HomeMy WebLinkAboutF2008-0119 - PermitsCity of Newport Beach
Building Department FIRE COMBO Permit No: F2008-0119
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR NB
Inspector Area:Skt
OF LOT
Owner.
Address:
Phone:
Applicant:
Address:
Phone:
RLtC.t, HI1
HOAG HOSPITAL FD&C
500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
949-764-4486
COLON MIGUEL
PO BOX 50816
PASADENA CA 91115
626-284-9178
Code Edit : 2007
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
0
0
0
0
N
Legal Description: I
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
Description: METHANE MITIGATION "ADV TECH PAVILION" ( 9 poi , 3oz i)
0726-2008
RVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR /4,
SA
Architect: eCT
Address: Oa
ADVANCED MEDICAL BLDR INC
571 N POPLAR ST #E
ORANGE CA 92868
714-614-1573
824317
08/31/2008
BT30023363
05/31/2009
Worker's Compensation Insurance
Cartier: STATE FUND
Policy No: 238-0003116
Expire: 05/01/2009
Issued Date: 06/23/2008
Setback- Front:
Rear:
Left:
Right:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
TOFANI GLENN D
15510 ROCKFIELD BLVD,ST3 C3
IRVINE, CA 92619
949/580-1818 State Lic: C-044229
ESM & ASSOC
115 W CALIFORNIA PMB-207
PASADENA CA 91105
626-284-9178
Construction Valuation: $30,000.00
Building Overtime Plan Check :
Plan check Exten Fee:
Building Fire Plan Check Fee:
TOTAL FEE : $877.56
$0.00
$0.00
$0.00
FEES
Fire Plan Check Fee :
Fire Permit/Inspection Fee:
Records Management
Investigation Fee:
Residential Issuance Fee
Plan Check Fee : $322.56
$322.56
$448.00
$32.00
$0.00
$0.00
Counter Review :
Zoning Plan Check Fee:
$0.00
$0.00
$0.00
$75.00
Fee Due at Permit Issuance : $555.00
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
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1/1:\•
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
• • • • • • P1MIP•EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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V
� 5C)-(5-
OWNER -BUILDER DECLARATION
PERMIT EXPIRED
DATE:
BY:
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON
(SEC.
BUSINESSIONS CODE: ANY CITY OR COUNTY WHICH EOUIRES A PERMIT TO SUSUCT, ALTER, GDEMOLSH, OR REPARANVSTRUCTURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING
WITH SEC. 7000) OF DIV. 3 OF THE BUSINESS NO PROFESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE
ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF
NOR MORE THAN FIVE HUNDRED DOLLARS ($500):
Ei I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL OD THE WORK, AND THE STRUC-
TURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES
NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
PERMIT CANCELLED
PERMIT EXTENSION
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH 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 HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.):
FIRE PROTECTION
PERMIT FINAL
11 tat4IDQ
A./MAILS
In I, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC.
7044, BUSINESS AND PROFESSIONS CODE: THE CONSTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO
BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CON-
TRACTORS LICENSE LAW.).
• I AM EXEMPT UNDER SEC B. & P.C. FOR THIS REASON
FOR OFFICE USE ONLY
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• • • • • • • • • • • • • • • • •
• • • • • • • • • • •
•RELATING
• • • � • • •• •••
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SEC. 7000) OF
DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCT AND EFFECT.
LICENSE CLASS LICENSE NO.
DATE\v/ T.J-f CONTRACTOR (-- ,
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
II I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SEC 3700
• THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
�I VEANDWILLMAINTAINWORKERS'COMPENSATIONINSUR NNCE,ASREQUIREDBYSEC3700OFTHE ABORCODE FOR THE PERFORM
•'- OF ThE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORERS' COMPENSATION INSURNCE CARRIER AND POLICY NUMBER ARE:
. - RIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS).
❑ 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 AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SEC OF T E LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE
PROVISI S./ - �/
DARE lac f L� ,� APPLICANT:
WA ING: FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS PROVIDED FOR IN SEC. 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 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 (SEC. 3097, CIV.C).
LENDER'S NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY
AND COUNTY ORDINANCES AND STATE. LAWS TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS
COUNTY TO ENTER UPON THE E QBOVE.MENTONED PROPERTY FOR INSPECTION PURPOSES.
PERMITTEE NAME (PRINT)
'R.Z-
SIGNATURE OF PERMITTEE DATE 1 /a
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1/23/07 rev