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Home My WebLink AboutX2011-1483 - PermitsCity of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Combination Type - CIP/ ELEC/ MECH/ PLUM/ Job Address: 1 (44) HOAG DR NB St: 1 FI: 2 Unit: 200 Description:TI/REDUCE SUITE AREA TO 1493 SF "HOAG ADMINISTRATION" Inspector Area: 7 Owner: HOAG HOSPITAL FD&C Address: 500 SUPERIOR AVE, STE 300 NEWPORT BEACH CA 92663 Phone: 949-764-4486 Applicant: WOOD RICK/WBS Address: 1800 QUAIL ST, STE 120 IRVINE CA 92660 Phone: 949-552-2061 Code Edit : 2010 Type of Construction: II-A-SPR Occupancy Group: B Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 3 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Y Flood Zone: Issued Date: 07/14/2011 Construction Valuation: $59,000.00 Building Permit Fee: $752.71 Plan Check Fee: $541.95 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $41.00 Energy Compliance: $53.00 CA Seismic Safety : $0.00 Disabled Access : $78.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : $15.00 Building Green Fee : $3.00 TOTAL FEE : $2,011.24 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Legal Desc.: Contractor: Address: Phone: FAR WEST CONTRACTORS CORP Architect: 11122 HOMEWAY DRIVE LVD Address: GARDEN GROVE CA 92841 714-636-8744 Phone: Con State Lic: 870705 Lic Expire: 01/31/2012 Bus Lic: Lic Exp Date: Worker's Compensation Insurance Carrier: Policy No: Expire: Building Setbacks Use Zone: Parking Spaces: Solar System PC Excise Tax: Grading Permit Fee: Grading PC Fee: WQ Insp. Fee: Electrical %: Mechanical %: Plumbing %: $181.25 $155.37 $129.46 Engineer: Address: Phone: Designer: WILLIAMSBURG NATIONAL, Address: WC0463848 03/18/2012 Phone: Rear: Front: Left: Right: $0.00 $0.00 0 Planning Department - Plan check Fee Fair Share : COMB Permit No: X2011-1483 PROJECT NUMBER: 1161-2011 Inspection Requests/Telephone (949)644-3255 INSPECTOR WOOD JACK FREDERICK III 4850. BARRANCA #203 IRVINE CA 92604 949-552-2061 State Lic:C01 5130 Special Conditions: Fire Hazard Zone : N $60.50 $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 P/W Plan Check : $0.00 San Dist: $0.00 NMUSD Fee: $0.00 Plan Check Fee : $790.05 State Lic: k - 3 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit • • • • •• 0060 • • • • • • ••. • • • • • • • • • ••.•• •• • • • • • • •• • • • • • •• • • ••• • •••• • • • • • • $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Fee Due at Permit Issuance : $1,221.19 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: PERMITS 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 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 ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ I am exempt from licensure under the Contractors' State License Law for the following reason: - • By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sey j.hructure tr§t jJQ a built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Rrofessisns Code• is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. SJnaiu're of Property Owner or Authorized Agent Date OCFN$ED COmtwtTOR'S DECLARATION Ib%2bgaffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division of the Business and Profess C e, and my license is in full force Liam's Class • License No X bate 7 f'(— Zo( I :tractor Signature L.,• • VYORS' COMPE(4SATION DECLARATION WARNING FAILURE•IObEEURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST QF•cOMPENSAtION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. flgl%byAffirm under penalty of perjury one of the following declarations: GI I have and wiTlmaintain 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 ice of lie woMfor which this permit is issued. Policy No. e and wIA„r9Cit5in 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 ce carrier and policy number are: Carrier 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 t, if I should become subject to the y/orke(s' compepsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Nicature of Applicant DECLARATION REGARDING CO RUCTION LENDING ICGENCY I hereby affirm under penalty of perju 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 Policy Number Expiration Date Phone # Date -7— / U'( — Z 0-1 ( 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 law relating to building construction. I authorize representatives of this city or county to enter t aheve-Id ntified rope f spection purposes. nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name1 J �_CZ V Efate ` �� ^��f' ACTION DATE I BY DEL(LARATION OFCOMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. ❑ ISUBMITTED ASBESTOS NOTIFICATION TO: 0 EPA ■ AQMD ASBESTOS NOTIF IS NOT APPLICABLE TO FOR OFFNF USE OI(ILY PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL Fegr.14 J vvv "`lJd POSED DEMOLIT ON.TION OCCUPCNCYISATE OCCUPANCY 51GNATLREi��'/,_ A Ait. /I/`!.►�4'4Y/