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Home My WebLink AboutX2012-0080 - PermitsCity of Newport Beach Building Division PO Box 1768 Newport Beach California 92658-8915 Permit Counter Telephone (949)644-3288 Combination Type - CIPi ELECr MECHr r COMB Permit No: X2012-0080 PROJECT NUMBER: 0059-2012 Inspection Requests/Telephone (949)644-3255 Job Address: 1 (44) HOAG DR NB St 1 FI: 3 Unit: 380 Description:TI "DR KARIMKHANI" SUITE 380, 1,299 SF Inspector Area: 7 Legal Desc.: 140 Owner: Address: Phone: Applicant: Address: Phone: HOAG HOSPITAL FD&C 500 SUPERIOR AVE #300 NEWPORT BEACH CA 92663 949-764-4486 PILKERTON TRICIA 17780 FITCH #150 IRVINE CA 92614 949-724-1499 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: 01/12/2012 2010 II-A-SPR B 0 0 3 0 0 Y Construction Valuation: $60,000.00 Building Permit Fee: $759.90 Plan Check Fee: $547.13 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management: $31.00 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 : $1,887.37 RESUB OF CORONA DEL MAR LOT 6 BLK 140(AND E 12 FT LOT 7 BLK Contractor: Address: Phone: TAMA CONSTRUCTION INC 192 TECHNOLOGY DR STE B IRVINE CA 949-450-0411 Con State Lic: 767052 Lic Expire: 08/31/2013 Bus Lic: Lic Exp Date: Worker's Compensation Insurance Carrier STATE COMP INS FUND Policy No: 1499559 Expire: 11/01/2012 Building Setbacks Use Zone: Parking Spaces Solar System PC : Excise Tax: Grading Permit Fee: Grading PC Fee: WO Insp. Fee : Electrical %: Mechanical %: Plumbing %: Rear: / Front: / Left: / Right: / Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: PILKERTON TRICIA 17780 FITCH #150 IRVINE CA 92614 949-724-1499 Special Conditions: Fire Hazard Zone : N $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 $182.99 $156.85 $0.00 Plan Check Fee : P/W Plan Check: $0.00 San Dist: $0.00 NMUSD Fee: $0.00 $60.50 $0.00 $0.00 $0.00 State Lic: State Lie: Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit $888.92 Fee Due at Permit Issuance : PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: AC PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. d#. lAispEtron • • •• •• • =••••• • 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 (_) 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 D 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 an and effect. r / License Class License No * Y (Zs— Contract ig nature 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 rmance of the work for which this permit is issued. Policy No. ave and MIl•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 • nsurance �carries nmipoli.c�yy� number are: Cir Name of Agent • • LiPcertify that, Tn the perfo • thak, if I shou18 beetle su • •• Signature of P.gpji :• jienders Name • By ray signatDre•he1ow, I certify to each of the following: • • • • 4 am the property owner or authorized to act on the property owner's behalf. • • •'I have ad JW1a application and the information I have provided i -. ect. I agree tetomply with all applicable city and count ordinance I authorize representatives of this city or county yf ; e the Policy Number 14tt R659 ' 41 Expiration Date Y ts-- Phone # nce of the .. ' r whthis 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 to the f fensat'- . rovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. //..i?G A, .. 2.0 z .• btt.ARARQISf&oA-?' •r'STRU T- L NDING AGENCY • I eereby 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 Address Signature of Property Owner or Authorized FLggnt e laws r, sting to building construction. ertor inspection purposes. Print Property Owner's or Authorized Agent's N ACTION CATER BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS DNS PART 61 OF TITLE 40 AND AQMD RULE 1403. FOR OFFICE USE ONLY PERMIT EXPIRED ■ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD ASBESTOS NORRCA IS NOT APPLICABLE TO ED DEMOiITKI SIGNATURE PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL Lb - I-) 'I 2 CERTIFIIA7E OF OCCUPANCY ISSUED