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Home My WebLink AboutF2003-0203 - PermitsFIRE APPROVAL: bt City of Newport Beach Building Department FIREMISC Permit No: F2003-0203 PO Box 1768/3300 Newport Blvd, Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288/3289 Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Bldg: 1 Hoop Suite: Description of Work: REPL EXGT METHANE GAS SENSORS "CHILDCARE BLDG" 1009-2003 Inspector Area:FIRE Legal Desc.: Owner: HOAG MEMORIAL HOSPITAL Contractor: BRIGGS ELECT Architect:IK Address: 1 HOAG DR Address: 16662 MILLAN AVE Address: NEWPORT BEACH CA 92663 IRVINE CA92606 Phone: Phone: 949-863-9901 Phone: State Lic: Applicant: PANDOLFI LOUIS Con. State Lic : 297836 Engineer: THURSTON STEVEN Address: 4454 INDUSTRIAL ST Lic Expire: 08/31/2005 Address: 611 HAZLEWOOD SIMI VALLEY CA 93063 Bus. Lic.: 8T01013033 OXNARD CA Phone: 805-526-6532 Lic Exp Date: 12/31/2003 Phone: 805-983-1853 State Lic: C-011412 Edit Code: 2001 Workers' Compensation Insurance - - Designer: Type of Construction: Carrier: AMERICAN GUARANTEED Address: Occupancy Group: E3 Policy No: 930512601 Added /New sq.ft. Bldg : Expire: 07/01/2004 Phone: Added /New sq. ft. Garage: No of Stories. : No of Units : Issued : 09/18/2003 Construction Valuation: $10,000.00 Fire Plan Check Fee : Fire Permit/ Inspection Fee: Record Management: Investigation Fee: 1 5112.46 3156.20 $10.00 $0.00 Special Conditions: FEES Plan Department - Counter Review : Zoning Plan Check: $50.00 $0.00 TOTAL FEE : $328.66 TOTAL PAYMENT : $112.46 TOTAL DUE : $216.20 $0.00 $0.00 ZONING APPROVAL: PROCESSED BY: • OTHER DEPARTMENT: PLAN CHECK B APPROVAL TO ISSUE: INSPECTOR WORtc rep.ST BE T 4RTFD'WHIN 4 PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR Zs PERMIT BECOMES NULL AND VOID APPROVALS DATE BY COMMENTS 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, DEMOL SH, 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 0 (COMMENCING WITH SEC. 7000) OF OIV 3 OF THE BUSINESS AND PROFESSIONS COOE)I OR THAT HE OR SHE 15 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 NOT MORE THAN FIVE HUNDRED DOLLARS 4500): I. AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION WILL DO THE WORK ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSINESS ANO PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES 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 IS SOLO WITHIN ONE YEAR OF COMPLETION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.1. I.AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS To CONSTRUCT THE PROJECT (SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW GOES 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 LICENSE LAW ) I AM EXEMPT UNDER SEC B&Pc. FOR THIS REASON - FIRE PROTECTION UNDERGROUND ROUGH PIPE THRUST BLOCKS EXCAVATION UNDERGROUND PIPING FLUSH UNDERGROUND HYDRO TEST U NDERGROUN D!BACKFLO W APRV_ SPRINKLER HYDRO TEST SPRINKLER FLOW TEST SPRINKLER ROUGH PIPE STANDPIPE HYDRO TEST STANDPIPE FLOW TEST STANDPIPE ROUGH PIPE CHEM SYSTEM FUNCTION TEST CHEM SYSTEM APPROVAL DATE OWNER FIRE ALARM SYSTEM GIdi-,. r (v—'K ' 4/14, /L-- CAr' - Cif LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 700010F DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC No ROUGH WIRING — SYSTEM FUNCTION TEST �=� � o.._'J r �. _j /._ i 6 CENTRAL STATION MONITOR j j' ; , f-'' .7 A,� 1, '-- �� ( i p TE 3 NTRACTGR WORKERS' COMP SETION DECLARATIO I HEREBY AFFIRM UNDER PENALTY OF PERJURYONEOFTHEFOLLOWNGDECLARATIONS- I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' C MPENSATION. AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE FOR THE r FIRE MISC. TANK REMOVAL PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 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 TANK INSTALLATION/TEST TANK PIPING PRESSURE TEST MEDICAL GAS PIPING TEST THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER CROSS CONNECTION TEST POLICY NUMBER MISC. INSPECTIONS: (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (9100) OR LESS( I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT iS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. A REE THAT IF I ULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROV S OF SECTION OF THE LABOR CO SM FORTHWITH COMPLY WITH THOS OVISION ATE ' '—' r':PNT SHALL l5/ WARNING. FAIW E TO SECURE VORKE COMPFjDCIVILN COVE E IS UNLA L, THOUSAND SUBJECT AN EMPLOYER o tl%MIIIP2 PENALTIES ANO CIVIL FINES P TO ONE HUNDRED THOUSAND DOLLARS (O N), IN XOPIRIO N E I TAE.•EST OF tOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOS INTEfIEST..1 ATTORNEY'S FEES. SECTION CONSTRUCTION LENDING AGENCY I HcREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE 15 A CONSTRUCTION LENDING AGENCY fOP11•Hj PEST waiL OF The W04001R WHIUF)THI. PERMIT IS ISSUED (SEC.3097, CIV O) - _ • LEM-SEAS NAVE i__I ~ r • rr—1 • 1 LENDERS ADDRESS • • r • F 1 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 AND STATE LAWS RELATING TO BI,1IIFJINi. 9NSTR}IGTION.,JLND HE AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ELATE(' 0ITON FLS MOOR, ME I1 4NE I;TV 1FOR INSPECTION PURPOSES V FINAL J N') {. i. _'n)�, . j L l 6 j � RMITTEE N/NI AT, 5 1 N / /it n 1�NATUR P 0.MITIEE ATF