HomeMy WebLinkAboutF2009-0322 - PermitsCity of Newport Beach
Building Department FIRE COMBO Permit No: F2009-0322
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 St: 1 FI: 2 Unit: 220
Inspector Area: 7
OF LOT
Owner:
Address:
Phone:
Applicant
Address:
Phone:
HOAG HOSPITAL FD & C
500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
949-764-4486
SPRINKMATIC A CORP
79 DAILY DR, #245
CAMARILLO CA 93010
805-300-2641
Code Edit : 2007
Type of Construction:
Occupancy Group:
Added /New stilt. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
I-B-SPR
B
0
0
3
0
Y
Description: FIRE SPRINKLERS (X2009-1788)
1575-2009 (X2009-1788)
Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Contractor: SPRINKMATIC A CORP
Address: 79 DAILY DR #245
CAMARILLO CA 93010
Phone: 805-640-9676
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
690171
06/30/2010
BT30011314
08/31 /2010
Worker's Compensation Insurance
Carrier: OAK RIVER
Policy No: 2200053163081
Expire: 06/01/2010
Issued Date: 11/10/2009
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
State Lic:
SPRINKMATIC A CORP
79 DAILY DR #245
CAMARILLO CA 93010
805-300-2641
Construction Valuation:
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee :
Fire Commercial PC Fee:
Fire Commercial Permit Fee :
Fire Residential Permit Fee
Fire Residential Alarm Fee :
TOTAL FEE:
$600.00
$64.80
$0.00
$0.00
$0.00
$0.00
$64.80
$0.00
$0.00
$153.60
FEES
Fire Residential Alarm PC Fee :
Planning Counter Review :
Planning Zoning PC Fee :
Public Works PC Fee :
Public Works Traffic Plan Check Fee;
Plan Check Fee :
$0.00
$0.00
$0.00
$0.00
$0.00
Records Management :
$64.80 Fee Due at Permit Issuance :
$24.00
$0.00
$0.00
$88.80
•
PROCESSED BY:
ZONING APPROVAL
FIRE APPROVAL :
• .•• ••• • • •
• • • •
• • • • •
•: • •: • • •• .•
• •
• •
•
•.• • • • ••• ••
•
• • • • • . • •
• •
• •• • • •• • • • • PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
400 •. .• • • ••• ••
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
0(01
OWNER -BUILDER 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, prior to 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 licensure 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 () all of or 0 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).
LI 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 owner 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 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below 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 a structure 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:httpi/www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is'n hill force and effect.
ae License No.
Date U Contractor Signatu
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (E100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABORCODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under 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 the performance of the work for which this permit is
issued.
Policy No.
❑ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
performance of e ork for whi 4 's p rmit is issued r y work s' compensation insuran - carrier and policy number are:
Carrier oligo�Isol1 ation Date
Name of Agent •
❑ I certify that, in the perform ce of the work for which thi rmit is issued, I sh fl of employ anyperson in any manner
so as to become subject tothe rkers' compensation laws alifornia, and agree that if 1 shouldbecom subject to the
workers' compensation p ovisions ction 370 ff the Labor ode, I shall forthwith comply with t ovJsl I}s c�
Signature of Applicant 7 l�f�%� Datd l v / 0) 0
DECLARATION REGARD NG CONSTRUCTION LENDING AGENCY
I hereby affirmunder penalty of perjury that there is a construction lending agency for the performance of the work for
is
sued this permit is (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 finances and state laws relating to building construction
I authorize representatives of this city or coun(yto e r the above-iden • I d property for inspection purposes.
Date
Signature of Properly Owner or Authorized Agent
Print Property Owner's or Authorized Agent's Name Sr)o1 t9 ( / tee• n
ACTION •
DATE:
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
►1-Iz.-Oct
CERTIFICATE OF
OCCUPANCY ISSUED
FOR OFFICE USE ONLY
•• • • •
• •• • ••
•
••o• • • •
• • • • • •
• • •
• •
•
•
• • • • • • •
• • •• • • • • •
• •••
•
•
•
• ••
•
•• ••• • • • •••
•
01/01/2009