HomeMy WebLinkAboutF2007-0046 - PermitsCity of Newport Beach Building Department
FIRE COMBO Permit No: F2007-0046
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 NB
Inspector Area:_Y
OF LOT
Owner. HOAG MEMORIAL HOSPITAL
Address: 1 HOAG DR
NEWPORT BEACH CA 92660
Phone:
Applicant: PANDOLFI LOUIS/GEO SCIENCE
Address: 608 HAILEY CT
SIMI VALLEY CA 93065
Phone: 805/526-6532
Code Edit : 2001
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:
V-N,SPR
E3
0
0
1
0
Y
Description: METHANE GAS MITIGATION "CHILD CARE CENTER"
0210-2007
Legal Description: 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:
RAYCON ENVIRONMENTAL INC
3287 WOODLEY AVENUE
THOUSAND OAKS CA 91362
805/955-0900
822958
08/31/2007
BT30018120
06130/2007
Worker's Compensation Insurance
Carrier: SURETY CO OF PACIFIC
Policy No: ADP32765102
Expire: 04/01/2007
Issued Date: 03/14/2007
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
BERRY ROLLIE
608 HAILEY CT
SIMI VALLEY CA 93065
8051526-6532 State Lic: C-017223
Special Conditions: (2) OR MORE TRADES
Construction Valuation:
Building Overtime Plan Check :
Plan check Exten Fee:
$10,000.00
$0.00
$0.00
FEES
Fire Plan Check Fee :
Fire Permit/Inspection Fee:
Records Management:
Investigation Fee:
Residential Issuance Fee
$131.90
$183.20
$35.00
$0.00
$0.00
TOTAL FEE : $637.10 TOTAL PAYMENT : $131.90 TOTAL DUE : $505.20
PC FEE
Counter Review:
Zoning Plan Check Fee:
$212.00
$0.00
$0.00
$75.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
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OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
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PERMIT EXPIRES:180 44tS :AFTER lt`SLANCE OR LAST VALID INSPECTION
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OWNER -BUILDER DECLARATION •
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON
DEMOLISH. OR REPAIRANYANYDSTRUCTURE, PRIOR FESSIONS TO ITS ISSUANCE, ALSO REQUIRES : ANY CITY OR COUNTY WHICH THEAPPUCANTFOR SUCH PERMA PERMIT TO IT ALTER,
O FIIiE A SIGNED
PERMIT EXPIRED
DATE:
BY:
STATEMENT
WITH
ALLEGED
NOR
II
THAT HE OR SHE LS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING
SEC. 7000) OF DIV. 3 OF THE BUSINESS AND PROFESSIONS COOE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE
EXEMPTION. ANY VIOLATION OF SEC. 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF
MORE THAN FIVE HUNDRED DOLLARS ($500):
1, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
PERMIT CANCELLED
TORE
NOT
COMPENSATION, WILL 00 THE WORK AND THE STRUC
IS NOT INTENDED OR OFFERED FOR SALE (SEC. 704E BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS UCENSE LAW DOES
APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR. HERSELF OR
THROUGH
THE
THAT
HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,
BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING
FIE OR SHE DID NOT BUILD R IMPROVE FOR THE PURPOSE OF SALE.):
PERMIT EXTENSION
•
7044,
BUILDS
TRACTORS
I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC.
BUSINESS AND P ROFESSIONS COOS: THE CONSTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO
OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CON-
LICENSE LAW-}
FIRE PROTECTION
PERMIT FINAL
$ —I ? -O$
•4
•
I AM EXEMPT UNDER SEC B. & P.C. FOR THIS REASON
DATE OWNER
FOR OFFICE USE ONLY
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SEC. 7000) OF
DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCT AND EFFECT. LICENSE CLASS LICENSE NO.
tTE .I r 0-2_ CONTRA
OP
ORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
AND WILL MAINTAIN A CERTFCCATE OF CONENT TO SELF•INSUE FOR WORKERS' COMPENSATION, AS PROVIDED FR BY SEC 3700
BOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED.
pi AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SEC 3700 OF THE LABOR CODE, FOR THE PERFORM -
THE WORK FOR WHICH THIS PERMIT IS 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, 1 SHALL NOT EMPLOY ANY PERSON IN ANY
MANNER SO AS TO BECOME SUBJECT TO THE WJ' ' COMPENSATION LAWS OF CALFORNIA, AND AGREETHAT IF I SHOULD BECOME
SUBJECT TO THE WORK' COMPENSATION P• • • OF . 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE
PROVISIONS. ✓G'
✓
DAT APPLH + r •. ' `
'
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARS ($100,000). IN ADDITION TO THE COST R COMPENSATION. DAMAGES
A5 PROVIDED FOR IN SEC. 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S 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, CIV,C). - LENDER'S NAME • • •
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LENDER'S ADDRESS•• • • ••• •
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I CERTIFY THAT I HAVE READ THIS APPLCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREWT10•COMPL EA
AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES
COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FO INS ECTION PURPoSES.
PERMRTE RINT) �L-� l-r •
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1/23/07 rev