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Home My WebLink AboutX2011-1486 - PermitsCity of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Combination Type - CIP/ ELEC/ MECH/ PLUM/ COMB Permit No: X2011-1486 PROJECT NUMBER: 1161-2011 Inspection Requests/Telephone (949)644-3255 INSPECTOR Job Address: 1 (44) HOAG DR NB St: 1 FI: 2 Unit: 210 Description:TIIINCREASE SUITE AREA BY 390 SF "HOAG PAYROLL" Inspector Area: 7 Owner: HOAG HOSPITAL FD&C Address: 500 SUPERIOR AVE, STE 300. NEWPORT BEACH CA 92663 Phone: 949-764-4486 Applicant: WOOD RICKIWBS Address: 1800 QUAIL ST, STE 120 IRVINE CA 92660 Phone: 949-552-2061 Code Edit : 2010 Type of Construction: II-A-SPR Occupancy Group: B Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 3 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Flood Zone: Issued Date: 07/14/2011 Construction Valuation: $22,000.00 Building Permit Fee: Plan Check Fee: Overtime Plan Ck: Investigation Fee: Record Management Energy Compliance: CA Seismic Safety : Disabled Access : $78.00 Fee Increase' Fee $0.00 Additional Fee: $0.00 Hazardous Mat : $15.00 Building Green Fee : $1.00 TOTAL FEE : $1,105.36 $383.40 $276.05 $0.00 $0.00 $1.00 $53.00 $0.00 Legal Desc.: Contractor: Address: Phone: FAR WEST CONTRACTORS CORP 11122 HOMEWAY DRIVE LVD GARDEN GROVE CA 92841 714-636-8744 Con State Lic: 870705 Lic Expire: 01/31/2012 Bus Lic: Lic Exp Date: Worker's Compensation Insurance Carrier: Policy No: Expire: WILLIAMSBURG NATIONAL WC0463848 03/18/2012 Building Setbacks Rear: / Front: / Left: / Right: / Use Zone: Parking Spaces: Solar System PC: Excise Tax: Grading Permit Fee: Grading PC Fee: WO Insp. Fee : Electrical %: Mechanical %: Plumbing %: $92.33 $79.14 $65.94 Plan Check Fee : $0.00 $0.00 0 Planning Department - Plan check Fee : Fair Share : Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: Fire Hazard Zone : N. $60.50 $0.00 SJH Trans : $0.00 $0.00 In -lieu Housing Fee: $0.00 $0.00 Public Works Department - $0.00 Park Dedication : $0.00 P/W Plan Check : $0.00 San Dist: $0.00 NMUSD Fee: $0.00 $428.43 WOOD JACK FREDERICK III 1800 QUAIL ST #120 IRVINE CA 92660 949-552-2061 State Lic:C015130 State Lic: .•.•.• • . ••••.• • • • •••••• • . •••• • O 00000 • • • • •••••• • ••••. O 0000 • O • • • .• • • • •• • • •• • • • • Fire Department •••• - • • Fire Inspection: • 0.00• Fire Plan Rev $O.db Demolition Fee Building Dept Adm $0.00. General Service $0.00 Refund Deposit $0.00 Fee Due at Permit Issuance : $0.00 $0.00 $676.93 • • PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. 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 licensure 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 L) all of or L) 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, providedthat the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ 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 Law). ❑ 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 this 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://www.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 I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P^rofessAi ns 7) Code,nand my license is in full force and effect. / / _ - License Class License No VDate ( �CI-101 WORKERS;c4WIDENSATION DECLARATION I]�, ! •••• • WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE • tttt8F COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. • I hereby affirriS ynaerpenalty of perjury one of the following declarations: • • ®.I h•• ave and 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 •'a ^^ance of tlt *erk for which this permit is issued. Policy No. ve and% ff maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatior rice carr1e{ apd policy number are: `,trier • • Policy Number Expiration Date rN�arne rlf Agent • Phone # �JI certify that in tterformance 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 t,1f1:ahould be write subjec to the work rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ^1 gnature of ApplioBNM"/ • t J %�- Date w 1 L(— Vcr I DECLARATION REGARDING 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 (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 provided is correct. I agree to comply with all applicable city and county ordinances and state law relating to building construction. I authorize representatives of this city or county to enter t e a ove-I entified property tor inspection purposes. �/ / �-nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name_ / �G�IM� __ O �L �[ ate _ ACTION DATE BY DECLARATION FEDERAL REGULATIONS AQMD RULE 1403. • I SUBMITTED • EPA OF COMPLIANCE WITH CODE OF PART 61 OF TITLE 40 AND FOR OFFICE USE ONLY PERMIT EXPIRED ASBESTOS NOTIFICATION TO: NOTIFICATION IS NOT APPLICABLE TO I' PERM , :CELLED PERMIT EXTENDED • AQMD • •'• BESTOS PRO 'OSED DEMON. SIGNATUR) atI PERMIT FINAL 7.7-6—i1 r,' CERTIFICATE OF DCCUPA,^;CY'SSUED II