HomeMy WebLinkAboutF2010-0147 - Permits•
City of Newport Beach
Building Department
FIRE COMBO Permit No: F2010-0147
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 NB
InsPpectorArea: ! R3$Z,
OF LOT
Owner. HOAG HOSPITAL FD & C
Address: 500 SUPERIOR AVE #300
NEWPORT BEACH CA92663
Phone: 949-764-4486
Applicant CHAIRES ROBERT
Address: 1150 W CENTRAL AVE
BREA CA 92821
Phone: 714-936-3125
Code Edit : 2007
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
V-B-SPR
B
0
0
2
0
Y
Description: R/R FM-200 PREACTION SYSTEM FIRE ALARM PANEL
0798-2010 (CONFERENCE CNTR BLDG)
Legal Description: 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:
FACILITIES PROT SYSTEMS
1150 W CENTRAL AVE # D
BREA CA 92821
714-257-2244
592289
04/30/2012
BT30015975
07/31/2010
Worker's Compensation Insurance
Cartier: TRAVELERS INDEMNITY CO
Policy No/ UB551K111709
Expire: 05/31/2010
Issued Date: 05/26/2010
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Spedal Conditions:
State Lic:
State Lic:
UPOLE GLEN
1150 W CENTRAL AVE
BREA CA 92821
714-257-2244
'pommy
1 1y-93(0.3301
Construction Valuation: $35,000.00
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee :
Fire Commercial PC Fee:
Fire Commercial Permit Fee :
Fire Residential Permit Fee :
Fire Residential Alarm Fee :
TOTAL FEE:
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL:
$0.00
$o.00
$0.00
$0.00
$135.56
;376.56
$0.00
$0.00
$525.47
FEES
Fire Residential Alarm PC Fee :
Planning Counter Review :
Planning Zoning PC Fee :
Public Works PC Fee :
Public Works Traffic Plan Check Fee;
$0.00
$0.00
$0.00
$0.00
$0.00
Records Management:
Plan Check Fee : $135.56 Fee Due at Permit Issuance :
6
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
• •
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• • •
• •
- •
• • •
• •••
••• • •
• • •
• • •
• •• •
• • • •
• ••
• •
• •
• •
• •
•••
$13.35
$0.00
$0.00
$389.91
• •-• • • • •
• • • • • •
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTIOti(: • •.. •. • : : :.
• •
•
•
••
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).
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
• I' as owner of the property, or my employees with wages as their sole compensation, will do U all of or ( I portions of the
PERMIT EXTENDED
work,and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors'
State License Law does got apply to an owner of property who, through employees' or personal effort, builds or improves the
property, provided that tl+6 improvements are not intended or offered for sale. If, however, the building or improvement is sold
within one eprol completion, the Owner -Builder will have the burden of proving that R was not built or improved for the
purpose e).
U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The ContractorsState 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),
PERMIT FINAL
573�/O✓��
�9
CERTIFICATE OF
OCCUPANCY ISSUED
• 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 thispermit, I cannot legally sell a structure that 1 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 Cade, 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
FOR OFFICE USE ONLY
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Division 3 ofthe Busine nd Professions Code, and my license is ulf ryg and ect.
icen lass C'`lfi(C-/te License No.
D Contractor nature
71a�ID
W RKER COM ENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 13 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
• I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of
Industrial lations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Polio
nd will maintainrworkers' compensation insurance, reub3700 of thed Labor Code, for the
wrker'as i
rformance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number Expiration Date
-Thame of Agent Phone #
• I certify that, in the performance of the work for which this permit is issued, I shall not employ anyperson in any manner
so as to become subject to.th orkers' pensation laws of California, and agree that if r shouldbecomesubject to the
workers' compensatio rove s 3700 of the Labor Code, 1 shall forthwith comply with th se provisi s.
Signature of A nt Dat
...flea.. �`//'a
DECLARATION REG DIN CONSTRUCTION LENDING AGENCY
I hereby affirmunder penalty of perjury that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature bele I Uhify to eech* f the.follavirg:
1 am the property o$n. or tiutharitea o act with; paopertyiowner's behalf.
I have read this applicationtthd thiViribritgttn I f jy4 Attlee is correct.
1 agree to comply witR all applicable city and county . rdinance nd state laws relating to building construction.
authorize representatives of this city or county to3r er therve-identified property for inspection ur ses.
S7u /1
Signature of Property Owner or ABMor� gt • . • •
. . : •. ` Y.Z.
Print Property Owner's or guttion is ante: fa_tea \4 S
01/01/2009