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Home My WebLink AboutX2010-2799 - PermitsCity of Newport Beach Building Department COMB Permit No: X2010-2799 PROJECT NUMBER: 2173-2010 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Combination Type - BLDG/ / / / Job Address: 1 (29) HOAG DR NB Description:NEW TRASH BALER ENCLUSURE (7'2 x 12' 9 x 13' 3 HT) ADJACENT TO HOSPITAL LOADING DOCK Inspector Area: 7 OF LOT Owner: Address: Phone: Applicant: Address: Phone: HOAG HOSPITAL FD & C 500 SUPERIOR AVE #300 NEWPORT BEACH, CA 92663 WOOD JACK FREDERICK III 4850 BARRANCA #203 IRVINE CA 92604 949-552-2061 Code Edit : 2007 Type of Construction: V-B Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: N Flood Zone: Issued Date: 01/11/2011 Construction Valuation: $10,000.00 Building Permit Fee: $207.40 Plan Check Fee: $149.33 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $194.40 Energy Compliance: $0.00 CA Seismic Safety : Disabled Access : Fee Increase: Fee: Additional Fee : Hazardous Mat : $0.00 $77.00 $0.00 $0.00 $0.00 Building Green Fee : $1.0 TOTAtf PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: • Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: DEB CONSTRUCTION INC 2230 E WINSTON ROAD ANAHEIM CA 92806 714-632-6680 372419 03/31/2011 8T30028854 08/31/2011 Worker's Compensation Insurance Carrier: TRAVELERS IDEMNITY Policy No: UB9072C011 Expire: 01/01/2012 Building Setbacks Rear: / Front: / Left: / Right: / Use Zone: Parking Spaces Solar System PC : Excise Tax: Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: •• • • • • • •• • • $0.00 $0.00 Architect: Address: Planning Department - Plan check Fee : Fair Share : SJH Trans : Phone: Engineer: Address: Phone: Designer: Address: Phone: R WOOD JACK FREDERICK III 4850 BARRANCA #203 IRVINE CA 92604 949-552-2061 State Lic:C015130 WELTON JEREMY 23441 S POINTE DR #245 LAGUNA HILLS CA 92653 949-916-3440 State Lic:S-004614 Special Conditions: Fire Hazard Zone : N $120.00 $0.00 $0.00 $0.00 In -lieu Housing Fee : $0.00 $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 $182.83 �Z- 20t7f Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit Fee Due at Permit Issuance : $0.00 $29.87 $0.00 $0.00 $0.00 $0.00 $0.00 $596.17 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: • • • -� • ; { • • '"j$E•IiNITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. • • • • • • • • • • • • • • 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 Profess ons Code) or that he or she is exempt from licensure and the basis for thealleged 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). O I, as owner of the property, or my employees with wages as their sole compensation, will do (, all of or ( 1 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 yearof 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: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 license is in full force and effect. ` License Class License No. JQate. 1' contractor Signature 7 v-a.v'j1 -,c7 -i / 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 ($1o0,00D), 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: O 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 it&go72CoK ye and will maintain workers' compensation insurance, as required, by, Section 3700 of the Labor Code, for the of the w rk for whyy��h this Tit is issued. Myywgrkers' compensaton insurance carrier and polio num er re: Carrier {a ye —Le jer r Policy Number U& D72C.(�(I Expiration Date Name of A ent I Phone # O I certify that, in the performance of the work for which this permit is issued, I shall not employ anperson in any manner so as to become subject to the workers'. compensation laws of California, and agree that if I shouldbecomesubject to the. workers' compensation provlsiopef S ction 3700� 'of the/Labor Code, I shall forthwith comply with thosg 9op sio nature of Applicant e'.4 T� e ,V (� i I DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjurythat 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 andthe 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 t%Pnter the above -identified property for inspection purpu es, Asignature of Property Owner or Authorized Agent �, A Ir Property Owner's or Authorized Agent's Name: ACTION DATE: BY: PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. El SUBMITTED ASBESTOS NOTIFICATION TO: CI EPA ❑ AQMD ❑ ASBESTOS' NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: • FOR OFFICE USE ONLY • • • • • • • • •• • • • • • • •.••• • • • • •• • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • • • • •• •• • • • • • • • • • • • • • • • • 01/01/2009 City of Newport Beach Building Department PO Box 1768Newport Beach, California 92658-8915 Combination Type - CI Pr ELEC/ / / Job Address: 1 (29) HOAG DR NB Description:EXTEND SANI-PAK SOUND ENCLOSURE @ THE LOADING DOCK Inspector Area: 7 OF LOT Owner: Address: Phone: Applicant: Address: Phone: HOAG HOSPITAL FD & C 500 SUPERIOR AVE #300 NEW PORT BEACH, CA 92663 WOOD JACK FREDERICK III 4850 BARRANCA #203 IRVINE CA 92604 949-552-2061 Code Edit : 2007 Type of Construction: VB Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: N Flood Zone: - Issued Date: 01/11/2011 Legal Desc.: Permit Counter Telephone (949)644-3288 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: DEB CONSTRUCTION INC 2230 E WINSTON ROAD ANAHEIM CA 92806 714-632-6680 372419 03/31/2011 BT30028854 08/31/2011 Workers Compensation Insurance Carver: TRAVELERS IDEMNITY Policy No: UB9072C011 Expire: 01/01/2012 Building Setbacks Rear: Front: Left: Right: Use Zone: Parking Spaces Architect: Address: Phone: Engineer: Address: COMB Permit No: X2010-2800 PROJECT NUMBER: 2173-2010` Inspection Requests/Telephone,(949)644-3255 ":• WOOD JACK FREDERICK III 4850 BARRANCA #203 IRVINE CA 92604 949-552-2061 State Lic:C015130 WELTON JEREMY 23441 S POINTE DR #245 LAGUNA HILLS CA 92653 Phone: 949-916-3440 State Lic:S-004614 Designer: Address: Phone: Special Conditions: Fire Hazard Zone : N Construction Valuation: $15.000.00 Building Permit Fee: $278.90 Plan Check Fee: $200.81 Overtime Plan Ck: $0.00 Investigation Fee: $0,00 Record Management : $1.05 Energy Compliance: $0.00 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 : $1.Q TOTAL FE PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: • • • • Solar System PC : Excise Tax: Grading Permit Fee: Grading PC Fee:- WQ Insp. Fee: Electrical %: Mechanical %: Plumbing %: • • • • • • • • • • • • • • • • • • • • • . • • • • • • • • •• • • • • • • • •• •• i- ; iP1ERiWiB $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 $48.81 $0.00 $0.00 Plan Check Fee : PiW Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $250.73 $180.00 $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: PIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTED $0.00 $40.16 $0.00 $0.00 $0.00 $0.00 $0.00 $591.40 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 permitto 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 ahy 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 O 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. ff, 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 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) Division 3 of theBusiness and Professions Code and license is m full force and effect. of my License Class License No. ,ontractor Signature I 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 permitis ed. No. ave and will maintain workers' compensation insurance, as required. by. Section 3700 of the Labor Code, for. the --e of e work for which this permit is issued. My workers' c4Simegaatwp insurance carrier and polio n mbbr re: Policy Number I] b 610 /[C CI I Expiration Date I / Name o 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. the workers' compensation laws of California, and agree that if I, shouldbecomesubject to the rkers' compensation prgvlsyahs of Section 3700 of the Labor Code, I shall forthwith comply with those_ pr vas ns DECLARATION REGARDING CONSTRUCTION LENDING AGENCY 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 nature of Applicant te Lender's Address By my signature below, I certify to each of the following: I amthe 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 enter the above -identified property for inspection purpose/s. gnature of Property Owner or Authorized Agent - e ,t (( Property Owner's or Authorized Agent's Name: 11- CC_-' ACTION DATE: BY: PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL 3-Z3-tl CERTIFICATE OF OCCUPANCY ISSUED DECLARATION OF COMPL ANCE 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: Inamam • • . • FOR OFFICE USE ONLY • ••• ••• ••• • • • • • • • • • • • • • • • • • • •• Se •• • • • • • • •• ••• • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • •• ••• • • •• •• • • • 1/01/2009