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Home My WebLink AboutF2004-0101 - PermitsCity of Newport Beach Building Department FIRE MISC Permit No: F2004-0101 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Job Address: 1 HOAG DR BIdg:1 Floor: Suite: Inspector Area: 7 Owner: Address: Phone: Applicant: Address: Phone: HOAG HOSPITAL 1 HOAG DR NEWPORT BEACH CA 92663 949-574-4488 REGIER D RANDY 2220 UNIV DR NEWPORT BEACH CA 92660 949/574-1325 Code Edit : 2001 Type of Construction. Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : 0 Legal Description: Contractor: Address: Phone: Con State Lic Lic Expire: Bus Lic: Lic Exp Date: MC CARTHY BLDG 20401 S W BIRCH ST #300 NEWPORT BEACH CA92660 949-851-8383 411173 08/3112005 BT00021561 03/31/2005 Worker's Compensation Insurance Carder: ARCH INSURANCE CO Policy No: 51WC13594800 Expire: 04/01/2005 Issued Date: 04/08/2004 Description of Work: U/G PIPING FOR GENERATOR & ADD DAY TANK 0614-2004 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: REGIER D RANDY 2220 UNIV DR NEWPORT BEACH CA 92660 N,�, 949/574-1325 State Lic: CO23842 cloy State Lic: Construction Valuation: $5,000.00 Fire Plan Check Fee : Fire Permit/Inspection Fee: Records Management: Investigation Fee: $114.00 $114.00 $54.00 $0.00 •. • • ••• TOTAL FEE : $282.00• FEES TOTAL PAYMENT : $114.00 TOTAL DUE : $168.00 $0.00 $0.00 PROCESSED BY: ZONING APPROVAL: • FIRE APPROVAL: r: • • • •• • • • • • •• ••• • • .. • • • • • •.• ••4. • • • • • • • • • • • • • • •. •• • • • • • • • •� • •. . • .• • • • • • • • • • • ••• •• • • . • • • .• •• • • •• ••. •• • • • • .•• • • OTHER DEPARTMENT: PLAN CHECK BY:: APPROVAL TO ISSUE: Kt- PERMIITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION -6z • APPROVALS /rJi / DATE BY COMMENTS OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 MI EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC. 70315, BUSINESS AND PROFESSIONS COPE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUCTURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED 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 ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500): L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE FIRE PROTECTION UNDERGROUND ROUGH PIPE THRUST BLOCKS EXCAVATION UNDERGROUND PIPING FLUSH UNDERGROUND HYDRO TEST UNDERGROUND/BACKFLOW APRV. COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS UCENSE 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 IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.). 1, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS COOE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORIS) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW.). I AM EXEMPT UNDER SEC. B el PC. FOR THIS REASON SPRINKLER HYDRO TEST SPRINKLER FLOW TEST SPRINKLER ROUGH PIPE STANDPIPE HYDRO TEST STANDPIPE FLOW TEST STANDPIPE ROUGH PIPE CHEM SYSTEM FUNCTION TEST CHEM SYSTEM APPROVAL DATE OWNER FIRE ALARM SYSTEM LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF OMSION 3 OF THE BUSINESS ALIO PROFESSIONS CODE, AND MY UCENSE IS IN FULL FORCE AND EFFECT. LICENSE CCL4SS LIG. NO. ROUGH WIRING SYSTEM FUNCTION TEST CENTRAL STATION MONITOR / //,•- DATE / I/ 5A1/ CONTRACTOR xiteCC��-Ci J-L i WORKERS' COMPENSATION DECLARATION / 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' '''"i PENSATION, AS PROVIDED FOR BY SECTION 3ID0 OF THE LABOR CODE, FOR THE IMP-; ORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. FIRE MISC. TANK REMOVAL TANK INSTALLATION/TEST TANK PIPING PRESSURE TEST1 / VE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH MEDICAL GAS PIPING TEST ECTION 3700 THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POUCY NUMBER ARE: CARRIER • CROSS CONNECTION POLICY NUMBER INSPECTIONS: (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO - T TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA. AND AGREE 'T IF I SHOUL• BECOME SUBJECT TO E RKERS' COMPENSATION PROVISIONS OF S- TION3700 OF T ELABOR DE,I O WITH COMPLYWITH THOSE Pr(: ),ILN DATE. • • AIi4I / dr•03 WARNING: FAILURE TO SECURE ~KISS' CSMPEN 'TJON C RAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRRAMAL MIALTtS AND CI'iL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITtNI T TH�C�*OFCCMP!NSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR C •c, T EST,tND ATTeRNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY POR THE PERFORMANCE R• •HE WONT( FOR WHICH TMIS PERMIT IS ISSUED (SEC3097. CIVC.). •••• • • • • •• • • •• • • • • ••••• LENDERS IMP • • • • • 0 • • LENDERS ADOAESS• I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 15 CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENT. R UP&PTHP#&E < ESIROPE0IE FOR INSPECTION PURPOSES. FINAL // , (/ . - City of Newport Beach Building Department PO Box 1768 Newport Beach, California 92658-8915 - Permit Counter Telephone (949)644-3288 FIRE MISC Permit No: F2004-0101 Inspection Requests/Telephone (949)644-3255 Job Address: 1 HOAG DR BIdg:1 Floor: Suite: Inspector Area: 7 Owner: " Address: Phone: Applicant Address: Phone: HOAG HOSPITAL. 1 HOAG DR NEWPORT BEACH CA 92663 949-574-4488 REGIER D RANDY 2220 UNIV DR - NEWPORT BEACH CA 92660 949/574-1325 Code Edit: 2001 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: - No of Units : 0 Legal Description: Contractor: MC CARTHY BLDG Address: 20401 S W BIRCH ST #300 NEWPORT BEACH CA92660 Phone: 949-851-8383 Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: 411173 08/31 /2005 BT00021561 03/31/2005 Worker's Compensation Insurance Cartier: ARCH INSURANCE CO. Policy No: 51WC13594800 Expire: 04/01/2005 Issued Date: 04/08/2004 Description of Work: U/G PIPING FOR GENERATOR & ADD DAY TANK 0614-2004 - - - Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: REGIER D RANDY 2220 UNIV DR NEWPORT BEACH CA92660 949/574-1325 - State Lic: CO23842 State Lic: Construction Valuation: $5,000.00 Fire Plan Check Fee : Fire Permit/Inspection Fee: Records Management: Investigation Fee: $114.00 $114.00 $54.00 $0.00 TOTAL FEE : $282.00 FEES TOTAL PAYMENT : $114.00 TOTAL DUE : $168.00 $0.00 $0.00 PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL .`. v 3 n ad cao. :W V C Li v OTHER DEPARTMENT: PLAN CHECK BY:: APPROVAL TO ISSUE: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION APPROVALS DATE BY COMMENTS FIRE PROTECTION UNDERGROUND ROUGH PIPE THRUST BLOCKS EXCAVATION UNDERGROUND PIPING FLUSH UNDERGROUND HYDRO TEST UNDERGROUNDBACKFLOW APRV. SPRINKLER HYDRO TEST SPRINKLER FLOW TEST SPRINKLER ROUGH PIPE STANDPIPE HYDRO TEST STANDPIPE FLOW TEST STANDPIPE ROUGH PIPE CHEM SYSTEM FUNCTION TEST CHEM SYSTEM APPROVAL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE' CONTRACTORS LICENSE LAW FOR THE FOLLOIMNG REASON (SEC. 7031.5, BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT. ALTER IMPROVE, DEMOaH, OR REPAIR ANY STRUCTURE PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS UCENSE LAW (CHAPTER 9 (COMMENCING WITH SEC 7000) OF DM. 3 OF THE BUSINESS AND PROFESSIONS CODE)) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031.5 BY ANY APPUCANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACMLPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (S500): AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, VALL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN °INNER 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 15 SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). I, AS OWNER OF THE PROPERTY, MI EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW.). - I AM EXEMPT UNDER SEC. BA P.C. FOR THIS REASON DATE OWNER FIRE ALARM SYSTEM ROUGH WIRING SYSTEM FUNCTION TEST CENTRAL STATION MONITOR FIRE MISC. TANK REMOVAL TANK INSTALLATION/TEST TANK PIPING PRESSURE TEST MEDICAL GAS PIPING TEST CROSS CONNECTION TEST r'er -.3s6ecc LICENSED CONTRACTORS 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 UCENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIG NO. DATE CONTRACTOR MISC. INSPECTIONS: WORKERS' COMPENSATION DECLARATION - - 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' C MPENSATION. AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100)OR LESS). - 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 WORKERS COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE ., QT" .- DLICALTJ WARNING: FAILURE TOSECIZ,RE WCFIKFNS CIIMPENSATTIN COVERAGE IS UNLAWFUL, AND SHALL' SUBJECT AN EMPLOYER TO CR')C'CL PJ0.LT:T3 AND CF1L FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,000), IN ADOIT.ON TOTH: CCSJOF.COMF_NSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COb .ATEREST,,AND A.TORREYS FEES. - CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY :OR THE F_RFORN,WCEQ 31E WOD( FOR � )1ICH P115 PERM? IS ISSUED (SEC.3097, CIV.CJ. 3 3 ' vCr. J ' _3 .. �J -; 0 N 3O0 3 ;0 ) J .3 CI 0 'J CI J:]J ,. LENDER'SO h _} ' u , .3 ,3 3 J LENDERS ADc,ESS"I " `J � -J _a FINAL I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UP:MTHCF3GVE:ACJCTONEC CBOPECDJT EC) INSPECTION PURPOSES 13 � 'J J1 J J 4 Cr J J J 1 1 I 1 PERMITTEE NAME(PRAT)0 Li. 9 ' 30 V,J —77rWE OF PERMITTFF