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Home My WebLink AboutX2009-1453 - PermitsJob Address: 1 HOAG DR NB Inspector Area: 7 OF LOT Owner. Address: Phone: Applicant: Address: Phone: City of Newport Beach Building Department COMB Permit No: X2009-1453 PO Box 1768 Newport Beach, California 92658-8915 HOAG HOSPITAL FD&C 500 SUPERIOR AVE, STE 300 NEWPORT BEACH CA 92663 949-764-4486 ZOLL GREGG 500 SUPERIOR DR STE#300 NEWPORT BEACH CA 92663 949-764-4468 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: 09/24/2009 Combination Type - GRAD/ / / / Project : Legal Desc.: Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Description: SITE DRAINAGE FOR CONTRACTOR PARKING 1173-2009 1173-2009 IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: SIMICH JOHN CONSTRUCTION INC 1400 S HARBOR BLVD SAN PEDRO CA 90731 310-519-8203 410855 03/31/2010 BT30024974 09/30/2009 Architect: Address: Phone: Engineer: Address: Phone: 2007 Worker's Compensation Insurance Designer: Carrier: STATE COMP INS FUND Address: Policy No: 044-0028699 Expire: 03/10/2010 Phone: 0 0 0 0 0 Construction Valuation: $0.00 Building Permit Fee: $0.00 Plan Check Fee: $0.00 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $16.00 Energy Compliance: $0.00 CA Seismic Safety : $0.00 Disabled Access • $0.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat: $0.00 Building Green Fee : $0.00 TOTAL FEE•r $5751Xl• • • .•_ PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: • • . • • • • • • • ••• • • • • C ••� • •• •• •• • Building Setbacks Rear Front: Left Right: San Dist: Excise Tax: NMUSD Fee: State Lic: HALLADAY DANA STANLEY 391 N MAIN ST #205 CORONA CA 92880 951-278-9700 State Lic:C-034751 Special Conditions: Use Zone: Parking Spaces: 0 Fire Hazard Zone : N Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: • •• • • • .• • . • • • •• • • FEES $0.00 Planning Department - $0.00 Plan check Fee : $119.00 $0.00 Fair Share : $0.00 SJH Trans : $0.00 $160.00 5160.00 $0.00 $0.00 $0.00 $0.00 Plan Check Fee : Public Works Department - Park Dedication : $0.00 P/W Plan Check : $120.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit $0.00 Fee Due at Permit Issuance : PUBLIC WORKS APPROVAL: PLAN CHECK BY: • ( APPROVAL TO ISSUE: • • • MITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $575.00 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from Iicensure 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, as owner of the property-, or my employees with wages as their sole compensation, will do U all of or (' 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, itr hln one yyeeareoftcompletio^n, improvements Builder will haave burfor sale. of proving thatritthwabuilding not but improvement r improved tfor the Expose of sale). U I, 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 for the projects with a licensed Contractor pursuant to the Contractors State License ID w)I am exempt from licensure under the Contractors' State License Law for the following reason: By my 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 thls permit, I cannot legally sell a structure that I have built as an owner - builder if it has not been constructed in Its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application Is submitted or at the following Web site:http:/Iwww.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions ha 9 (coalmen • e with Section 7000) of Division 3 of the 0 iness and Professions Code, and my license is in full I ect cense Class /f zyIcense No. "/O ite 9— — 0 Qs Contractor Signature WORKERS' COMPENSATION DE RATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE M UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,000), 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 • Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issu d. ACTION PERMIT EXPIRED DATE: PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL Meg' 0 CERTIFICATE OF OCCUPANCY ISSUED e and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the nce of the work for which this permit is Issued. My workers' compensation insurance carrier and policy number are: ler Policy Number Expiration Date Name of Agent ❑ I certify that, in the perfora e so ras to become subject tb rke ' Phone # Is Issued, I shall not employ any person in any manner y ifomia, an agree that if I should become subject to the nature of Applicant p etu compensation pro ' ons e, I sh hwth comply with those visions. I � -ib/ !/�� for which this pensation laws n 3700 of the DECLARATION REG • NG 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 perk 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 property owner's behalf. I have read this application and the information I have p Is ct. I agree to comply with all applicable city and coun an tate laws relad I authorize representatives of this clty or cou enter identified p v th �,6rlgnature of Property Owner or Authorized Agent not Property Owner's or Authorized Agent's Na 01/01/2009 building construction. fortis on purposes Date if DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: FOR OFFICE USE ONLY •• • • • • •• ..• •• • •• • • • . . .• . • • • • • •• • • • • • • •• ••• • • • ••• • • • • • • • • • • •• •• •• •• cog - CITY OF NEWPORT BEACH BUILDING DEPARTMENT CIVIL ENGINEER'S CERTIFICATION FORM City of Newport Beach 3300 Newport Blvd. P.O. Box 1768 Newport Beach, CA 92658-8915 From: Halladay & Mim Mack, Inc 391 N. Main St., #205 Corona, CA 92880 Date: December 3, 2009 ATTENTION: GRADING ENGINEER, BUILDING DEPARTMENT GPC No.117 3- 2 0 0 9 Tract/Subdivision/Lot No.: Rough Final X Project Names: Hoag Hospital Temporary Contractor Parking Owner/Developer: Hoag Memorial Hospital Presbyterian Type of Project: - Tract - Commercial - Industrial Yardage for Project: - Cut - Fill 0 0 - Drainage - Other - Borrow - Export X 0 0 I hereby approve the grading for this project in accordance with my responsibilities under the City Grading Code. I have inspected the project and hereby certify that all areas exhibit positive surface flow to public ways or City approved drainage devices. The grading has been completed: in conformance with, X with the following changes to the approved grading plan. Description of Changes: Revised limits of fencing and gravel placement added erosion control for one existing area drain per as -built Revision No. 1. November 25, 2009. Company: Name: Halladay & Mim Mack, Inc. Dana S. Halladay (print) LicenseNo.: RCE 34751 Exp. 9-30-11 (RCE/LS) MECatfmtt I1-90 3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, t'alifornia 92658-89 Telephone: (949) 644-3275 • Fax: (949) 644-3250 •Website: www.newport-beach.ca.us/building e-mail: cnb_blg@city.newport-beach.ca.us