• • •
•
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 :
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•• •••••• 0•
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$0.00
$0.00
$0.00
$0.00
$0.00
Records Management:
$0.00 Fee Due at Permit Issuance
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:.
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECT!
$3.10
$0.00
$0.00
$304.20
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 tpermit 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 (J all of or O 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. It, 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:httpi/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 Busine�ssss and Professions Code, and my license is 194ull for B and effect.
License ass C—/le License No. 170/ 3
WORKERS' COMPENSATION DECLARATI
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), N ADDITION TO THE COST OF
COMPENSATION, DAM GEBAS PROVIDED FOR IN SECTION 3708 OFTHELABOWCODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
❑ f 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
issued.
licy No.
I have and will maintain workers' compensation insurance, as required. by. Section 3700 of the Labor Code, for the
ormance of the work for which this permit is issued. My workers' compensation insurance carrier and police nuryber are:
r7ier7utica ,Qh1-Jcn.' Policy Number qj'7 Vo -O G Expiration.Date / /{
Name of Agent Phone #
❑ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ anyperson in any manner
so as to become subject to, the worker ' coinppeensati aws ofCaliforniaand agree that if I shouldbecomesubject to the
workers' compensation provisions/on'700 e Labor Code, I shall forthwith comply with those pr ions.
Signature of Applicant
DECLARATION REGARDING CONSTRUCTION LENDING 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 (Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature below, 1 certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
1 have read this application and the information I have provided is correct.
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 enter the e-identifie �etoperty for inspection purposes.
Signature of Property Owner or Authorized Agent / / •v .< " Date ��� a- �b
Print Property Owner's or Authorized Agent's Name:/ ✓E#"/J ''2.1
D 12 -z.—/D Contractor Si ure
Date /
ACTION
PERMIT EXPIRED
DATE:
BY:
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
FOR OFFICE USE ONLY
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01/01/2009