HomeMy WebLinkAboutX2010-0345 - PermitsCity of Newport Beach
Building Department
PO Box 1768 Newport Beach, California 92658-8915
COMB Permit No: X2010-0345
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Combination Type - CIR ELED MECI-1/ PLUM/
Job Address: 1 HOAG DR NB St: 2 FI: 3 Unit: 370
84-0 CR 44 Project:
Legal Desc.:
Inspector Area: 7
OF LOT
Owner: HOAG HOSPITAL FD&C
Address: 500 SUPERIOR AVE, STE 300
NEVVPORT BEACKCA, 9fl63
Phone: 949-764-4486
Applicant: WILKERSON BEN
Address: 4850 BARRANCA 8203
IRVINE CA 92604
Phone: 949-552-2061 X122
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: 04/19/2010
2007
II-A-SPR
0
0
3
Construction Valuation: $35,620.00
Building Permit Fee: $533.30
Plan Check Fee: $383.98
Overtime Plan Ck: $0.00
Investigation Fee: $0.00
Record Management: $0.00
Energy Compliance: $52.00
CA Seismic Safety: $0.00
Disabled Access: $77.00
Fee Increase: Fee: $0.00
Additional Fee: $0.00
Hazardous Mat: $14.40
Building Green Fee: $2.00
TOTAL FEE: $1,379.11,
•
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Description: TI "HOAG CONFERENCE" 548 SF
0283-2010 0283-2010
IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Contractor:
Address:
Phone:
PHILCO CONSTRUCTION INC
1762 N NEVILLE ST
ORANGE CA 92865
714-283-0604
Con State Lic 764578
Lic Expire: 06/30/2011
Bus Lic:
Lic Exp Date:
Workers Compensation Insurance
Carrier:
Policy No:
Expire:
EVEREST NAT INS
7600001642101
04/01/2011
Building Setbacks Rear: /
Front: /
Left: I
Right: /
Use Zone:
Parking Spaces: 0
Solar System PC: $0.00
Excise Tax: $0.00
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee :
Electrical %:
Mechanical %:
Plumbing °A:
••
• ; • •
• ; ••• ; • „; • •
; •••• • •
••• ;
ICLUL
$0.00
$0.00
$0.00
• $93.32
$80.00
$66.66
FEES
Planning Department -
Plan check Fee:
Fair Share:
SJH Trans:
Architect
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
WOOD JACK FREDERICK III
4850 BARRANCA #203
IRVINE CA 92604
949-552-2061 State Lic:C015130
Phone:
Special Conditions:
Fire Hazard Zone : N
Somo
$0.00
$0.00
Public Works Department -
Park Dedication: $0.00
P/W Plan Check: $0.00
San Dist:
NMUSD Fee:
Plan Check Fee: $560.77
Soso
$0.00
State Lic:
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Del:rasa
Fee Due at Permit Issuance:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
• •!. • • ; • PERVOS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
• • • 1.4.•
••• •• ••
$0.00
$76.80
$0.00
$0.00
$0.00
$0.00
$0.00
$818.69
, •••
•• t •: t :
OMD
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Q-8 5
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:1 as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) portions of
ithe
work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: 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:1 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).
El I am exempt from (teensy° 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 Professions Code, and my license is in full ce and effect.
Licens3essi( , icr
Date / C Contractor SignatureX
License No. a
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:I I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director 91
stria! Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
rmance of t rk for whic this rmit is issued. My workers' compensatio nsurance carrier and policy number are:
arrier Polic ion Date
Name of Agent
I:I I certify that, in the performance of the work for which this p mit is issued, I shall employ any person in any manner
so as to become subject to rkers' corn ensation law f California, and agree that, if f should becometo subj t the
workers compensation rov the f Se 'on of the Code, I shall forthwith comply with tikapr itoin
DECLARATION REGARDING CONSTR CTION LENDING AGENCY
I hereby affirm under penalty of perjuiy 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 laws relating to building construction.
I authorize representatives of this city or county to e the abov enfified operty for inspection purposes.
Signature of Property Owner or Authorized Age Date
-
Print Property Owner's or Authorized Agent's Name;--\---- j)..Y.T1 faseq—e—f—.."
Signature of Applicant
Date
ACTION
PERMIT EXPIRED
DATE:
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
7 L 0
c1-16-lo
cec:s
DECLARATION OF OF COMPL ANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403.
El I SUBMITTED ASBESTOS NOTIFICATIONo
TO:
o
EPA
AOMD
I:I ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
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01/01/2009
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