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Home My WebLink AboutF2022-0164 - PermitsCity cf .New;'crt Beach - Building Division 1pi1111111111111111111111111111111111111111111111111 b 100 Civic Center Drive, Newport Beach, CA 92660 F 2 0 2 2 0 1 6 4 4` Permit Counter Phone (949)644-3288 Job Address�OAG DR NB Inspector Area: FIRE Owner: HOAG MEMORIAL HOSPITAL - Address: PO BOX Y IEWPORT-BEAC—HTGA Phone: Applicant: DOLLO JEFF Address: 1601 W ORANGEWOOD AV ORANGE CA 92868 Phone: 714-634-3923 Code Edit: 2019 Type of Construction: V-B-SPR Occupancy Group: B Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 1 No of Units : 0 Flood Zone: X Bldg Sprinklers: Y FIRE Permit: F2022-0164 Project No : 0812-2022 Inspection Requests Phone (949)644-3255 Description: COMM FIRE SPRINKLER TI - 280 HEADS (X2021-2023) RND UN0M(iROt)MZ> arLE L1Ne' Legal Description: IRVINE SUB BLK 1 LOT 172 POR OF LOT Contractor: A & D FIRE Architect: Address: 7130 CONVOY CT Address: Phone: 858-277-3473 Con State Lic: 1069002 Lic Expire: 0913012022 Bus Lic: BT30073130 Lic Exp Date: 10131/2022 Worker's Compensation Insurance Carrier: ZURICH AMERICAN INS CO Policy No: GLO100923506 Expire: 01/01/2023 Issued Date: 05/27/2022 Setback- Front: Rear: Left: State Lic: ' n eo State Lic: DOLLO JEFF 99 1601 W ORANGEWOOD AV ORANGE CA 92868 714-634-3923 l� ! ti �I lil I1, rnun !l `" Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: y I-r I�t-jI IL, Li I1 I LL✓ W 1 1 1 FEES Construction Valuation: $30,000.00 Building PC Fee : $0.00 Fire Residential Alarm PC Fee : $0.00 Records Management : $8.00 Building Overtime PC Fee: $0.00 Planning Counter Review : $0.00 Building Extention Fee : $0.00 Planning Zoning PC Fee : $0.00 Building Investigation Fee : $0.00 $0.00 Fire Plan Check Fee: $680.00 Public Works PC Fee : $0.00 $0.00 Fire Permit Fee : $1,092.00 Public Works Traffic Plan Check Fee; $0.00 Building Permit Fee: $0.00 TOTAL FEE : $1,780.00 Plan Check Fee : $680.00 Fee Due at Permit Issuance : $1,100.00 PROCESSED BY: SO — OTHER DEPARTMENT: ZONING APPROVAL: PLAN CHECKED BY:: FIRE APPROVAL: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION R 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, priorto 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 Iicensure 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 U 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). 1, 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 ow.ler 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 w o exempt from Iicensure under the Contractors' State License Law for the following reason: By my -ignatum talow 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 astructure 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://v .leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CCNTR:4CTOR'S DECLARATION I hereby affirm ui^vr penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an Professions Code, and my license is in full force aui; ..a,fe _.S.tcClass Class_ License No Dat S/a!/aa Contractor Signatur XOZXERS' COMPFNSATION DECLARATION .YARNING: FAILURe TO SE-URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUB.IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO E HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE LOFT CF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm'mde- 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 th performance of the work for which this permit is issued. Policy No. have 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' compensatio carrier and policy number are: Carrier Ah.K)CPo Zu Ud- Iv15• CO, Policy Number Expiration Date Name of Agent Phone # 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 agre that, if I should beco a subject thew kers' ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those isionCCs. Signature ofApplica Dat DECLARATION RE"enaltyo TRUCTION LENDING AGENCY I hereby affirm undery that there is a construction lending agency for the performance of the work for which this permit is issue (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 S aws relating to building construction. I authorize representatives of this city or cou t to enter tea d ntified property for inspection purposes. CG Signature of Property Owner or Authorized Age t Print Property Owner's or Authorized Agent's Namt �� Sl �Oi l0 ACTION DATE DECLARATION OF COMPLIANCE VA TH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONSPART 01 OF TITLE40 AND AQMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTEDASBESTOS NOTIFICATIONTO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMITEXTENDED ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION, PERMIT FINAL r 3 (D CERTIFICATEOF OCCUPANCYISSUED SIGNATURE: