HomeMy WebLinkAboutX2010-2482 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2010-2482
PROJECT NUMBER: 1944-2010
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
/ CTOR
Combination Type - BLDG/ / / /
Job Address: 1 (42) HOAG DR NB
Description:NON-ILLUM WALL SIGN' HOAG NEUROSCIENCES INSTITUTE' @ EXISTING WALL (BLDG 42)
Inspector Area: 7
OF LOT
Owner: HOAG HOSPITAL FD&C
Address: 500 SUPERIOR AVE #300
NEW PORT BEACH CA 92663
Phone: 949-764-4486
Applicant: RYAN JENNIFER
Address: 5325 E HUNTER AVE
ANAHIEM CA 92807
Phone: 714-578-9555
Code Edit : 2007
Type of Construction:
Occupancy Group: U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories:
No of Units :
Bldg Height:
Bldg Sprinklers:
Flood Zone:
Issued Date: 10/25/2010
0
0
0
Legal Desc.:
IRVINE SUB BLK 2 LOTS 169 & 170POR OF LOTS & BLK 1 172 POR
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
OUTDOOR DIMENSIONS
5325 E HUNTER AVE
ANAHEIM CA 92807
714-459-6695
532856
06/30/2012
BT00007018
06/30/2011
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 478-000012
Expire: 04/01/2011
Building Setbacks Rear:
Front:
Left:
Right:
Use Zone:
Parking Spaces:
0
Architect:
Address:
Phone:
Engineer:
Address:
State Lic:
Phone: State Lic:
Designer: LE TUNG
Address: 5325 E. HUNTER AVE
ANAHEIM CA 92807
Phone: 714-578-9555
Special Conditions:
Fire Hazard Zone : N
Construction Valuation: $2,000.00
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 :
Hazardous Mat :
$93.00
$66.96
$0.00
$0.00
$5.15
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Solar System PC :
Excise Tax:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
Building Green Fee : $1.00
TOTAL FEE j.$2$6.11 •:• ,•.
• • •
it. •• • •
•
PROCESSED BY- • • : • •• ••-
ZONING APPROVAL:
•
•
GRADING APPROVAL!? ••� •: • • :•
• • • • •- •
•s
•• •• • • •• •
•i• s•
$0.00 Planning Department -
$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
$0.00
$0.00
$0.00
Plan Check Fee :
P/W Plan Check : $0.00
San Dist : $0.00
NMUSD Fee: $0.00
$126.96
$60.00
$0.00
$0.00
$0.00
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:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$99.15
Signature of Property Owner or Authorized Agen
(t' rim Property Owner's or Authorized Agent's Na
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). El I,
as owner of the property, or my employees with wages as their sole compensation, will do U all of or U 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
pnor 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 uponrequest when this application is submitted or at the
following Web site:httpJ/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 licensg is in full force and effect.
41 icense Class License No.
WORKERS' COMPENSATION DI?C19.ARATIONcrate 1'D ' 177\ u 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 performance of the work for which this permit is
i = ed.
N.
1 - e and will maintain workers' compensation insurance, as required. 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 #
❑ I certify that, in the performance 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 that if f should become subject to the
rkers' compensation roves o SbTO/p� ofshe Labor Code, I shall forthwith comp, with th a provisions.
nature of Applicant 11/4.,
CLARATION RICONSTRUCTION LENDING AGENCY Date
I hereby affirmunder penalty of perjury that there is a construction lending agency for the performance of the work for
is
sued this permit is (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 p operty 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 o dinances and state laws relating to building construction.
f authorize representatives of this city or couplty to enter the above -identified property for inspection pu oses.
Date 1� 0
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
2.-t-tr 1)
cekt
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AOMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
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1/01/2009