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Home My WebLink AboutB2000-3256 - PermitsBLDG Permit No: B2000-3256 City of Newport Beach Building Department 3300 Newport Blvd -PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255 Job Addrest. 1 HOAG DR Floor: Inspector Area 7 Owner: Address: Phone: Applicant: Address: Phone: Suite: HOAG MEMORIAL HOSPITAL PRESBY 1 HOAG DR, BOX 6100 NEWPORT BEACH CA92658 949/574-4483 CHARTIER DAVID 296 REDONDO AVE LONG BEACH CA90803 562/987-4666 Code Edition: 97 Type of Construction: 1 -SPR Occupancy Group: 11.1 Added/New sq.R. Bldg; N Added/New sq. ft. Garage: N No of Stories: 0 No of Units : Receipt Number: Bldg: 1 Legal Descr: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: WATSON INVES 18182 SERRANO AVENUE VILLA PARK CA 714/974-6421 436023 03/31/2003 BT98038807 10/31/2001 Workers' Compensation l surance-- Canier: ST UND Policy No: 229-09928 Expire: 01/01/2002 Building SetbacksRear: Font:. Left:, Right: Use Zone; Parking Spaces Construction Valuation: $85.000.00 Building Permit Fee : $694.75 Plan Check Fee: $500.22 Investigation Fee: $0.00 Clean Up Deposit: $1,100.00 Disabled Access: $68.00 PROCESSED BY: PLANNING APPROVAL: FIRE APPPO"A.L: GRADING APPROVAL - PUBLIC WORKS: Microfilm: Excise Tax- Res.: Excise Tax- Com.: Supplemental P/C: Fair Share: TOTAL FEE : $3,110.74 $34.20 $0.00 $0.00 $0.00 $0.00 / / Description of Work; CONVERT EXT COURTYARD INTO COFFEE COURTYARD 2639-2000 541 499 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: CHARTIER DAVID 296 REDONDO AVE LONG BEACH CA 90803 5621987-4666 State Lic: C015736 Special Conditions: State Lic: FEES Hazardous Mat Disclosure: CA Seismic Safety: Fire Dep - Plan Review: Fire Dep - Inspection: $0.00 $0.00 $0.00 $200.09 $486.33 TOTAL PAYMENT : $199.93 TOTAL DUE : $2,910.81 OTHER DEPARTMENT: PLAN CHECK BY: APPROVAL TO ISSUE: Planning Dep - - Plan Check:\$27.15 . Counter Rev.:�/f' $0.00 \j OverTime Plan Check Fee: $0.00 ,4 L ?oa,1 WORK MUST BE STARTED WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT -BECOMES NULL AND VOID. �o2P32 APPROVALS DATE BY COMMENTS FOUNDATION: ROUGH GRADE LINE & GRADE CERT/SETBACKS ERECTION PADS FOOTINGS SLAB ON GRADE DECK SLAB FRAMING SUBFLOOR ROOF & BUILDING HT EXT. SHEAR/HOLD DOWNS GENERAL FRAMING OWNER -BUILDER DECLARATION ! HEREON AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FO1101NN0 REASON (SEC. 7031.5. BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT ALTER. IMPROVE. DEMOLISH. OR REPAIR ANY STRUCTURE. PRIOR TO ITS ISSUAINCE, ALSO REOUIRE3 THE AFPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO T HC PROVISIONS O. ➢,E "ONTRACTORS LICENSE LAW !CHAPTER 9 (COMMENCING WHH SEC 101'J) OF DIV. 3OF THE BUSINESS AND PROFESSIONS COOEB OR THAI HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031.5 SY ANY PPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO 4 GIVE PENALTY OF NOT MORE THAN FIVE NUNORED DOLLARS !$500): D I, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THE.R SOLE COMPENSATION. WILL 00 THE WORN, AND THE STRUCTURE :S 7I0T INTENDED OR OFFERED FOR SALE (SEC 3044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO ODES SUCH WORK HIMSELF OR HERSELF OR THROUGI! HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER, THE BUILDING OR IMPROVEMENT S SOLD WITHIN ONE YEAR OF COMPLE-IQN. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.). El I. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 1014, BUSINESS AND PROFESSIONS CODE' THE CONTRAO TORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BOLDS OR ''PROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORIS) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW.) ❑ 1 AM EXEMPT UNDER SECS......—__- _ _.. 6&PC. FOR THIS REASON CATE NSULATION DRYWALL SUSPENDED CEILING PLASTERING: INTERIOR LATH EXTERIOR LATH SCRATCH (2 DAY) MASONRY FOOTING LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER E (COMMENCING WITH SECTION 7700) OF DIVISION 3 OF 'I HE DUSINE55 AND PROFESSIONS CODE. AND 10F LICENSE 15 IN FULL FORCE AND EFFECT. GATE S•1 ut CONTRACTOR /341-9.4-1._._____ WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE F0tL0WING DECLARATIONS'. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COSPENSA'lON, AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEIL'AT IS iSOE. PRE -GROUT 3 FIREPLACE MISC. INSPECTIONS: PERMIT EXTENSION 1ST EXP LETTER 2ND EXP. LETTER PERMIT EXPIRED PERMIT CANCELED FINAL yCERTIFICATE OF OCCUPANCY TENANT NAME: TYPE OF BUSINESS USE: $ woo. DATE TO: di }10102 Ii o a l '' Memoria P .poxkt00 liePori ea Gift I C gZto REFUNDED I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOUIREO BY SE.,TIaN 4700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER ANC POLICY NUMBER ARE CARRIER DATEoiCu— WARNING', FAILURE TO SECURE WOR.5R.,' COM.PEI.S,IGN COVERAGE 1S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRV.IINM, .3ENgLTlES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000). IN ADDITIONTO THE PUS! CF CDMPEPSATION, DAMAGES AS PROVIDED FOR 1N SECTION 3700 OF THE LABOR CODE 'rERFST. AHD ATT IENEYS FEES. POLICY NUMBER. _......... RN155EOTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100)ORLESS. 1 CERTFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I 5 ALA NOT EMPLOY h.Y 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 370E OF THE IT490R CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVIS1.0. �I'ol APPI)CANPQ1�W1 CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE 0P TIF WORK FOR WPICH THIS PERMIT IS ISSUED (SE0.3097, CIV.C.).. LENDER'S NAME' LENDERS ADORt3 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 ANC STATE LAWS RELATING TO BUILDING CONSTRUCTION AND HEREBY AUTHORQE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON PT W11'1. MEITT!'ED PE ❑ERR RJR I.ISPECTICN PURPOSES. 1_ Ril- ' L4Ia-r CY/J yPERMITTEEENNAAME (PRP IT) J — 1' . k LJOCR/iei s-l-D OATS RMITTFE CIVIL ENGINEER's CERTIFICATION FORM City of Newport Beach From: BOYLE ENGINEERING 2096 S. GRAND AVE #A SANTA ANA, CA. 92705 3300 Newport Blvd PO Box 1768 Date: 4/30/02 Newport Beach, CA 92658-8915 Attention: Grading Engineer, Building Department GPC No.: Project Names: Project Address: Owner/Developer: Type of' Project: Tract/Subdivision/Lot No.: Rough Final X Hoag Hospital South EntrY Courtyards Hoag Memorial Hopital Presbyterian • Tract • Drainage X • Commercial • Other Exterior Patio drainage • Industrial Yardage for Project: N/A • Cut • Borrow • Fill • Export I hereby approve the grading for this project in accordance with my responsibilities under the City Grading Code. I have inspected the project and hereby certify that all areas exhibit positive surface flow to public ways or City approved drainage devices. The grading has been completed: in conformance with, X with the following changes to, the approved grading plan. Description of Changes: Small modifications to the curb shapes as requested by Hoag Facilities and Design, Leif Thompson. Company: Name: License No.: Boyle Engineering David A Boyle rint) R.C.E 1 p559 (RCE/LS) City of Newport Beach Building Department GRADING Permit No: G2000-0427 PO Box 176813300 Newport Blvd., Newport Beach, California 92656-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Floor: Suite: Bldg: 1 Description of Work: DRAINAGE FOR COURTYARD 2639-2000 Inspector Area 7 Code Edit: 97 Legal Desc.: ID Address: 1 HOAG DR, Owner: HOAG MEMORIAL ( 61HOSPITAL PRESBY ContractAddress: 18182 SERRANO AVENUE Address: 296 REDONDO WATSON INVES Architect: CHARTIER VAVE '�s^Car NEWPORT BEACH CA 92658 VILLA PARK CA LONG BEACH CA 90803 fOr Phone: 949/574-4488 Phone: 7141974-6421 Phone: 562/987-4666 State Lic: C015736 Applicant: CHARTIER DAVID Con. State Lic.: 436023 Engineer: Address: 296 REDONDO AVE Lic Expire: 03/31/2003 Address: LONG BEACH CA90803 Bus. Lic.: BT98038807 Phone: 562/9874666 Lic. Exp Date: 10/31/2001 Phone: State Lic: Geo. Tech, Engr.: Workers' Compensation Insurance - - Designer: Carrier: STATE FUND Address: Policy No: 229-0019928 Phone: Expire: 01101/2002 Phone: State Lic: Address: Valuation: $0.00 Yardage FILL: 0 Yardage CUT: 0 Issued : Grading Permit: N Drainage Permit: Y Plan Check Fee: Permit Fee: Investigation Fee: Clean Up Deposit : $98.00 $98.00 $0.00 $100.00 Planning Dept - Counter Review : Zoning Plan CK : Fair Share : $13.10 $0.00 $0.00 FEES Special Conditions: ?7 SJH Trans Corridor: Park Ded Fee : Record Mgmt: $0.00 $0.00 $0.27 TOTAL FEE : $309.37 TOTAL PAYMENT : $202.50 TOTAL DUE : $106.87 $0.00 $0.00 PROCESSED BY: PLANNING: TRAFFIC: SdRdIVtS'ON: OTHER DEPARTMENT: PLAN CHECK BY: APPROVAL TO ISSUE: WORK MUST BE STARTED WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOID. gif ”7 APPROVALS PREGRADE MEETING GRADING INSPECTION AREA DRAINS ROUGH GRADE s ,OU'r• P ' °'-'EU ROUGH GRADE FP ROVA, PREPAVING MEETtNf CURB AND GUTTER PAVEMENT SLI[sGRA[)E AGGREGATE 13,6, 3 FLATWCRK STORM DRAIN ATCH BASN EROSION CONTROL OTHER PRECISE GRAUIi4E DOCUMENTS FINAL GRADING 1 ,SPORT AP ROvItD FINAL CERTIFICATE TYPE ROUGH GRADE RENC K', FINAL GRADING REPORT CIVIL CERTIFICATE SLAB ELEVATION CERTIFICAT ❑ i FIRM COMMENT DATE0112OiOZ TO: __--14oa-memoil 41 Hoseka1 __ P 9_8o ntewpo r# 1a�bl; e�—�f21$-4e- O WNER-BUILDER DECLARATf0k 1 75RS5Y LFrIr1 v C•O0I P00411Y (Jr pF'`I;RA TN0.: AM 0XLYi ➢ , a VSr THE CCMFA0t0t stt"-t- L Cdt =' Y''AL 'r411 6 L1U SE S AhS l'ACF_S1Th S CCO* FY: ft 1 f Y WHE4'. CLP.ZE5 R PER 10 !NEFvc'T AVIER, IM'RpJ1 LY 70 31 OR • '.1:;PJ2' P 0 1r5 RREORNC.E, ARA, mfzivws.kB 40-7 -., t 7 f Rk SIC-N“).57ATEM475.7 P."A"ri00 S£.06-.EN 10 (oA0 `.JT PRAESEPE. 14 Uf0.l:E mix BCI.:c+CPK i, ➢(,b- ..r RN,/ 20-•SIF 'J f. Jrt IHi dC i :rA , t,< M rtiRRAFROP. ANO1Vi fs'.filri 44: AT V /1 4NV ..1`ftl^jL r Yto, A ^EA,A1 ALIT A: NOT MOM. THAT, E .c' 14,`GT2=0 0. f -•:913 xj 5!1 0„ES :.Y ?ALA SA:RR ;Et)(&<O C1C0'�Ci11LE l/J'luci(F P..O D ra tar, (RC ' M.6 10 a xt;ata-nre CVG 14 I_ tix.0 a tot -5S. Y9 04 H [ JC '4i,A T+ .04 fA' E.1L E 1 r ! cf 111Prt .-+:S C 6L 1H 07) 43 7 0 C)4, Tl ELAR ROAT PC.ecrt n. :'4.JAIn411! CO* giRO Ef7 Yq@7 P ltG f ay{ JFF:' A) ROaRTYW E =%t R71 :IEH Y I 0PR:AkeT 0771 ✓S�c lalr-.cnsuT rn.ncnklu;c`r(s7 r if Ppi DCON rNNAc I0PSD_t 741ION g I -ur.r 4 r r Act 0 c Y) T. t L 0: Ta -4 H Y n uv.' r A A, rn4 t v n. 5v f 4 ! D 4 o.: vl .e -n, I 1 Fof lays 6 J.Rht W.VAI,ARRE,Rt ,cu WORKERS' COMPEUSA/FON IJECL4R/TICN w"IP-3 t;N0 i FF ` r? t✓ mlPl+' CM Cr 1116;'Y . 701 v) :: RCL.A4:fb43' I RAVE AN!.: Wri M4.1,441Y1., CirR 'AIE C—Cdl7 J Z..n.,-;AR"RAE roo L.i.CRXR: CfAliPEN:RATrON. 4 J:. i. - i ..":T (q: 3- U ?D(J. i_1..i. rs?'2 rk PSA (ARIAAA Y i}F : WE IAA:R,. RAP'rt'HcA 1' 31FF0i11i IS Ft' [J HAVI2 wia .i! :J RYLMEr_ 007/0'aAS4,,...J,,U.1H'h'c, iR='-JL. r&'! E 1 1N ANO rm,. T.l- T56C¢ 000 e P.PrCW ARN OF If: t 0 4 0C i.1 ArRID f ERAAI L: 4J.'„ 7Sl VA-A,R.TRFALA C J I .,AWN ; hS i ♦w Cy0Ei1 j. an POI 'h:4'JE:2 ARE • AP1E.6 mr2,,eNn �., r.~ra: r[:-. .L ru;.•z4 A f ur (n.h Fw,. r.>•u.NS 1 FAR) 77:l1v r-ISr IN ) RrORIA' G- C:.SFd HCR V41-1+0:17..'.C° `AIF1.) S 1 -4l hXi pY' RE TO SCo 4 I:ds FS', i I Pt y. M, ft ,44 :0 LNrA irA PA) S14141 '0 Itd :R : fy4410 E4L' ' 'LLflp f Fp 1.4Er JDa PARR `A.1 CGS1 Y'' ry 4tYAYrt ',RE CO h;CR ATClD MEIES 3S ,v4 lt4:L;U'N CNJ 5 `PIr:Ffth , ITFES e:FAS P:C4i.4FA [ CONSTRUCTION I.EN DING AGYNtaY ti.4 WA UNDEk PENARTA c+?:JAriv 145('oA' s r, 5:76 :I PCF.*Oi` +or RAJAH FON '4JLd 11-I`9 PERMIT 1:i F.:r c,.i.G wenk t,V,S, CR,o_--,.. v. grgl 1.31ro.':: `rl I 1rr;04,4 ERAR.RCI ( F`u A YF -bt ONE C `h.47.4. 0. Tor .A'C*' • Ara' l ti .11'nGI `YLl\PI Ov'.GhO l3 Ah �- (3' L. S NA, 17 Cr City of Newport Beach Building Department ELECTRICAL Permit No: E2000-1610 PO Box 1768/3300 Newport Blvd, Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255 Job Ad4ress: Inspector Area Owner: Address: Phone: Receipt #: Processed By: 1 HOAG DR Bldg: 1 Floor Suite: 7 Code Edit: 96 HOAG MEMORIAL HOSPITAL PRESBY 1 HOAG DR, BOX 6100 NEWPORT BEACH CA 92658 9491574-4488 Legal Desc.: Contractor: Address: Description of Work: ELECTRICAL (B2000-3256) OUTL£TS,FIXTURES.SEP CIR WATSON INVESTMENT DEVELOPMENT 18182 SERRANO AVENUE VILLA PARK CA Phone: 714/974-6421 Con. State Lic.: 436023 Lic Expire: 03/31/2003 Bus. Lic.: BT98038807 Lic. Exp Dale: 10/3112001 FEE New Construction Residential Multi -Family 1-2 Family Receptacle/Switch/Outlets Recep/Outlets 2 $1.86 0 $0.00 Fixtures 49 $34.55 0 $0.00 Sep Circuit 5 $18.00 Service Signs 0 to 600V up to 200A 0 $0.00 Branch Circuit 0 to 600V over 200A 0 $0.00 each Add Circuit Over 600A/1,000A 0 $0.00 Time Clocks TOTAL: $87.98 0 0 0 $0.00 $0.00 $0.00 INSPECTOR NOTES: NesC� L SA/5'//070' D Motors/Transformers IHPIKVA( 0 to 1 HPIKW/KVA 1 to 10 HP/KW/KVA 10 to 50 HP/KW/KVA 50 to 100 HP/KW/KVA over 100 HP/KW/KVA Piggy Back / Temp Power PAYMENT: $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Temp Power Pole Temp Underground Sub Panel Record Managment Fee: Investigation Fee Plan Check Issuance Supplemental Fee BALANCE: $74.38 0 0 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.27 $0.00 $13.60 $19.70 $0.00 C£ ED CONTRACTORS DECLARATION ereby affirm under penally of perjury That I am licensed under provisions of Chapter 9 [commencing with Section 7000) of Division 3 of the Business and Professions code, 45, nd my license is In fullforce and effect. license No: 436023 Class: Conhactor: WATSON INVESTMFNT DEVELOPMENT WORKERS' COMPENSATION DECLARATION k hereby affirm under penally of perjury one of the following declarations: _I hove and will maintain a certificate of consent lo self-Insuro Fcw workers' compensation, as provided for by Section 3700 of the labor code. for the performance of the work for which This permil is issued. _I hove and will maintain worked compensation Insurance, as required by Section 3700 of the labor code, for the performance of the work for which This permit is issued. My workers compensation insurance canter and policy numbers rs: Carrier: STATE RIND Polley number. 2294019920 Expire: 01/01/2002 This section need not be completed if the permit is for one hundred dollars ($100) or less. I certify that in the performance of the work ford hich thisfneggt' is ^ei I shall not employ any person in any manner so as lo become subject to the workers' compensation lows of California, and agree that if I should become subi6.d to Ike vL.N,serr od, npenraIion provisions of Section 3700 of the labor code, 1 shall forthwith comply with those provisions. Dale: S- t - U1 Applicant Signature: Warning: Faifute lo secure workers compensation coverage Is unlawful, and shall subject an e(nployerto criminal penalties and civil lines up to one hundred t10000.3k in addition to the e 'St -if corn; iensvioredom,ges as r ovid,d 1 sr ir Sehom-3]06of the labor code, interest, and attorney's fees. I hereby acknowledge That I ha ve re-C Lils cap:cation', !hot thes.,slormdvion gw n is cursed: and that I am the owner, or duly authorized agent of the owner. I agree to comply with oily and state laws regulating construction, and In doing the work oulhorized thereby, no person will be employed in viohlton of the labor code of the state or California retaling to workmen's compensation Insurance. Permittee Name (Print) "C it P ic.Ac' ,u' tf v'r.) ' . Address : q Signature ofpermittee;� '(Z+-uk (1/r��r+� � " Date: S- t -o1 Approvals Grounding Electrode Underground Underslab/deer Rough Conduit Walls Rough Wiring Ceilings Rough Service Temp Power Utility Co. Notified Final Inspector/Date WORK MUST BE STARTED WITHIN A PERIOD OF 180 OA VS FROM THE DATE OF VALIDATION OR THIS PLK M,il BECOMES NULL AND VOID. . City of Newport Beach Building Department PLUMBING Permit No: P2000-1389 PO Box 1768/3300 Newport Blvd., Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255 Job Address:1 HOAG DR Bldg: 1 Floor: Suite: Inspector Area: 7 Code Edit: 97 Owner: HOAG MEMORIAL HOSPITAL PRESBY Address: 1 HOAG DR, BOX6100 NEWPORT BEACH CA 92658 Phone: 949/574-4488 Issued : Processed By: Legal Desc.: Contractor: Address: Phone: Con. State Lic Lic Expire: Bus. Lic.: Lic. Exp Date: Description of Work: PLUMBING (62000-3256) FLOOR SINK.BACKFLW.HOSE BIBB WATSON INVESTMENT DEVELOPMENT 18182 SERRANO AVENUE VILLA PARK CA 714/974-6421 436023 03131/2003 BT98038807 10131/2001 Bathroom Fixtures Toilet 0 Bidet 0 Urinal 0 Bath Tub Shower Stall Wash Basin Hydro -Mass Tub Floor Sink 0 0 0 0 1 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.65 Floor Drain Kitchen Fixtures Kitchen Sink: Garbage Disp Bar Sink Vegetable Sink Ice Maker Dishwasher Lndry/Trap O $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 O $0.00 O $0.00 TOTAL: $59.60 FEES INSPECTOR NOTES: sG�- 6 dIckfrAA0 elk Regulator 0 $0.00 Lawn Sprinkler 0 $0.00 Misc Water Piping 0 $0.00 Water Softener 0 $0.00 Water Heater 0 $0.00 Gas up to 4 outlets 0 $0.00 Gas over 4 outlets 0 $0.00 Backflow up to 2" 1 $8.75 PAYMENT: $7.93 Backflow over 2" 0 Hose Bibb 2 Drinking Fountain 0 Roof Drain 0 Grease Trap 0 Grease Interceptor 0 P-Trap 0 Other BALANCE: $51.67 $0.00 $15.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Sewer Sewer 0 $0.00 Sewer Alter/Repair 0 $0.00 Sewer Abandon 0 $0.00 Record Management Fee: $0.27 Investigation $0.00 Plan Check $7.93 $0.00 Issuance $19.70 Supplemental Fee $0.00 D CONTRACTORS DFCLARATION =by affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000j of Division 3 of the Business and Professions code, r:. a my license kin full lorce and effect. 3 -1 - 0t License No: 43E023 Clam DateX i ,-t Dt Contractor: WATSON INVESTMENT DEVEIQPMENT WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a cediticate of consent to self -insure for workers' compensation. as provided for by Section 3700 of the labor code, for the performance of the work for whlck this pencil 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 is Issued. My walkers' compensation insurance carrier and policy number is. Carrier: STAFF FUND Policy number 229-001992a Explre: 01/01/2002 (This section need not be completed :t Me permit :3 cr one hundred dollars ($100) or less. I certify that in the performance of the work for iyhich this permit is .ssueal I shall nol employ any person in any manner so as lo become subject to the workers' compensation laws of Calitorr la, and agree that if I should become subject In 'he Wooed/compensation provisions of Seelan 37 a lab cod_ e, tsh IQ uorth�wilh comply with those provisions. Date: S-1-VI Applicant Signature: t/✓EJ�Yu-- Warning: Failure lo secure workers' compensation coverage Is unlawful, and shall subiecl an employer to criminal penalties and civil fines up lo one hundred thousand dollars j$100,000j, In addition In the cost of campensgtion.dnmegec ps arovired for in Seclion 3706 of the labor code, interest. and attorneys tees. I hereby acknowledge Thal I' sav; re 3d this or Alit atis r •that ti a it Ian loll in give sis2Lrec1: and that I am the owner, cr duly authorized agent of the owner. I agree to comply with city and slate laws regwanhg consutctlon. land in oeing the work authorized thereby, no person will be employed In violation of the Iahor code of the state of California relating to workmen's compensall insurance. -Permittee Name (Print)_)( PAAEhc- va.2S-erJ - - -Address-; •• •- - .- - --- -- - - - - - ---- - - -- Signature of permittee: 7'-'!�^^-�`L - Date: S-i-ol Approvals Soil Pipe (ground) Sewer Water Pipe (ground) Gas Pipe (ground) Plumbing (rough) Gas Pipe (rough) Water Heater Gas PSI Test Gas Co Notified Final WORK MUST BE STARTED WTTHIN A PERIOD OP_188 _ DAY5 FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NUN AND VOID. Inspector/Date City of Newport Beach PO Box 1768 Newport Beach, California 92658-8915 Building Department Permit Counter Telephone (949)644-3288/3289 PLUMBING Permit No: P2000-0951 Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Bldg: 1 Inspector Area: Owner: Address: Phone: Floor: Suite: Description of Work: PLUMBING/4" FLARE GAS PIPELINE REPLACES EXP PMT P9905019 $ Code Edit: 97 HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH, CA Legal Desc.: Contractor: COAST PIPELINE CO, Address: P 0 BOX 5711 ORANGE CA98635711 Phone: 714/998-0550 Con. State Lic.: 222184 Lic Expire: 04/3012001 Bus. Lic.: PjT4�yo�'Td Lic. Exp Date: Bathroom Fixtures Toilet 0 $0.00 Bidet 0 $0.00 Urinal 0 $0.00 Bath Tub 0 $0.00 Shower Stall 0 $0.00 Wash Basin 0 $0.00 Hydro -Mass Tub 0 $0.00 Floor Sink 0 $0.00 Floor Drain Kitchen Fixtures Kitchen Sink: Garbage Dlsp Bar Sink Vegetable Sink Ice Maker Dishwasher Lndry?rap FEES INSPECTOR NOTES: 7�.,J' inspector Ohe Q0 )l t✓.ivjnt (&i 1 O $0.00 Regulator 0 $0.00 Lawn Sprinkler it Misc Water Piping ,{! 0 $6.00 Water Softener 'r 0 $0.00 Water Heater } 0 $0.00 Gas up to 4 outlets 0 $0.00 Gas over 4 cattle" 0 $0.00 Backflow up to 2? 0 $0.00 TOTAL: $283.00 PAYMENT: $0.$0 O $0.00 O $0.00 O $0.00 O $0.00 0 $0.00 0 $0.00 O $0.00 I MESSED CONTRACTORS DECLARATION _I hereby affirm under penally of perjury Ihat I am licensed under provisions of Chapter 9 (commencing with Section 7000 and my license Is In full force and eflecl. License No: 222104 Clew: Date: Contractor WORKERS' COMPENSATION DECLARATION: I hereby affirm under penally of perjuryone of the following declarations: I have and will maintain a certificate of censer Ito self -insure for workers'compensation. as provided for by Section 3700 of e labor for whick this permit is Issued. _I hove and will maintain workers compensation insurance. as requied by Section 3700 of the labor code, far the perform° My waken compensation insurance carrier and policy number is: Confer sun FUND Policy number, 013-0000498 Expire : 04/01/200i (This section need not be completed if the permit is for one hundred dollars ($100) 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 o as to b:come subject to the workers compensation lows 0 $0.00 Backflow over 2" 0 Hose Bibb 0 Drinking Fountain 0 Roof Drain 0 Grease Trap 0 Grease Interceptor 0 P-Trap 0 Other 112 FEE BALANCE: $283. of California, and agree that if I should become subject to the workers compensation provisions Dale: 7_ / 9 2 0 co Applicant SIgne re • ply with thos= provisions. Warning: Failure to secure workers compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars l$I°°.000f in addition to the cost or compensallon.damages as provided for in Section 3706 of the labor ccde,:interest, and attorneys fees. I hereby acknowledge that I have read fills application; that the Information given is correct: and that I am the owner. or duty ailthorized agent of the owner. I agree to comply with clty and state laws regulating construction: and in doing the work authonzed thereby, no person will be employedrin violation of the labor code of the state of California relating to workmen's co�mp}}nsaron insurance. Permittee Name {Printt))iV,. EnSeT L C ASULE-GtyAddress : 7 /p 9 Signature of permittee. a Date: $0.00 $0.00 $0.60 $0.00 50.00 $0.00 50.00 1 $264.00 50.00 Sewer Sewer 0 $0.00 Sewer Alter/Repair 0 $0.00 Sewer Abandon 0 $0.00 Investigation Plan Check Issuance Approvals Soil Pipe (ground) Sewer Water Pipe (ground) Gas Pipe (ground) Plumbing (rough) Gas Pipe (rough) Water Heater Gas PSI Test Gas Co Notified Final Inspector/Date $0.00 $0.00 $19.00 WORK MUST 8E STARTh WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOID.