HomeMy WebLinkAboutX2009-1788 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2009-1788
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288
Combination Type - CIR ELEC/ PLUM/ /
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB St: 1 FI: 2 Unit: 220
Project:
Legal Desc.:
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant
Address:
Phone:
HOAG HOSPITAL FD & C
500 SUPERIOR AVE 0300
NEWPORT BEACH CA 92663
949-764-4486
FOTHERINGHAM JUANITA
101 $ KFtAEMER BLVD
PLACENTIA CA 92870
714-496-4185
Code Edit: 2007
Type of Construction: II-A-SPR
Occupancy Group:
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 Dabs: 10/21/2009
Construction Valuation
$49,280.00
Building Permit Fee: $660.00
Plan Check Fee: $475.20
Overtime Plan Ck:
Investigation Fee:
Record Management:
Energy Compliance:
CA Seismic Safety:
Disabled Access:
Fee Increase: Fee:
Additional Fee:
1-lazardous Mat:
$0.00
$0.00
$30.00
$50.00
$0.00
$75.00
$0.00
$0.00
$14.00
Building Green Fee: $2.00
$1$5.3111.
• • • • •
OS • •
PROCESSED BY: • •
ZONING APPROVAL:
GRADING APPROVAL:
•
•
Description: TI 1120 SFrBLOOD DONOR CENTER"
1437-2009 1437-2009
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:
Workers Compensat
Carrier
Policy No:
Expire:
Building Setbacks
Use Zone:
Parking Spaces:
San Dist:
Excise Tax:
NMUSD Fee:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
• 40
• • •
• • OS
• • •
• •
OOOOOO
• 41 0 41 •
• 4 • 411 SO
•
• 4.41 OO • • 000
W
•
•
•
•
•
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$115.50
$0.00
$82.50
PHILCO CONSTRUCTION INC
1762 N NEVILLE ST
ORANGE CA 92865
714-283.0604
764578
06/30/2011
B103011002
03/31/2010
ion Insurance
EVEREST NAT INS
7600001642091
04/01/2010
Rear /
Front /
Left /
Right /
0
FEES
Plan Check Fee:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Planning Department -
Plan check Fee:
Fair Share:
SJH Trans:
State Lic:
State tic:
FOTHERINGHAM JUANITA
101 S ICRAEMER BLVD
PLACENTIA CA 92870
714-496-4185
Spedal Conditions: NOT REVIEWED FOR OSHPD 3
COMPLIANCE.
Fire Hazard Zone: N
$59.50
$0.00
$0.00
Public Works Department -
Park Dedication: $0.00
P/W Plan Check: $0.00
$564.80
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
Fee Due at Permit Issuance:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
/A49p
ecibiet
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$998.90
•PERANTS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of pequty that I am exempt from the Contractoms State License Law for the reason(s)
Indicated befow 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 requInn 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 lioensed 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 Seetion
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more -than five hundred dollars ($500).
s I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or o 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. ii, 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
moose of sale).
U I, as owner of the property, arn exclusively contracting with licensed Contractors to construct the project (Section 7044,
Business and Professions Cole: 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). •
E I am exempt from licensure under the Contractors' State License Law for the following reason:
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
lI 3 -09
1 "
ischt,e rb
CERTIFICATE OF
OCCUPANCY ISSUED
DECLARATION
REGULATIONS
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SIGNATURE
I SUBMITTED
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ANCE WITH CODE
TITLE 40 AND AGMD
NOTIFICATION
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OF FEDERAL .
RULE 1403.
TO:
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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,
Secfion 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.govroalaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED
of
CONTRACTOR'S DECLARATION
I hereby affirm under penalty_ of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
Division 3 of the Business and Professions Code, and my license is in I fo and effect.
censeiffass License No.
Contractor Si
te p-69-7 -cnq Signature
I
11
Industrial
E(../ _.....2
ORKERS' COMPENSATION D LARATION
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 9708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
d.
o.
FOR OFFICE USE ONLY
00 • 000 000 • ,
• • • • • ' • •
00 • • • • • •
• • • • •
• • • • tip • • • •
• • • • .
•• ••• • • • •••
• • • • •• • •• •••
• • • • • • • •
• • •• • • • • •
• • • • • • • •
• 41.. 0 a dam am -
•
•
ve and will maintain workers' compensation insurance, as rc-ouired by Section 3700 of the Labor Code, for the
ance of the work for which this permit is issued. MY workers' compensation insurance carrier and policy number are:
r Policy Number Expiration Date
Name of Agent Phone it
a I certify that, in the pe • 0 7. nce of the work for which this permit Is issued, I shall not employ any person In any manner
so as to become subject •rk: 7' •• - • rnsation laws of California, and agree that, If I should become subject to the
item' compensation p • .. i s o ..". or Labor Code, I shall forthvAth comet with thos‘e_ provisions. ,•-%
,,
gnature of Applicant 4 ...• Date
?I -ay
il //a
ECLARATION REGARDING CONSTRUCTION LENDING AGENCY •
I hereby affirin under penalty of paltry 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 owneror 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 ordi and state laws relating to building construction.
I authorize representatives of thia city or county to en bo en roperty for Inspection purposes. ,
(
Signature of Property' Owner or Authorized Agent *a/•
,int Property Ownei's or Authorized Agent's Name.,___IAS•••
01/01/2009