HomeMy WebLinkAboutX2007-3096 - PermitsCity of Newport Beach
Building Department
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288
Combination Type - CIP/ GRAD/ ELEC/ /
COMB Permit No: X2007-3096
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB
Inspector Area: 7
OF LOT
Owner: HOAG HOSPITAL FD&C
BALBONA JOSEPH
Address: 500 SUPERIOR AVE STE 300
NEWPORT BEACH CA 92663
Phone: 949-764-4486
Applicant: BALBONA JOSEPFi
Address: 10980 WILSHIRE BLVD
LOS ANGELES CA 90024
Phone: 310-473-3555
Code Edit : 2001
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 0
No of Units: 0
Bldg Height: 0
Bldg Sprinklers:
Flood Zone:
Issued Date: 05/14/2008
Construction Valuation: $1,000,000.00
Building Permit Fee: $5,455.00
Plan Check Fee: $3,927.60
Overtime Plan Ck: $0.00
Investigatin Fee: $0.00
Record Management : $130.00
Energy Compliance: $0.00
CA Seismic Safety : $0.00
Disabled Access : $582.00
Fee Increase: Fee: $0.00
Additional Fee : $0.00
Hazardous Mat: $25.00
TOTAL FEE : $12,256.23
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
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Project :
Legal Desc.:
Description: INSTL UNDRGRND CONDUITS (FIBEROPTIC ROUTE)
2612-2007 2612-2007 (SOUTH CAMPUS)
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:
Worker's Compens
Carrier:
Policy No:
Expire:
Building Setbacks
San Dist :
Excise Tax:
NMUSD Fee:
SYSKA HENNESSY GROUP CONSTRUCTION INC Architect:
11500 W OLYMPIC BLVD
LOS ANGELES CA90064
310-312-0200
752617
08/31/2008
ation Insurance
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
NATL UNION FIRE Address:
WC5315162
04/01/2009 Phone:
Rear: /
Front: /
Left: /
Right: /
Use Zone:
Parking Spaces: 0
$0.00
$0.00
$0.00
Grading Permit Fee: $598.00
Grading PC Fee: $299.00
WQ Insp. Fee : 50.00
Electrical %: $954.63
Mechanical %: $0.00
Plumbing %: $0.00
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•• •• • • ••• APPROVAL TO ISSUE:
FEES
Planning Department -
Plan check Fee :
Fair Share :
SJH Trans :
INSPecrO1i
10980 WILSHIRE BLVD
LOS ANGELES CA 90024
310-473-3555 State Lic:C006451
BLACK JOHN
PO BOX 260875
ENCINO CA 91426-0875
State Lic:C-021510
Special Conditions:
$75.00
$0.00
$0.00
Public Works Department -
Park Dedication : $0.00
PAN Plan Check : $210.00
Plan Check Fee : $4,417.53
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID 1NSPECTIO
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$0.00
$0.00
$0.00
S0.00
$0.00
$0.00
$0.00
Fee Due at Permit Issuance : $7,838.70
1
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS UCENSE LAW FOR THE FOLLOWING REASON
(SEC. 7031.5, BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE,
PERMIT EXPIRED
DATE:
BY:
DEMOLISH. OR REPAIR ANY STRUCTURE. PRIOR TO ITS ISSUANCE, ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING
WITH SEC. 7000) OF DIV. 3 OF THE BUSINESS AND PROFESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE
N OF SE SEC.
ALLEGED � NOR MORE NO FIVEY VIOLATION
7031; 5 BY ANY APPUCANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF
PERMIT CANCELLED
I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK, AND THE STRUC-
TURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES
NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER.
THE BUILDING OR IMPROVEMENT I SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING
PERMIT EXTENSION
■
I.
BUSINESS
IMPROVES
THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.):
AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044,
AND PROFESSIONS COOS: THE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR
THEREON AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) UCENSED PURSUANT TO THE CONTRACTORS
PERMIT FINAL
3-t7._- to
V`-'
MILICSE
I AM
EN LAW.).
EXEMPT UNDER SEC B.S P.D. FOR THIS REASON
CERTIFICATE OF OCCUPANCY
DATE
OWNER
TENANT NAME
LICENSED
CONTRACTORS DECLARATION
ER PENALTY OF THAT I AM ICENSED UNDER PROVISIONS OF CHAPTER (COMMENCING WITH SEC. 7000) OF
AFFIRM UUSIINESS
TYPE OF BUSINESS
DNIESION
CODE, ANOURY
3 OF THEAND PROFESSIONS MY LICENSE IS I FULL FORCE AND EFFECT.
LICENSE
CLASS UCENSE NO.
nTE
0 CTOR SICOF lig.WNTS5Ly
FOR OFFICE USE ONLY
WORKERS'
■
I HAVE
0
I HAVE
ANCE
CARRIER
COMPENS ION DECLARATION
I HEREBY AFFIRM UNDER PE TY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SEC 3700
OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
ANO WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SEC 3700 OF THE LABOR CODE, FOR THE PERFORM-
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POUCY NUMBER ARE:
POLICY NUMBER
■
1 CERTIFY
NER
TO
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS MOO) OR LESS).
THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MAN-
SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT
THE W OR , S COMPENSATION PROVISIONS OF `��QO OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WNH THOSE PROVISIONS.
i Ot
WARNINGlIJ: FFMLURRE1TOO SECURE •' 1 - -' COMPENSATION COVERAGE_IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
NACRES AND CIVIL FINES UP TO • E HUNDRED THOUSAND DOLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS PROVIDED FOR IN SEC. 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
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 (SEC. 3097, CN.C).
LENDER'S NAME
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LENDER'S ADDRESS
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1 CERTIFY THAT 1 HAVE READ THIS APPLICATOR
CITY AND COUNTY ORDINANCES AND STATE LAWS
THIS CITY TO ENTER UPON THE ABOVE -MENTIONED
NAME (PRINT) COPS 'i
AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF
PROPERTY FOR INSPECTION PURPOSES
MAt6L I V
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TURF OF PERMITTEE
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