HomeMy WebLinkAboutX2010-0340 - PermitsCity of Newport Beach
Building Department
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288
Combination Type - CIR ELEC/ MECI-1/ PLUM/
COMB Permit No: X2010-0340
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB St: 2 FI: 3 Unit: 300
91...2C4 44 Project:
Legal Desc.:
Inspector Area: 7
OF LOT
Owner: HOAG HOSPITAL FD&C
Address; 500 SUPERIOR AVE, STE 300
• NEWPORT BEACK CA 92663
Phone: 949-764-4486
Applicant WILKERSON BEN
Address: 4850 BARRANCA #203
IRVINE CA 92604
Phone: 949-552-2061 X122
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 04/19/2010
2007
II-A-SPR
0
0
3
0
0
Construction Valuation: $140,335.00
Building Permit Fee: $1,265.50
Plan Check Fee: $911.16
Overtime Plan Ck: $0.00
Investigation Fee: $0.00
Record Management: $148.25
Energy compliance: $84.20
CA Seismic Safety: $0.00
Disabled Access: $140.34
Fee Increase: Fee: $0.00
Additional Fee: $0.00
Hazardous Mat: $14.40
Description: TI "BRAIN & SPINE SURGEONS" 2,159 SF
0283-2010 0283-2010
IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Contractor:
Address:
Phone:
PHILCO CONSTRUCTION INC
1762 N NEVILLE ST
ORANGE CA 92865
714-283-0604 Phone:
Architect:
Address:
Con State Lic: 764578 Engineer:
Lic Expire: 06/30/2011 Address:
Bus Lic:
Lic Exp Date: Phone:
Worker's Compensation Insurance Designer:
Carrier: EVEREST NAT INS Address:
Policy No: 7600001642101
Expire: 04/01/2011 Phone:
Building Setbacks Rear: /
Front: /
Left: /
Right: /
Use Zone:
Parking Spaces: 0
Solar System PC:
Excise Tax:
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee:
Electrical %:
Mechanical %:
Plumbing "/0:
Building Green Fee : $6.00.
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TOTAL FEE: 13,Z11.56
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
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FEES
WOOD JACK FREDERICK III
4850 BARRANCA #203
IRVINE CA 92604
949-552-2061 State Lic:C015130
Special Conditions:
Fire Hazard Zone N
$0.00 Planning Department -
$0.00 Plan check Fee: $180.00
Fair Share: $0.00
SJH Trans: $0.00
$0.00
$0.00
$0.00
$221.46
$189.83
3158.19
Plan Check Fee:
Public Works Department -
Park Dedication: $0.00
P/W Plan Check: $0.00
San Dist : $0.00
NMUSD Fee: $0.00
State Lic:
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$1,291.49 Fee Due at Permit Issuance:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
$0.00
$182.23
$0.00
$0.00
$0.00
$0.00
$0.00
$2,210.07
co
me
• • • • • • • • • PERMF116 EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s)
indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions
Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors' State License Law (Chapter 9. (commencingwith Section 7000) of Division 3 of the Business and
Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I:I I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the
work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the
property, provided that the improvements
are not intended or offered for sale. If, howeverthe building or improvement is sold
within one year of completioni , the Owner -Builder will have the burden of proving that t was not built or improved for the
Earpose of sale).
U f, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or
improves thereon, and who contracts tor the projects with a licensed Contractor pursuant to the Contractors State License
Law).
I:I I am exempt from licensure under the Contractors' State License Law for the following reason:
Bymy signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year
prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -
builder if it has not been constructed in its entirety bylicensed contractors. I understand that a copy of the applicable law,
i Section 7044 of the Business and Professions Code, s available upon request when this application is submitted or at the
following Web site:http://www.leginfo.ca.govicalaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S 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 license is in full force and effect.
Licensstss License No.
Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: NLURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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' compensation, issued by the Director of
In• t Arial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
d
r4
1,4
0.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
rmance of t rk for which this permit is issued. My workers' co ipensation insurance carrier and policy number are:
k %rev I A
.,arrier
or — lip .... isr• pi or. honeE4txpiration Date
El I certify that, in the performance of the work for whic this permit is issuxt , I shall not employ any person in any manner
so as to become subject to the work rs' com ensation laws of California, an. agree that, if 1- should become sub to the
workers' compensation pr vis' tio 3
Signature of Applicant
tthe Labor ....,...e, 1711 forthwith comply with those irsions.
Date's-- In Jo
Name of Agent
DECLARATION REGARDING 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 (Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the properly owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county to erite above -identified propert for inspection purposes.
II
Signature of Property Owner or Authorized Agent "\--- 67/(11r-0, Date eVqfict 15
>CDUCTIta Print Property Owner's or Authorized Agent's Name: _
ACTION
PERMIT EXPIRED
DATE:
BY:k '
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
s - 4 i 0
CERTIFICATE OF
OCCUPANCY ISSUED 9 - t c- to VA
DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND ACM RULE 1403.
I:I I SUBMITTED ASBESTOS NOTIFICATION TO:
I:I EPA
I:1 AQMD
I:I ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
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FOR OFFICE USE ONLY
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WW1 INFMFINI. Mr MI Mr. WWI, WM.".
01/01/2009