HomeMy WebLinkAboutX2011-0238 - PermitsCity of Newport Beach
Building Department
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288
Combination Type - SFP/ ELEC/ / /
COMB Permit No: X2011-0238
PROJECT NUMBER: 0164-2011
Inspection RequestsTTe'ephone ta49)644-3255
Job Address: 1 (17) HOAG DR NB
Description:INSTL (2) ILLUM SIGNS, ADJACENT TO MRI (BLDG 17) & ER (BLDG 15)
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL FD & C
500 SUPERIOR AVE #300
NEWPORT BEACH, CA 92663
HEYER ROBERT
5329 HUNTER AVE
ANAHEIM CA 92807
714-578-9555
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: 03/02/2011
2010
V-B
U
0
0
0
0
0
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 tic:
Lic Exp Date:
SIGN LIGHTS PLUS
929 BARKLEY AVE
ORANGE CA 92686
714-318-2545
771149
11/30/2011
Worker's Compensation Insurance
Carrier: WC EXEMPT
Policy No: (NO EMPLOYEES)
Expire:
Building Setbacks Rear: I
Front: I
Left: /
Right: /
Use Zone: PC-38
Parking Spaces: 0
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
YAKOB GHJAN
3336 AQUA DULCE CANYON RD #103
AQUA DULCE CA 91390
661-268-8899 State Lic:C-053791
FLYNN TERRI
5329 HUNTER AVE
ANAHEIM CA 92807
Special Conditions: AUTH FOR OUTDOOR DIM/
SUMMER HOWERTON TO PULL
PMT FOR SIGN LTS PLS ATT
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 :
Hazardous Mat :
$135.90
$97.85
$0.00
$0.00
$23.60
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Building Green Fee : $1.00
TOTAL FEE ; $0297,4
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Solar System PC:
Excise Tax:
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee:
Electrical %:
Mechanical %:
Plumbing %:
$0.00 Planning Department -
$0.00 Plan check Fee : $150.00
Fair Share : $0.00
SJH Trans : $0.00
$0.00 In -lieu Housing Fee : $0.00
$0.00 Public Works Department -
$0.00 Park Dedication : $0.00
$11.89
$0.00
$0.00
•• •'• '• • •••
•• Plan Check Fee:
• • • • •
•
• . •
• • • -
• •••
•••
•
•
_S_.
P/W Plan Check :
San Dist :
NMUSD Fee:
$100.23
$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:
••• ••• •.. :Fitwf tXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$320.01
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 cherdcmark(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 (j all of or () 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).
U 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.govicalaw.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 encing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is in full foeffect/
Licenge Class_ , License No.
Date 2 .4 (I Contractor Signature
WORKERS' O ENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND n, I JBJECT 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
No.
ve and will maintain workers' compensation insurance, as requiredinsurance
Section 3700 of the Labor Code, for the
nce of the work for which this permit is issued. My workers' compensation carrier and policy number are:
Policy Number Expiration Date
Phone #
ich this permit is Issued, I shall not employ any person in any manner
laws of California, and agree that if r should become subject to the
e Labor Code, I shall forthwith comply with those $rovjsions
Date
that, in the •erf
become subje
ers' compensation
Signature of Applican
DECLARATION
I hereby affirm u
which this permit is issue
Lender's Name
TION LENDING AGENCY -
re Is a construction lending agency for the performance of the work for
Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's beh
I have read this application and the information I have •. - is corre
I agree to comply with all applicable city and county or ' -nces . d sta
I authorize representatives of this city or county to nter t;` -iden
Signature of Property Owner or Authorized Agent
Print Properly Owner's or Authorized Agent's Name:
relating to building construction.
roperty for inspection purposQs.
Da
I�vteC— ^
ACTION
DATE:
BY:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
DECLARATION OF COMPL ANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AOMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
, . ,,.:� <. <.§a.. max: ,. , .:
FOR OFFICE USE ONLY
• • • • • • • • • • • •
• . .• • • • • • •
•• • • •
:. •• • ' • • • • • • • • .
• •• •• • ••••
•
•• • • • • • • •
• • • • • •
• • •• • •• •
• • • • • • •
•• • • • • • •••
•• •
•
•
01/01/2009
PSLP
Sign Lights plus Inc
1 John T. Martinez Jr. hereby give authority to Outdoor
Dimensitms to pull permits with my contractors license on my
behalf, for any project that Sign Lights Pied swill be installing and
or fabricating. .
'Eftatwr Wedn sdsy Aptil 30, 20a8 fSnr Wednesday. Dem9bar31
• John T. Martinez 7r.
Dina 71481$. 545
Conaatms Uae,e a 771149
Gra1laMaty Policy a 2097534591
•
• • • •
• •
• • ••
-
••JOil •
• • • •.' T
•••• •
• •' . • •
•40' - •f' •.
• • •. •..
•
•_ ,• •, •
•••• .
• •
• •: •00 .
•
July 21, 2008
To Whom It May Concern:
I, Brian Cox, as the Responsible Managing Employee (RME) for Outdoor Dimensions,
License if 532856, do hereby authorize, Summer Howerton to sign any and all permitting
documents. Perthe attached; I hereby provide a notarized copy of my signature for your .,
approval.
If you have any questions regarding this matter; please feel free to contact our Corporate
Secretary; JoAnne Boudreau, at 714-578-9555, Ext. 6589.
Sincerely,
Brian Cox
•.•.
• •• . •
.•
• • •• • • .. .
• • •
••
••••
• S.
....•
•
•.••
5325 E. Hunter Avenue, Anaheim, CA 92807 • 714-578-9555 • Fax 714-693-9578
www.outdoonlimensions.com
• ..
• .:• .
• ••.
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
}
On -7/a 8/ ® r before me, o5hA�0/l) 6eEbe e
ate Here Insert Name and Ti of the Officer /
/9t0 COX
State of California
County of OR /
personally appeared
Name(s) of Signer(s)
SHARON 6ERfiAER
cognation • 175227 1
^` , Hollow ruble • CtotRomlo
f1!1 Orotgo County
1"CaTvnsflesaa;t2511
Place Notary Seal Above
who proved to me on the basis of satisfactory evidence to
be the personf� whose nameJ) is/are subscribed to the
within instrument and acknowledged to me that
he/shektiey executed the same in his/her/their authorized
capacity(fe*, and that by his/her,4Heir signature($) on the
instrument the person(s5, or the entity upon behalf of
which the person(g) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand and official seal.
Signature
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:.
Document Date:
Signer(s) Other Than Named Above
Number of Pages:
•
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner — 0 Limited 0 General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
RIGHTTHUI
OF SIG
PRINT
R
Top of thumb here
• •
•
• •.
• • •
Signer's Name: • • •
❑ Individual
❑ Corporate Officer — Title(s):
0080
0000
❑ Partner — 0 Limited 0 General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
•
RIGHTTHI'ME°1INT
Or.SIGLER
'op el umb here
••. •
• •
•.•.
02007 National Notary Assocetlon• 9350 De Soto Ave.,P.G.8ox 2402•Chatsworth,CA 91313-2402•www.NationatNotaryorg Item 10907 Reorder:CatTolbFree 1A00.87&8327
••. •
• •
• •
• • •
•• •
• • •
• •
•. •
• • •
• •
•