HomeMy WebLinkAboutX2008-0423 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2008-0423
PO Box 1768 Newport Beach, California 92658-8915
Combination Type - CIP/ / / /
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
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Job Address: 1 HOAG DR NB
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
500 SUPERIOR AVE, STE 300
NEW PORT BEACH CA 92663
949-764-4486
Description: ALT PRIOR TI "ADVANCED TECHNOLOY"
Project : 0407-2008 0407-2008
Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
AARON/ADVANCED MEDICAL BUILDER
571 N PAPLAR #E
ORANGE CA 92868
714-614-1573
Code Edit :
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage
No of Stories:
No of Units :
Bldg Height
Bldg Sprinklers:
Flood Zone:
Issued Date: 03/03/2008
2007
B
0
0
0
0
0
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
ADVANCED MEDICAL BUILDER INC
17291 IRVINE BOULEVARD, #418
TUSTIN CA 92780
714-614-1573
824317
08/31 /2008
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No:
Expire:
Building Setbacks
Use Zone:
Parking Spaces
238-0003116
05/01/2008
Rear:
Front:
Left:
Right:
0
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions: CAPS ON E,M,P'S
LICAUCO MARGIE
2973 HADDONFIELD LOOP
FULLERTON CA 92831
714-904-4004 State Lic:C002814
State Lic:
Construction Valuation: $60,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigatin Fee:
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
Additional Fee :
Hazardous Mat :
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
$721.00
$519.12
$0.00
$0.00
$6.50
$0.00
$0.00
$60.00
$0.00
$0.00
$0.00
•
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San Dist :
Excise Tax:
NMUSD Fee:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
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•
FEES
$0.00 Planning Department -
$0.00 Plan check Fee : $45.00
$0.00 Fair Share : $0.00
SJH Trans : $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
!•S%• •
y r • • •
•
• •
• •
Public Works Department -
Park Dedication : $0.00
P/W Plan Check : $0.00
• • TOTAL FEE : $1,351.62
••• • •• ••• ••
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• • • • N•• t : • -•
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• • • • • • •• • •. • • • • • • APPROVAL TO ISSUE:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
h
ERMfa E (f4R4 110 DAYS.AFTER ISSUANCE OR LAST VALID INSPECTION.
�_.5S41-)
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,
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 IS 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 CIVIL PENALTY OF
❑ NOR MORE THAN FIVE HUNDRED DOLLARS ($500):
I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUC-
TURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW GOES
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 15 SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING
❑ THAT HE OR SHE 010 NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.);
I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044,
BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS UCENSE 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
❑ UCENSE LAW.).
I AM EXEMPT UNDER SEC
B. 8 P.C. FOR THIS REASON
DATE OWNER
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 LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CJASS : .JJ LICENSE NO.
DA TA\ d / `� / U U CONTRACT
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SEC 3700
E 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 COOE, FOR THE PERFORM-.
E OF 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 MAN-
NER 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 SEC. 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE' APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CML 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. CN.C).
LENDERS NAME
•
LENDER'S •
ADDRESS • •• • •
• • ••
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLYI4ITIt4Lt
CITY AND COUNTY ORDINANCES AND STATE WS RELATING TO BU NG CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF
THIS CRY TO ENTER UPON THE ABOVE-MENT)ONED PROPERTY F NSPECTION PURPOSES.
PERMITTEE NAME (PRINT)
SIGNATURE OF PERMITTEE ^✓ 1 cL DA
DATE:
PERMIT EXPIRED
BY:
PERMIT CANCELLED
PERMIT EXTENSION
PERMIT FINAL
CERTIFICATE OF OCCUPANCY
,e4,1
TENANT NAME
TYPE OF BUSINESS
FOR OFFICE USE ONLY
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