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Home My WebLink AboutX2011-1756 - PermitsCity of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Combination Type - BLDG, ELECT / r Job Address: 1 (15) HOAG DR NB Description:(1) HOAG LOGO SIGN & (1) SIGN LIGHT STRIP Inspector Area: 7 OF LOT Owner: Address: Phone: Applicant Address: Phone: HOAG HOSPITAL FD&C 500 SUPERIOR AVE, STE 300 NEWPORT BEACH CA 92663 949-764-4486 BALBONA JOSEPH 10980 WILSHIRE BLVD LOS ANGELES CA 90024 310-473-3555 Code Edit : 2010 Type of Construction: V-B 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: 07/22/2011 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 Lic: Lic Exp Date: BLAKE SIGN COMPANY INC 11661 SEABOARD CIRCLE STANTON CA 90680 714.891-5682 506422 02/28/2013 8T30032367 07/31/2011 Worker's Compensation Insurance Carrier: EMPLOYEE SERV GRP Policy No: 2246 Expire: 06/01/2012 Building Setbacks Rear: / Front: / Left: / Right: / Use Zone: Parking Spaces: 0 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: COMB Permit No: X2011-1756 PROJECT NUMBER: 1383-2011 Inspection Requests/Telephone (949)644-3255 SPECTOR BALBONA JOSEPH 10980 WILSHIRE BLVD LOS ANGELES CA 90024 310-473-3555 State Lic:C006451 Special Conditions: Fire Hazard Zone : N State Lic: • • • • •• • •• • • •• • • • •• • • •• Construction Valuation: $30,000.00 Building Permit Fee: Plan Check Fee: Overtime Plan Ck: Investigation Fee: Record Management Energy Compliance: CA Seismic Safety : Disabled Access : $0.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : $0.00 Building Green Fee : $2.00 TOTAL FEE : $1,006.65 $477.15 $343.55 $0.00 $0.00 $13.00 $53.00 $0.00 Solar System PC: $0.00 Planning Department - Excise Tax: $0.00 Plan check Fee : Fair Share : SJH Trans : Grading Permit Fee: $0.00 In -lieu Housing Fee Grading PC Fee: $0.00 Public Works Department - WQ Insp. Fee : $0.00 Park Dedication : $0.00 Electrical %: Mechanical %: Plumbing %: $57.45 $0.00 $0.00 Plan Check Fee : PiW Plan Check : $0.00 San Dist : $0.00 NMUSD Fee: $0.00 $367.60 $60.50 $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 : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $639.05 •• • • • • • • • • •••••• • •• • • • • • '•• • • • • • • • •••.•• • PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: rS 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 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) of Division 3 of the Business and Professions Code,' li e is in full force and effect. � /P License Class License No �� (f a Z Date 7 2-Z_ i\contractor Signature — 10ICIRKcRS' OOMPENSATION DECLARATION• YILMI FAILURE TO SECUR E RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OFQOMPEN§4119JN DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S'FEES. • ffirm utter penal ty ty of perjury one of the following declarations: WV and wilt maintain a certificate of consent to self -insure for workers' compep$ation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the ance of tRJprot for which this permit is issued. Policy No. 2J'Z -t L..Q • .. R: <- and willmaintain 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' compensatior &ice carisLrd policy number are: C-1-Weir S Nee% s.n rto--r- S/.VCsS Policy Number 2 Z I(fi Expiration Date Piamerof Agent, Phone# I ter fy that in%tlla 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' compensationlawsof California, and agree )4,t, if lshould tLepp ie s ' to the workers' compensation pro ' ions of Section 3700 of the Labor Code, I shall forthwith comply with those pro isions. nature of Applft9M - Date 7- Zoi / / DECLARATION REGARDING CONSTROC ION L 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 county tetrter the above-i operty for inspection purposes. i nature of Property Owner or Authorized Agent -Print Property Owners or Authorized Agent's Name e 7—ZZ—// ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE4O AND AQMD RULE 1401 1 FOR OFFICE USE Six PERMIT EXPIRED ■ I SUBMITTED ASBESTOS MC)TIFICATION TO: ■ EPA - • AQMD El ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PERMIT CANCELLED PERMIT AIDED PERMIT FINAL I I,S -a ��7, PROPOSED DEMOLITION. SIGNATURE: CERTIFICATE OF OCCUPANCY ISSUED