HomeMy WebLinkAboutF2001-0434 - PermitsCity of Newport Beach
Building Department FIREALRM Permit No: F2001-0434
P-0 Box-A768/3300NewportBlud&NewportBeach. California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection RequestsTelephone (949)644-3255
Job Address: 1 HOAG DR Bldg: 1 Fioor:
Inspector Area j/�L'ega sc.:
Owner:
Address:
Phone:
Applicant
Address:
Phone:
HOAG HOSPITAL
1 HOAG DR
NEWPORT BEACH CA 92660
Edit Code:
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg :
Added /New sq. ft.. Garage:
No of Stories: :
No of Units :
97
B
Suite:
Contractor:
Address:
Phone:
Description of Work: RELOCATE (1)F.A. STROBE LIGHTISUPPORT SVCS BLDG
2672-2001
BRIGGS ELECT
16ENUE
V62 CA 9271 (-11, +)
IRVINE CA 92714 f\ "1
4)- rty..� ux).A atf2
Con. State Lic.: 297836
Lic Expire: 08/31/2003
Bus. Lic.: BT01013033
Lic Exp Date: 12/31/2001
Workers' Compensation Insurance --
Carder: FIDELITY & GUARANTY
Policy No: DRE33174001
Expire: 07/01/2002
Issued :
Construction Valuation: $300.00
Fire Plan Check Fee :
Fire Permit/ Inspection Fee:
Record Management :
Investigation Fee:
$106.00
$106.00
$6.50
$0.00
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
State Lic:
FEES
TOTAL FEE : $218.50 TOTAL PAYMENT : $0.00
$o.00
$0.00
TOTAL DUE : $218.50
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
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.
APPROVALS 1, DATE I BY
FIRE PROTECTION
!UNDERGROUND ROUGH PIPE
:THRUST BLOCKS EXCAVATION
;UNDERGROUND PIPING FLUSH
'UNDERGROUND HYDRO TEST
JUNDERGROUNDBACKFLOW APRV,
SPRINKLER HYDRO TEST
SPRINKLER FLOW TEST
SPRINKLER ROUGH PIPE
;STANDPIPE HYDRO TEST
STANDPIPE FLOW TEST
r
STANDPIPE ROUGH PIPE
CHEM SYSTEM FUNCTION TEST
CHEM SYSTEM APPROVAL
FIRE ALARM SYSTEM
ROUGH WIRING ft
SYSTEM FUNCTION TEST ' /WV
'CENTRAL STATION MONITOR
FIRE MISC
:TANK REMOVAL
+.TANK INSTALLATION/TEST
'TANK PIPING PRESSURE TEST
"MEDICAL GAS PIPING TEST
CROSS CONNECTION TEST
MISC. INSPECTIONS:
=.FINAL
L
COMMENTS
OWNER -BUILDER DECLARATION
1 I hEREOI AFFIRM UNDER PENALTY OF PERJURY THAT I AL, EXEMPT FROM THE CONTRACTORS
LICENSE LAW FOP THE FOLLOWING REASON 18E0 7031,5. BUSINESS AND PROFESSIONS CODE ANY CNN
O4 COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE. DEMOLISH. OR REPAIR ANY
STRUCTURE PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PER1Al1 TO FILE A
3SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE
33 COFITRACTOP3 LICENSE LAW (CHAPTER 91C0M0ENCI1G'PATH SEC TOGS) OF DIY 3 OF THE BUSINESS
AND PROFESSIONS CODE31 OP THAT HE CP S4£ 1: EKELPT THEREFROM AND THE CAB'S FOR THE
ALLEGED EXEMPTION 0Ni VIOLA➢ON OF SEC. MN; 3 BY ANY APPLICANT FOR A PFPoFlT SUBJECTS THE
Q101 WANT 10 A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOEL0R5 15001
j I. AS OWNER OF THE PROPERTY, OP MY EMPLOYEES 3/11TF WAGES AS 'HEIR SOLE
COMPENSATION VALL 000 T4£ WORK AND THE STRUCTURE IS NOT INTENDED OR OFFEPEO FOR SALE
(SEC 7044 BUSINESS AND PROFESSION; CODE THE CONTRACTORS LICENSE LAW DOTS .NOT APPLY TO
AN OVMER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH NARK HIMSELF
OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH INP1tOVEMENTS ARE
HOT III ENDED OR OFFERED 404 SALE IF HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN
ONE YEAR OE 6061PLETI ON. THE OWNER BUILDER YVILL HAVE THE BURDEN OF PROVING THAT HE OR SHE
3 DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.I
I. AS OWNER OF THE PROPERTY MI EXCLUSIVELY CONTRACTING WITH LICENSED
j CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 1064., SU51NE55 AND PROFESSIONS CORE. THE
- CONTRACTORS LICENSE LAW DOES MI APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR
5 IMPROVES THEREON. AND WHO CONTRACTS FOR St/CH PROJECTS %MTH A CONTRACTORS) LICENSED
3Y PURSUANT TO THE CONTRACTORS LICENSE LAW I
_y
y _ I AM E XEJAPT UNDER SEC 66 PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I KUHR'Y AFFIRM 'UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVI8ONS OF
CHAPTER 0 IOOLIMEHCING 11TH FECTON 70091 OF 01\9510N 3 OF FHE BUSINESS AND PROFESSIONS
CODE. ANO MY LICENSE IS IN FULL FORCE AND EFFECT
LICENJS Gl
DATE
/0
TIC NO
CONTRACTOR'
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF TILE FOLLOWING DECLARATIONS'
I HAVE AND MALL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
-- COMPENSATION AS PRONOED FOR BY SECTION 3700 OF THE LABOR CODE. FOR THE
PERFORMANCE OF 'WE WORE FOP WHICH THIS PERMIT IS ISSUED
HAVE ANO NALL %SATAN WORKERS' COMPENSA ION INSURANCE, AS REODIRED
SECTIONANC OF TILE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS
PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY 4
NUMBER ARE
CARRIER
POUCY NUMBER
r,TMS SECTION NEED NOT BE COMPLETED IF THE PERNIIIT IS FOR ONE HUNDRED DOLLARS 3
(S1001 OR LESS)
I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WATCH THS PERMIT IS ISSUED, I
___ SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CA3FORNW, AND AO THAT IF I SHOULD BECAME
'EJECT TO THE WORKERS' CO MPENBATION PROVISION SECTION 3700 OFE LABOR
L FORTHWITH COMPLY WITH THOSE FROM
APPLICANT Jam''
WARRANT, FAILURE TO ISec4RE''WORLkRS' ,'ULU? TIIOCOVERASE IyuwLAWFUL 341 SHALL
SUBJECT AN EMPLOYER TO 919HINAL fNALTIES $UIO CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 151000001 M 7r79501'T2 T'E COST C' COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE PDOR SOL Z. IN TIRES TANG ATTORNEYS FEES
CONSTRUCTION
LENDING AGENCY
I HEREBY AFFIRFA UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IG I55UEOISEC 309i. CH.0 I
LENS R'SOTMF `,
LENrE^'SriDEGSS.
I CERTIFY MAT I NAVE RL3O THIS A3PLICATIJN AND SATE THAT THE ABOVE :NFCRMATION IS;
3 CORRECT I AGREE TO COMPLY MATH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING
TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY 10 ENTER
UPON THE ABOVE IAliY${i4ED PROPERTY FOR ECTION PURPOSES
PERMITTELN' IPR..T.;
0