HomeMy WebLinkAboutX2009-1789 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2009-1789
PO Box 1768 Newport Beach, California 92658-8915
Combination Type - BLDG/ / 1 I
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)6443255
Job Address: 1 HOAG DR NB
Inspector Area: 7
OF LOT
Project:
Legal Desc.:
Owner: HOAG MEMORIAL HOSPITAL FD&C
Address: 500 SUPERIOR AV, STE 300
NEWPORT BEACH CA 92663
Phone: 949-764-4486
Applicant: JASON/CAREY SIGN CORP
Address: 2871 BLUE STAR ST
ANAHEIM CA 92806
Phone: 714-6304414
Code Edit: 2007
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg: 0
Added Mew sq. ft. Garage: 0
No of Stories: 0
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Flood Zone:
Issued Date: 10/14/2009
Construction Valuation: $3 500.00
Building Permit Fee: $117.80
Plan Check Fee: $84.82
Overtime Plan Ck: $0.00
Investigation Fee: $0.00
Record Management: $4.00
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: $386.62
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Description: Ft/R (E) MONUMENT SIGN "HOAG CONFERENCE CTR"
1439-2009 1439-2009
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:
CAREY SIGN CORPORATION
2871 BLUE STAR STREET
ANAHEIM CA 92806
714-630-8414
376085
11/30/2009
BT30026535
12J31/2009
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 478-0000172
Expire: 04/01/2010
Building Setbacks Rear:
Front:
Left:
Right:
Use Zone:
Parking Spaces: 0
San Dist:
Excise Tax:
NMUSD Fee:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
FEES
Architect:
Address:
Phone:
State Lie:
Engineer: GEE DUANE JOSEPH
Address: 7827 CONVOY CT 11406
SAN DIEGO CA 92111
Phone: 858-278-2400 State Lic:C-058476
Designer:
Address:
Phone:
Special Conditions:
Fire 1-lazard Zone N
$0.00 Planning Department -
$0.00 Plan check Fee: $119.00
$0.00 Fair Share: $0.00
SJH Trans: $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
ScLoo
Plan Check Fee:
Public Works Department -
Park Dedication: $0.00
P/W Plan Check: $60.00
$tr482
• • •
•
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10011
4, • se • • • • •
• PUBLIC WORKS Ailibtitt:
PLAN CHECK BY:
• • 006 00
: • • • • • • • • •
• ArPROVAL:112 ISSUE:. •
PERMITS EXPIRE 180 DAYS AFTER ISSMIMIMQIVLASTILIKINSPEDTION.
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
• Foe Due at Permit Issuance:
Agy
$0.00
$0.00
$0.00
$0.00
$0.00
$0.80
$0.00
$301.80
t.wo5k-f-
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 checbnark(s) I have placed next to the applicable Item(s) (Section 7031.5, Business and Professions
Code: Any dry 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 Ili:ensure 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).
El I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or (_) 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
arpose of sale).
U I, as owner of the property, am exclusively contracting loath 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:1 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 bylicensed 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.govicalaw.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.
Lice e Class Licen o.
cift dr, 1 Con Ignature
ERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CWIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
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 die performance of the work for which this permit is
issued.
licy No.
I ve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
ance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
0 I certify that, In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner
so as to become subject to the works 'compensation laws of California, and agree that, if I should become subj ct to the
workers' com provision on 3700 of the Labor Code, I shall forthwith comply wi ose provls4�ns.
Signature of atA, AY
DECLARATION REGAR NG CONSTRUCTION LENDING AGENCY
I hereby affinn under penalty of perjury that there is a construction lending agency for the performance of the work for
which this permit is Issued (Secfion 3097, Civil Code).
Lender's Name '
Lender's Address
By my signature below, I certify to each of the followigg: , .•• • •••
• •
I am the property owner or authorized to act on the propertypwnplbehatf.• 60 • • • • •
•
I have read this application and the Information I have proiaTed 1. corrects • • „ •• • •
I agree to comply with all applicable city and county ordinangda Elliptate laws relating to beildin truction.
I authorize representatives of this city or county to enter the Above -identified property for in es. / A
Signature of Property Owner or Authoriz /CyP:9
Print Property Owner's or Authorized
•• ••• • • GO.
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AQM1) RULE 1403.
1:1 I SUBMITTED ASBESTOS NOTIFICATION TO:
I:1 EPA
El AQMD
o ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
01/01/2009