HomeMy WebLinkAboutX2008-0429 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2008-0429
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288
Combination Type - CIP/GRAD/ / /
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
Project :
Legal Desc.:
HOAG HOSPITAL FD&C
500 SUPERIOR AVENUE, STE. 300
NEWPORT BEACH CA 92663
949-764-4486
HOAG HOSPITAL FD&C
500 SUPERIOR AVENUE, STE. 300
NEWPORT BEACH CA 92663
949-764-4486
Code Edit :
Type of Construction:
Occupancy Group:
Added /New sq.fL Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units :
Bldg Height:
Bldg Sprinklers:
Flood Zone:
Issued Date: 09/02/2008
Description: PAD & RETAINING WALL FOR FUTURE TRANSFORMER
0414-2008 0414-2008
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:
SIMICH JOHN CONSTRUCTION INC
1400 S HARBOR BLVD
SAN PEDRO CA 90731
310-519-8203
410855
03/31/2010
8T30024974
09/02/2009
2007 Worker's Compensation Insurance
V-B Carrier: STATE FUND
U
0
0
0
0
0
N
Construction Valuation: $32,500.00
Building Permit Fee: $478.00
Plan Check Fee: $344.16
Overtime Plan Ck: $258.12
Investigatin Fee: $0.00
Record Management : $126.00
Energy Compliance: $0.00
CA Seismic Safety :
Disabled Access : $58.00
Fee Increase: Fee: $0.00
Additional Fee : $0.00
Hazardous Mat : $0.00
TOTAL FEE : $2,740.04
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Policy No: 044-0028699
Expire: 03/10/2009
Building Setbacks Rear: /
Front: /
Left: /
Right: /
0
Use Zone:
Parking Spaces:
San Dist :
Exdse Tax:
NMUSD Fee:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
$0.00
$0.00
$0.00
$584.00
$292.00
$0.00
$0.00
$0.00
$0.00
FEES
Planning Department -
Plan check Fee :
Fair Share :
SJH Trans :
Architect:
Address:
Phone: State Lic:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
HALLADAY DANA STANLEY
1181 CALIFORNIA AVE
CORONA CA 92881
951-278-9700 State Lic:C-034751
HALLADAY DANA
1181 CALIFORNIA AVE
CORONA CA
951-278-9700
Special Conditions:
$75.00
$0.00
$0.00
Public Works Department -
Park Dedication : $0.00
P/W Plan Check : $52.50
•tIa?I'Gheclt fe e� • •
• • •• •
$77.3.82,
• • • •
• • • • ' : : • • • • •
• • • • 'UBLt: N•
OflRS APPROVAL:
PLAN CHECK BY:
••• • •
•• • • APF$2OV4L j0 ISSUE:
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
INSPECTOR
$334.60
$137.66
$0.00
$0.00
$0.00
$0.00
$0.00
Fee Due at Permit Issuance : $1,966.22
PERMITS EXPIRE 180 DA YgAFJ'EJ 1961UA•SC6 C$tLA$T VALID INSPECTION.
•• • • ••• ••
ee(.T.a.nn e_ LS K-
Lez
cslick
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON
(SEC. 7031.5, BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE,
PERMIT EXPIRED
DATE:
BY:
DEMOLISH,
STATEMENT
WITH
ALLEGED
AL
OR REPAIR ANY STRUCTURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
THAT FIE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING
SEC. 7000) OF DIV. 3 OF THE BUSINESS AND PROFESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE
VIOLATION
N OF SEC.E ($500): 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF
EXEMPTION. THAN FIVE HUNDRED
NOR MORE
PERMIT CANCELLED
I,
TURE
AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUC-
IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE' THE CONTRACTORS LICENSE LAW DOES
NOT
THROUGH
THE
APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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
PERMIT EXTENSION
.
I,
BUSINESS
THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.):
AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WTH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044,
AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR
PERMIT FINAL
-! 7 ^O 9
IMPROVES
THEREON AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS
❑
I AM
LICENSE LAW.).
EXEMPT UNDER SEC B. & P.C. FOR THIS RFA.SON
CERTIFICATE OF OCCUPANCY
DATE
OWNER
TENANT NAME
LICENSED
DIVISION
CONTRACTORS DECLARATION
CENSEDIS IN FULL FORCE AND EFFECTER PENALTY OF PERJURY THAT I AM LICESED UNER PROVISIONS OF CHAPTERS (COMMENCING WITH SEC. 7000) OF
OFITT EREBY AFFMU BNUSINESS ANDRO PROFESSIONS C/ITIF,, AND MYLICENSED
TYPE OF BUSINESS
LICENS
CLASS LICENSE NO.
DATE
i
t L - [) CONTRACTOR !1i�t
FOR OFFICE USE ONLY
WORKERS'
•
SHAAND
CARR
I HEREBY
COMPENSATION DECLARATION
AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SEC 3700
THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SEC 3700 OF THE LABOR CODE, FOR THE PERFORM-
F THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
ER S /77/ /7'' ./-!%N,✓
.
POLICY NUMBER A'y K'Z a O S� 0 4�a/aq 9 - top 7) tv. c
,
. (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS WOO) OR LESS .
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I .ISSUED, I SHALL NOT PLOY ANY PERSON IN ANY MAN-
NER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATIO OF TFORNIA, AND AGR THAT IF I SHOULD BECOME SUBJECT
TO Til, E W, ORKERS COMPENSATION PROVISIONS OF `SEC. 3700 E O DE, I SHALL FORT ITH COMPL WITH THOSE PROVISIONS.
DATE' 7 - 2 " Of APPLICANT: 1( �/J--/ /%
WARNING: FAILURE TO SECURE WORKERS' COMPEENSAATIOI / COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS 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
•• •
• •1 ••• ••• • •
•TENDER'S ADDRESS •• •
• • •.
• •..
•
�•LL .
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATIONS C0tECT. N AGREE 70 COO:VWI%F% ALL
CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTIO�I.•jj4NO HEREBY AUTRORIZEREPRESENTATIVES OF
THIS CITY TO ENTER UPON THEf1BOVEE-/-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
PERMITTEE NAME (PRINT) T/CA'2J/ 12417 {`� • • •
/ • •
SIGNATURE OF PERMITTEE % j " ,X �" • • • • • ORTE • . r'-�
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