HomeMy WebLinkAboutX2022-0778 - Misc (2)STATE OF CALIFORNIA - FORESTRY AND FIRE PROTECTION
FIRE SAFETY INSPECTION REQUEST
STD. E30 (REV. 41000)
(16l2.0)7$'/
See Instructions on reverse.
AGENCY CONTACTS NAME
California Department of Public Health
TELEPHONENRtBER
(714) 567 =
I uEBT'nATE
01i13/2023
PROGRAM
Licensing and Certification
EVALUATORS NAME
Bernabela Garcia, RN, MSN, FIFES
(TNGAOENC! FAL71riY NUIO$t
060000122
REQUEST COOE
l A .
LICENSING California
AGENCY Licensing
NAME AND Orange
Department of Public Health
and Certification
County District Office
S. Parker Street. Suite 200
CA 92868
J
1. ORIGINAL A. FIRE CLEARANCE
a RENEWAL B. LIFE SAFETY
A CAPACITY CHANGE
4 OWNERSHIP CHANGE
S. ADDRESS CHANGE
S. NAME CHANGE
7. OTHER
ADDRESS 681
Change.
L
- AMBULATORY
NONAMBULATORY . . i,_ _
.BEDRIDDEN :
TOTAL CAPACITY
CAPACm
PREnCU8C 71Y
CAPACITY-•- • .
.._
PWeV101MeAMp1Y.•
`CAPACITY ..
_
PRNOA01®CMICRy
..—•-- - - ... ..-
N/A
FACILITY NAME
Hoag Cancer Center
UCe ECATEGORY
OACH
STREET ADDRESS (AMEN L0281/94
One Hoag Drive Building 41
MASER OF aUa.DINGS
1 ..
CITY ..
Newport Beach, CA 92658
RESTRAIN
0
FACILITY CONTACT PERSONS NAME
Monica D. Deng
FACLITY CONTACT PERSONS TELEPHONE NUMBER
(949) 422.3418
HOURS
SPECIAL 03,43nIOy6
Cancer Center • 3rd Floor Renovation
TO BE COMPLETED BY INSPECTING AUTHORITY
FIRE
AUTHORITY
NAME AND
ADDRESS
Newport. Beach Fire Department
PO Box 1768
Newport Beach. CA 92658
L
INSPECTORS NAME (Typo orPomo)
Nadine Morris
INSPECTION DATE
01/18/2023 .2a.
EXPLAIN DENIAL OR LIST SPECIAL COMMIS
f'•
I
Girvido
CLEARANCE MEAL CODE
1. Fire Clearance Granted
CODES
1. FIRE CLEARANCE GRANTED
7. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
O . SPDNF4ERS
E- HOUSEKEEPING
F. SPECIAL HAZARD
0. OTHER
Department of Health Care Access and Information
FACILITIES DEVELOPMENT DIVISION
355 South Grand Avenue, Suite 1900. Los Angeles, CA 90071
Phone (213) 897-0166 Fax (213) 217-8511
2020 West El Camino Avenue, Suite 800, Sacramento, CA 95833 Phone (916) 440-8300 Fax (916) 274-0102
CERTIFICATE OF SUBSTANTIAL COMPLIANCE
Page 1 of 1
SC
Facility Name and Address
Hoag Memorial Hospital Presbyterian
1 Hoag Drive Newport Beach, CA 92663
Facility No.
10428
Project No.
S202109-30-00
Date
1/17/2023
Parent Project No.
N/A
Contractor
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
Inspector of Record
Dennis Baltbardis (A20159)
Telephone No.
(949) 254-6437
Construction Documents
Written Approval
6/24/2021
Project % Complete
90
Title or Scope of Project
126181 HHNB Cancer Center 3rd Floor Upgrade
CERTIFICATE OF SUBSTANTIAL COMPLIANCE: The building project, or a designated portion of the project, is sufficiently complete in
accordance with the approved construction plans and applicable California Building Standards Code such that the owner may use or
occupy the building project, or designated portion thereof, for the intended purpose.
Any exceptions or conditions related to this CERTIFICATE OF SUBSTANTIAL COMPLIANCE, if any, are noted in the Comments or
Additional Conditions section below:
PATIENT ADMITTING, TREATMENT OR CARE: This Certificate of Substantial Compliance is not an approval for patient admitting,
treatment or care, if applicable. The owner/health care provider must contact Licensing and Certification for their review and approval
prior to patient admitting, treatment or care in the affected room, space or area. Clearances may also be required from the local Fire
Department and/or the State Fire Marshal.
Comments or Additional Conditions
Certificate of Substantial Compliance Granted
HCAI FDD Staff: Nathan Steele, Compliance Officer Date Printed: 1/17/2023
Report Received By/Title: Dennis Baltbardis Date Printed: 1/17/2023