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Home My WebLink AboutF2004-0042 - PermitsCity of Newport Beach Building Department FIRE ALARM Permit No: F2004-0042 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 BIdg:1 Floor: Suite: Inspector Area V. Owner: Address: Phone: Applicant: Address: Phone: HOAG MEM HOSP 1 HOAG DR NEWPORT BEACH CA 92658 949-574-4467 RINELLA NEAL 2220 UNIVERSITY DR NEWPORT BEACH CA 92660 949-574-1325 Code Edit : 2001 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : VN B 0 Legal Description: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: Description of Work: FIRE ALARM (BLDG 2/OUTPAT SURG CTR) (B2004-0289) 0216-2004 o,•i=•- frra_e MILES & KELLEY CONSTRUCTION COMPANY INC 1102 E VALENCIA DRIVE Address: FULLERTON CA 92831 714-773-9272 Phone: 312206 02/28/2005 BT00018695 12/31/2005 Worker's Compensation Insurance Carrier: STATE COMP Policy No: 1679210 Expire: 01/01/2006 Issued Date: 01/12/2005 Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: Architect: RINELLA NEAL 2220 UNIVERSITY DR NEWPORT BEACH CA92660 949-574-1325 State Lic: CO21102 TAYLOR WILLIAM C 2220 UNIV DR #200 NEWPORT BEACH CA92660 714/574-1323 State Lic: 5-000702 Construction Valuation: $30,000.00 Fire Plan Check Fee : Fire Permit/Inspection Fee: Records Management: Investigation Fee: Residential Issuance Fee $280.44 $389.50 $0.50 $0.00 $0.00 0 TOT L FEE : $670.44 FEES TOTAL PAYMENT : $280.44 TOTAL DUE : $390.00 $0.00 $0.00 PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL : 1W� OTHER DEPARTMENT: PLAN CHECK BY:: APPROVAL TO ISSUE: PERMATS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION APPROVALS DATE j BY FIRE PROTECTION COMMENTS UNDERGROUND ROUGH PIPE THRUST BLOCKS EXCAVATION UNDERGROUND PIPING FLUSH UNDERGROUND HYDRO TEST UNDERGROUND/BACKFLOW APRV 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, BUSINESSAND PROFESSIONSCODE A. •” D'TY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT.ALTER. IMPROVE, DEMOLISH, OR REPAIR ANY 1 STRUCTURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A F fi SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE 1 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 i ALLEGED EXEMPTION, ANY VIOLATIONOF SEC 7031 5 BY ANY APPLICANTFOR A PERMIT SUBJECTS THE (. APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (S500) I. AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE t, COMPENSATION,WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044. BUSINESSAND PROFESSIONSCODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO t AN OWNER OF PROPERTYWHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF } OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE fi NOT INTENDEDOR OFFERED FOR SALE IF, HOWEVER. THE SUILDINGOR IMPROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR t SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE ) L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED t5 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 M' IMPROVESTHEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WWITH A CONTRACTOR(S) LICENSED j PURSUANT TO THE CONTRACTORS LICENSE LAW ) SPRINKLER HYDRO TEST SPRINKLER FLOW TEST SPRINKLER ROUGH PIPE fi STANDPIPE HYDRO TEST j(STANDPIPE FLOW TEST !STANDPIPE ROUGH PIPE !CHEM SYSTEM FUNCTION TEST [CHEM SYSTEM APPROVAL 'CO2 SYSTEM APPROVAL FM 200 FUNCTION I AM EXEMPT UNDER SEC ,BBPC FOR THIS REASON € € DATE OWNER DRY CHEM SYS FUNCTION TEST DRY CHEN SYS FUNCTION APRV. HALON SYS FUNCTION TEST HALON SYS FUNCTION APPROVAL HOOD SYSTEM APPROVAL DOCK PROTECTION ROUGH DOCK PROTECTION HYDRO €DOCK PROTECTION FLOW ROUGH WIRING FIRE ALARM SYS „p5/ /��/r ��' '_I�gt'f/I S SYSTEM FUNCTION TEST CENTRAL STATION MONITOR ti FIRE MISC. !TANK REMOVAL €ETANK INSTALLATION/TEST !TANK PIPING PRESSURE TEST !FUEL MODIFICATION -0THER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS DATE) 1-n.-6$- v LIC NO CONTRACT WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS' i COMPENSATION, AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE, FOR THE I PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED - I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE. AS REQUIRED BY i SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH I, THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY ! NUMBER ARE CARRIER POLICY NUMBER (IHIV SLL IIUN NELL) NO Bt CUMPLE I LU IF IHt YEHMII I5 JOH UNt NUNLIKE)) UULLPHS 5 (5100) OR LESS) ? I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE I WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME + SUBJECT TO THE WORKERS' COMPENSATIONPROVIS ON50F SECTION 3700 OF THE LABOR { `CODE,-I/SHHALL FORTHWITH COMPLY WITH THOPR SIGN [L DATE) 014 VJ APPLICANr'7 b WARNING FAILURE TO SECURE WORKER:: CL.MPENEAT.ON CCVERAGE 15 UNLAWFUL, AND SHALL 1 SUBJECT AN EMPLOYER TO CRIMINAL^FN^LTIFS ANL, CIVIL FINS UP TO ONE HUNDRED THOUSAND fi DOLLARS (5100.000), IN ADDITION TC THE r-OS' OF COMPENSA' ION, DAMAGES AS PROVIDED FOR IN I SECTION 37060F THE LABOR CODE, IN. E i_ST,\ND A'TORYS"s FEES , 11 1- 4 O-- &F-k- L'C(- .4l / sacS r,3\ts it‘DYtYiS CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY x FOR THE PERFORMANCE OF THE WCSK FOR WHICH THIS PERMIT IS ISSUED (5EC3097, CIV C) i LENDERS NAME L LENDER'S ADDRESS # I CERTIFY THAT I HAVE READ THIS APPLICATION AND STA •E THAT T, P ABOS I INFORMATION 15 p CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING f TO BUILDING CONSTRUCTION,ANO HEREBYAUTHORIZEREPRESENTATIVESOF THIS COUNTY TO ENTER # UPON Tj1'EL({ABOVE-M^EENTIONEED PROPERTY FOR INSPECTION PURPOSES f V Y 4r C rcarb FINAL N.0 -(J P AME( 1 51G ATUREOFPERMI SE Formslrl FirePermIBaek