HomeMy WebLinkAboutX2008-1405 - PermitsCity of Newport Beach
Building Department COMB Permit No: X2008-1405
PO Box 1768 Newport Beach, California 92658-8915
Job Address: 1 HOAG OR NB
Inspector Area: 7
OF LOT
Owner: HOAG HOSPITAL FD & C
Address: 500 SUPERIOR AVE STE 300
NEWPORT BEACH CA92663
Phone: 949-764-4486
Applicant: JACK/NORDQUIST
Address: 2820 E GRETTA LN
ANAHEIM CA 92806
Phone: 714-721-9462
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: 07/21/2008
2007
U
0
0
1
0
0
Construction Valuation: $1 800.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigatin Fee:
Record Management :
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
Additional Fee :
Hazardous Mat :
$72.00
$51.84
$0.00
$0.00
$10.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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TOTAL FEE : $17C84
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PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
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Combination Type - BLDG/ / / /
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Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Description: (2) SIGNS "DONNA & JOHN CREAN CHILD CARE CENTER"
Project : 1295-2008 1295-2008
Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Contractor:
Address:
Phone:
Con State Lic
Lie Expire:
Bus Lic:
Lic Exp Date:
P S SERVICES INC
2820 E GRETTA LANE
ANAHEIM CA 92806
714-721-9462
614676
10/31/2008
BT30017294
10/31/2008
Worker's Compensation Insurance
Carrier: DELOS INSURANCE
Policy No: OIDKRM11001007
Expire: 04/01/2009
Building Setbacks
Use Zone:
Parking Spaces:
San Dist :
Excise Tax:
NMUSD Fee:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
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Rear:
Front:
Lek:
Right:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0
FEES
Planning Department -
Plan check Fee :
Fair Share :
SJH Trans :
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
State Lic:
NORDQUIST
312 W LAKE ST
MINNEAPOLIS MN 55408
612-823-7291
Special Conditions:
$37.50
$0.00
$0.00
Public Works Department -
Park Dedication : $0.00
PAN Plan Check : $0.00
Plan Check Fee : $51.84
PUBLIC WORKS APPROVAL:
• PLAN CHECK BY:
•
•
APPROVAL TO ISSUE:
• PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Fee Due at Permit Issuance : $120.00
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON
(SEC. 7031.5, BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE,
PERMIT EXPIRED
DATE:
BY;
DEMOLISH. OR REPAIR ANY STRUCTURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAPTER 9 (COMMENCING
WITH SEC. 7000) OF DIV. 3 OF THE BUSINESS AND PROFESSIONS CODE) OR THAT HE OR SHE 15 EXEMPT THEREFROM AND THE BASIS FOR THE
ALLEGED • NOR MOREMPTION. ANY VIOLATION OF SEC. ETHAN FIVE HUNDRED DOLLARS ($500): 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF
PERMIT CANCELLED
I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO 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
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,
THE BUILDING DR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER.BUILDER WILL HAVE THE BURDEN OF PROVING
PERMIT EXTENS ION
MITHAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.):
1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044,
BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS 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 CONTRACTORS
PERMIT FINAL
$�'�
<
,
UCENSE LAW.).
•
IAM EXEMPT UNDER SEC B. & P.C, FOR THIS REASON
CERTIFICATE OF OCCUPANCY
DATE OWNER
TENANT NAME
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I 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 FORCE AND EFFECT.
TYPE OF BUSINESS
LICENSE CLASS LICENSE NO.
/DATE -71at( O� CONTRACTOR IM
FOR OFFICE USE ONLY
/ `WORKERS' COMPENSATION DECLARA ION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
•
I D WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SEC 3700
E LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
�!• AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE. AS REQUIRED BY SEC 3700 OF THE LABOR CODE, FOR THE PERFORM-
ANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT
IN
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK
NER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION
TO THE WORKERS' COMPENSATION PR IONS OF SE
DATE' 7 / 2I I J 6 MPPLICANT:
IS FOR ONE HUNDRED DOLLARS (5100) OR LESS).
FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MAN.
LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT
00 OFFTHE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
.514
WARNING: FAILURE TO SECURE WORKERS COMPEN TION COVERAGE 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
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK
FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CN.C).
LENDER'S NAME
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LENDER'S ADDRESS
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I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL
CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF
IS CITY TO ENTER UPON THE ABOVE-MEN�T1IO+NED PROPERTYFORINSPECTION PURPOSES.
RMITTEE NAME (PRINT) ,5LLLVL Wait \C.11Y4 G,
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SIGNATURE OF PERMIITEE 7 w TE ��OTI ��
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