HomeMy WebLinkAboutX2011-0843 - 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/ /
COMB Permit No: X2011-0843
PROJECT NUMBER: 0544-2011
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB St: 2 FI: 3 Unit: 390 -
Description:Tl "SPEC SUITE" SUITE AREA 1250 SF, 100 SF AREA OF WORK
Inspector Area: 7
OF LOT
Owner.
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL FD & C
500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
949-764-4486
ANDELIN SHEILA
2070 BUSINESS CENTER DR
IRVINE CA 92612
949-757-6996
Code Edit :
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 3
No of Units :
Bldg Height:
Bldg Sprinklers:
Flood Zone:
Issued Date: 05/02/2011
2010
II-A-SPR
B
0
0
0
0
Y
Legal Desc.: 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:
D BAC INC
101 SHIPYARD WAY #100
NEWPORT BEACH CA 92663
949-723-0147
637651
02/29/2012
BT00016282
10/31/2011
Worker's Compensation Insurance
Carrier: DELOS INSURANCE
Policy No: 04DKRM12001526
Expire: 11/11/2011
Building Setbacks Rear: /
Front: /
Left: /
Right: /
Use Zone:
Parking Spaces:
0
Architect:
Address:
Phone: -.
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
State Lic:
ANDELIN SHEILA/03 DESIGN
2070 BUSINESS CTR DR #220
IRVINE CA 92612
949-757-6996
Special Conditions:
Fire Hazard Zone : N
Construction Valuation: $5,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
Additional Fee :
$135.90
$97.85
$0.00
$0.00
$1.05
$52.00
$0.00
$77.00
$0.00
$0.00
Hazardous Mat : $14.40
Building Green Fee : $1.00
TOTAL Pit : 44$3.3$ :
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
• •.•
Solar System PC:
Excise Tax:
Grading Permit Fee:
Grading PC Fee:.
WO Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
••• • • •• •••
• • •
• • • •
•- '•fl /t: ":
$0.00 PlanningDepartment-
$0.00 Plan check Fee :
Fair Share :
SJH Trans :
$0.00 In -lieu Housing Fee :
$0.00 Public Works Department -
$0.00 Park Dedication : $0.00
$23.79
$20.39
$0.00
Plan Check Fee :
• • • •
•
• •
• R L4 ••
P/W Plan Check : $0.00
San Dist : $0.00
NMUSD Fee: $0.00
$158.69
• Fire Department
$0.00 Fire Inspection:
$0.00 .. Fire Plan Rev
$0.00 Demolition Fee
$0.00 Building Dept Adm
General Service
Refund Deposit
Fee Due at Permit Issuance :
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
• • • • • _• •
_• • • •• • • - APPROVAL TO ISSUE:
• • • ••
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$o.00
$264.69
• • • • • • p@RWI(TS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Liecyc
R 131 j
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 (_) 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, provided that 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
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 70 0) of Division 3 of the Business and Profess'c. ns de, ndrmYYY' license is in full force
DI
and effect.
License Class License No Date J 2 I Contractor Signature
WORKERS' COMPENSATION DECLARATION
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
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
.f the work for which this permit is issued. Policy No.
I ha - and will 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' compensation
ce carrier and policy number are:
arrier
Name of Agent
❑I certify that, in the performance of the work f.. whic
that, if I should become subject to the workers' I. mpen
Signature of Applican
DECLARATION REGRDI ` CONSTRUCTION ` D G AGE CY
Expiration Date
Phone #
I not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date
I hereby affirm under penalty of perjury that there is a con c' ' 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 o
I have read this application and the information I have p
I agree to comply with all applicable city and county o
I authorize representatives of this city or county to e
Signature of Property Owner or Authorized Agent
aws relating to building construction.
r inspection purposes. I rC
rint Property Owners or Authorized Agent's Name - LV Ccl
• !l r
Dat
ACTION
(DATE
AY/ �..
DECLARATILON-OF COVPLIMCETWTH CODE OF
FEDERAL REGULATIONS PART 61OFTITLE40ANO
AMID RULE 1401
• I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
• AD
0 ASBESTOS NORRCATION IS NOT APPLICABLE
PROPOSED DEMOUTINN.-•
-
SIGMA TIRE:
•
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•
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•
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FQROFRCF•
• ••: ••• •••
• • • • •
• • •••
•• • • • •
•• •• •• •• ••
• • ••• ••• •
USE ONLY
• •
• • •
•
•
•
PERMIT EXPIRED
PERMIT CANCELLED
-
PERMIT EXTENDED
PERMIT FINAL
6 `-, l
CERTIFICATE OF
OCCUPANCY ISSUED
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