HomeMy WebLinkAboutX2011-1052 - PermitsCity of Newport Beach
PO Box 1768 Newport Beach, California 92658-8915
Combination Type - BLDG/ / / /
Job Address: 1 (41) HOAG DR NB
Description:ADD CANOPY OVER RAISED WALKWAY 7' X 96' X 15'6 MAX HT.
inspector Area: 7
Owner: HOAG HOSPITAL FD&C
Address: 500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
Phone: 949-764-4485
Applicant: CAPELLO JEANIE
Address: 3901 SEGERSTROM AVE
SANTA ANA CA 92704
Phone: 714-556-1204
Code Edit : 2010
Type of Construction:
occupancy Group: U
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 0
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Flood Zone:
Issued Date: 05/19/2011
Legal Desc.:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
Building Division COMB Permit No: X2011-1052
PROJECT NUMBER: 0817-2011
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
NEWPORT AWNING COMPANY INC
3901 SEGERSTROM AVENUE
SANTA ANA CA 92704
714-556-1204
337453
01/31/2013
BT30034944
03/31 /2012
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 1894932
Expire: 06/23/2011
Building Setbacks Rear:
Front:
Left:
Right:
Use Zone:
Parking Spaces:
0
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
CHIEN HSI-HWA
5603 B TEMPLE CITY BLVD
TEMPLE CITY CA 91780
714-369-3928 State Lic:C-023319 •
•
Special Conditions:
Fire Hazard Zone : N
Construction Valuation: $18,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
$321.80
$231.70
$0.00
$0.00
$31.00
$0.00
$0.00
$0.00
$0.00
Additional Fee : $0.00
Hazardous Mat : $0.00
Building Green Fee : $1.00
TOTAL FEE : $64
Solar System PC :
Excise Tax:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
$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
$60.00
$0.00
$0.00
$0.00
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$291.70 Fee Due at Permit Issuance :
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$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$353.80
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PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
e-,-J359a
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 dvil 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 (_) 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).
❑ 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 Modespenalty 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
I,icense•Class • License No 5 ` ( Contractic Signature. l.. X.cr-
travYERS' COMPtbISATION DECLARATION
II( 44819: FAILURE TelSECURE 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 tOMPENSPMION►DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES.
I hereby affirm urdti malty of perjury one of the following declarations:
E.1 h$0e and yl agitain 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
ance of the work for which this permit is issued Policy No.
and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation
co carrier ape ¢glicy number are:
&Me. "•• • Policy Number
Name'of Agent .••••
..•.
❑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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of nt 0 yvwwo- N AGENCY
DECLARATIONON G NG CONSTRUCTION LEN AGENCY
Expiration Date
Phone #
I hereby affirm under penalty of perjury 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 coup to enter the above -identified pro erty for inspection purposes. }k
Signature of Property Owner or Authorized Flgg�r t 2�G.+vWY� Print Property Owner's or Authorized Agent's N2rj�Je
C pelk)'JteS—r`1-r1
ACTION
DATE
BY
— DECLARATION OF CVMPLTANCE WITH CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AMID RULE 1401
O I SUBMITTED ASBESTOS M9DFICAPDN TO:
■ EPA
0 AQMD
FOR OFRCE USE ONLY
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
■ ASBESTOSROPRCARONISNOTAPPLICABLETO
PROPOSED DEMOLITION-
PERMIT FINAL
6 73—Il
CERTIFICATEOF
OCCUPANCY ISSUED
SIGNATURE: