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Home My WebLink AboutF2003-0456 - PermitsCity of Newport Beach Building Department FIRE PROTECTION Permit No: F2003-0456 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Job Address: 1 HOAG DR Bldg:1 Floor: Suite: Inspector Area:tif/ilk Owner: Address: Phone: HOAG MEMORIAL HOSPITAL 1 HOAG DR BOX 6100 NEWPORT BEACH CA 92658 Applicant: COSCO FIRE PROTECTION INC Address: 321 E GARDENA BLVD GARDENA CA 90247 Phone: 323-321-5155 Code Edit : 2001 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : V-N U2 N N 0 Legal Description: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: Description of Work: UNDERGROUND FIRE LINE"EMERGENCY REPAIR" 2822-2003 COSCO FIRE PROTECTION INC 321 E GARDENA BLVD GARDENA CA 310-321-5155 577621 09/30/2005 6T00022773 07131 /2004 Worker's Compensation Insurance Carrier: Policy No: Expire: ZURICH INS CO WC3520373 01/07/2004 Issued Date: 11/05/2003 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: State Lic: State Lic: Construction Valuation: $8,000.00 Fire Plan Check Fee : Fire Permitllnspection Fee: Records Management: Investigation Fee: $114.00 $136.80 $3.00 $0.00 TOTAL FEE : $253.80 FEES TOTAL PAYMENT : $114.00 TOTAL DUE : $139.80 $0.00 $0.66 PROCESSED BY: ZONING APPROVAL: ••• ••• FIRE APPDOVAt. : Ate doe • • • • • • •• ••• • • •• • • • •• . • ••- • • ••• • • - • • • • • • • • • • • • • - • • • • • . • • ••• • • • ••• •• •• • • • • •• • • •• •• • ••• • •• ••• • • • • OTHER DEPARTMENT: PLAN CHECK BY:: APPROVAL TO ISSUE: PERMIITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Naz o coo st) APPROVALS DATE BY COMMENTS owNERauILoeRDECARAnoN FIRE PROTECTION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWED REASON (SEC. 7031.5. BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRES 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 UCENSE 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. 70315 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPUCANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($5007 I. AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSINESS ANO PROFESSIONS CODE. TIE 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, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS COOE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR IMPROVES COFN�`ORRSSLICENSESLFOR AW.ISUCH PROJECTS WITH ACONTMCTOR(8)LICENSED PURSUANT TO THE I AM EXEMPT UNDER SEC. Ell P.C. FOR THIS REASON . UNDERGROUND ROUGH PIPE tatile I iv.- THRUST BLOCKS EXCAVATION - UNDERGROUND PIPING FLUSH O YAG L K`'3 1 `i 1. fit-R41 UNDERGROUND HYDRO TEST � �L LO%1�g V-C/ UNDERGROUND/BACKFLOW APRV. SPRINKLER HYDRO TEST - _ ' l� . 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 _ LICENSED CONTRACTORS 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 UCENSE IS IN FULL FORCE AND EFFECT LICENSEECC 8 MQ. NO. ROUGH WIRING SYSTEM FUNCTION TEST CENTRAL STATION MONITOR DATE JC II — S- U 3 CONTM/, TCTOR )( ln 5 C 11 WORKERS' COMPENSATION DEC RATIO I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWED DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFK:ATE OF CONSENT TO SELF -INSURE FOR WORKERS FIRE MISC. TANK REMOVAL TANK INSTALLATION/TEST MPENSATION, AS PROVIDED FOR BY SECTION 3100 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE ANO WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY TANK PIPING PRESSURE TEST MEDICAL GAS PIPING TEST SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSUNANCE 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 (5)00) 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 AS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR DATE/OI-15HALL FORTHWITH LO-P. 4T PiC.IONS nth/J,/❑�'10 A:.. WARNING: FAILURE TO SECURE WORKERS' GGDQ PE�IBASATIR,•H COVERAGE I UNLAWFUL, `PMD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEMALTTE� A4I%WC FIFFM�EES UITO ONE HUNDRED THOUSAND DOLLARS (5100,000). IN ADDITION TO THE COIF gOMVENSAh EAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM WIDER PENALTY 9F PE$.IQIIjY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMA•ICESOF ITHE•WORK xOR 10JlCI T�IS•gERMI} itiiSSOEO,SEC.3097. C.C.) • • • • • • NAME • • • •� = • •• LENDERS• '4. • • • • • • ••• • - • •• LENDER'S ADDRESS 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 AND STATE LAWS RELATING TO BUILDING CONSTR• ITIOM,WID ES)iBY 1%111310RIZJ,RE RESENTATIVES OF THIS CODUNTY TOEKENTER UPON THE ABCVP•,MENTIIO••R/EO}{PPRO•PER•TY FOR EISPECTWN PURPOSES. • Qqq�1•C1 • •• . FINAL A� // /Z/l (03 �. RMI TE 1P NT •• • / 03 AJi Z J SIGMAfPF OF'FRMI E DATE