HomeMy WebLinkAboutF2022-0503 - Misc (3)STATE OF CAUFORNIA - FORESTRY AND FIRE PROTECTION
FIRE SAFETY INSPECTION REQUEST
STD. 850 (REV. 4-2000)
See instructions on reverse.
AGENCY CONTACTS NAME
California Department of Public Health
TELEPHONE NUMBER
(714) 567-2906
REQUEST DATE
02/15/2023
PROGRAM
Licensing, and Certification_
EVALUATOR'S NAME
Tu Tonnu, RN, MSN, FIFES
REQUESTING AGENCY FACILITY NUMBER -
060000122
REQUEST CODE --
1 A
—
LICENSING I California Department of Public Health
AGENCY Licensing and Certification
NAME AND Orange County District Office
ADDRESS 681 S. Parker Street, Suite 200
Orange, CA 92868
L _I
CODES
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY -
N/A
FACILITY NAME
Hoag Hospital Newport Beach
LICENSE CATEGORY
GACH
STREET ADDRESS (Actual Location)
One Hoag Drive
NUMBER OF BUILDINGS
1
CITY
Newport Beach, CA 92658
RESTRAINT
0
FACILITY CONTACT PERSONS NAME
Monica D. Dung
FACILITY CONTACT PERSONS TELEPHONE NUMBER
(949) 422-5418
HOURS
SPECIAL CONDITIONS
Acute Care Rehabilitation - Phase 2
3 North
TO BE COMPLETED BY INSPECTING AUTHORITY
FIRE
AUTHORITY
NAME AND
ADDRESS
I Newport Beach Fire Department
PO Box 1768
Newport Beach, CA 92658
L
CLEARANCE (DENIAL CODE
1. Fire Clearance Granted
CODES
INSPECTOR'S NAME (Typed or Printed)
Nadine Morris
TELEPHONE NUMBER
949-644-3105
CFIRS NUMBER
30055
OCCUPANCY CLASS
1-2
INSPECTION DATE
02/ 500'73
INSPECTORS SIGNATU E (typed orPrin
(,7d V 1Lo
1. FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER
EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS
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
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Facility Name and Address
Hoag Memorial Hospital Presbyterian
1 Hoag Drive Newport Beach, CA 92663
Facility No.
10428
Project No.
1200002-30-04
Submitted Date
2/14/2023
Parent Project No.
1200002-30-00
Contractor
HOWARD BUILDING CORPORATION
Inspector of Record
Dennis Baltbardis (A20159)
Telephone No.
(949) 254-6437
Construction Documents
Written Approval
8/17/2021
Project % Complete
90
Title or Scope of Project
126253 HHNB North Building Restack
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 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 for Milestone #4.
Okay to proceed to local fire for review of the space.
HCAI FDD Staff: Nathan Steele, Compliance Officer Date Printed: 2/14/2023