HomeMy WebLinkAboutX2006-0120 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2006-0120
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Combination Type - BLDG/ GRAD/ / /
Job Address: 1 HOAG DR NB
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
301 N NEWPORT BLVD
ORANGE CA92869
949/7644578
TRC SOLUTIONS/TOM
21 TECHNOLOGY DRIVE
IRVINE CA 92618
949/727-9336
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: 01/25/2007
2001
V -N
U2
0
0
0
0
0
N
Project :
Legal Desc.:
Description: CNSTRCT 14' TIE BACK WALL 26' HIGH@ CANCER CENTER
2842-2006 2842-2006
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:
T R C SOLUTIONS INC
21 TECHNOLOGY DRIVE
IRVINE CA 92618
949/727-9336
409606
07/31/2007
BT00004143
05/31/2007
Worker's Compensation Insurance
Carrier:
Policy No:
Expire:
TWINCITY FIRE
20WNMF5434
07/01/2007
Building Setbacks Rear: /
Front: /
Left: /
Right: /
Use Zone:
Parking Spaces:
0
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
WeN
O
BARAR PIROOZ P
124 GREENFIELD AVE
SAN ANSELMO CA 94960
415/259-0191 State Lic:S-002502
SEQUEIRA LEANARD
21 TECHNOLOGY DRIVE
IRVINE CA92618
949/727-9336
State Lic:C052787
Construction Valuation: $120,000.00
Building Permit Fee : $1,107.00
Plan Check Fee: $797.04
Overtime Plan Ck: $0.00
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
Additional Fee :
Hazardous Mat :
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
$25.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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San Dist :
Excise Tax:
NMUSD Fee:
$0.00
$0.00
$0.00
Grading Permit Fee: $584.00
Grading PC Fee: $1,372.00
WQ Insp. Fee: $0.00
Electrical %:
Mechanical %:
Plumbing %:
• ••• • • •
$0.00
$0.00
$0.00
•. • ;TOM:FEE: $3,922.54
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• • • • •• •• • APPROVAL TO ISSUE:
FEES
Planning Department -
Plan check Fee :
Fair Share :
SJH Trans :
$37.50
$0.00
$0.00
Public Works Department -
Park Dedication : $0.00
P/W Plan Check : $0.00
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
TOTAL PAYMENT : $797.04 TOTAL DUE : $3,125.50
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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• • • • • •'PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
RO I --(Di 0I5'
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 CRY OR COUNTY WHICH REQUIRES 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 LICENSE LAW (CHAPTER 9 (COMMENCING
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
WITH SEC. 7000) OF DN. 3 OF THE BUSINESS AND PROFESSIONS CODE) OR THAT FIE OR SHE IS 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
NOR MORE THAN FIVE HUNDRED DOLLARS ($500):
1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK, AND THE STRUC-
TURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES
THEN GH HIS OR HER OWN EMPLOYEES, ROVIDED T APPLY TO AN OWNER OF PROPERTY WHO THAT SUCH IOR IMMPROVEMENTS ARE NOT INTVES THEREON, AND WHO ENDED ED OR OFFERED FOR SALE. IF, OWEVER ES SUCH WORK HIMSELF OR HERSELF OR
THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING
PERMIT EXTENDED
■ THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.):
PERMIT FINAL
12-10 •
07
10
I. AS OWNER OF THE PROPERTY, AM EXC
USIVELY
CONTCTING THE PROJECT (SEC. 7
BUSINESS AND PROFESSIONS CODE: THELCORAC ORSLILICE SE LAWTH DOES NOT APPLLICENSEDTYTO ANNS OWN RTOOT OF THE CPRO PROPERTY WHO BUILDS o
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. & P.C. FOR THIS REASON
CERTIFICATE OF
OCCUPANCY ISSUED
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SEC. 7000) OF
DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY ICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS LICENSE NO.
TENANT NAME
TYPE OF BUSINESS
DATE/ 07 CONTRAC
FOR OFFICE USE
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WORKERS' COMPENSATION DECLARATION
HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
D WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SEC 3700
OF T E LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, A5 REQUIRED BY SEC 3700 OF THE LABOR CODE, FOR THE PERFORM-
ANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
❑ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) 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 MAN-
NER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT
TO THE WORKERS' COMPENSATION PROVISIONS OF SEC. 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND S HALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS PROVIDED FOR IN SEC. 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
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 (SEC. 3097, CIV.C).
LENDER'S NAME
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 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF
THIS CITY TO ENTER UPON THE ABOVE-MENTIONDPRROPPERTY FOR INSPECTION PURPOSES.
PERMITTEE NAME (PRINT)
I �[/
SIGNATURE OF PERMITTE/ IL ids. DAT /AOi
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