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HomeMy WebLinkAboutF2011-0053 - PermitsCity of Newport Beach Building Department PO Box 1768 Newport Beach, California 92658-8915 FIRE COMBO Permit No: F2011 0053 PROJECT NUMBER : 0264-2011 Permit Counter Telephone (949)644-3288. Inspection Requestsf(eleptrone (949)844-3255 Job Address: 1 (29) HOAG DR NB St: 1 Inspector Area: 7 OF LOT Owner: Address: Phone: Applicant Address: Phone: HOAG HOSPITAL FD & C 500 SUPERIOR AVE #300 NEWPORT BEACH, CA 92663 WOODS JAYMIS 215 E EL SUR ST MONROVIA CA 91016 626-359-0034 Code Edit : 2010 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. It. Garage: No of Stories: No of Units : Flood Zone: Bldg Sprinklers: Description: INSTL (2) FIRE SPRINKLERS © THE SANI-PAK LOADING DOCK 0264-2011 (X2010-2800) IISOR Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: SOUTHWEST FIRE PROTECTION COMPANY Address: 215 E EL SUR STREET MONROVIA CA 91016 Phone: 626-359-0034 Con State Lic: 190173 Lic Expire: 09/30/2011 Bus Lic:. BT300001854 Lic Exp Date: 01/31/2012 Worker's Compensation Insurance VB Canter: ZURICH AMERICAN INS CO Policy No: WC437640707 0 Expire: - 01/01/2012 0 0 0 Issued Date: 02/14/2011 Setback- Front: Rear. Left: Right Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: State Lic: Statelid::. WOODS JAVIER&' 215 E: EL.SUR ST - MONROVIA CA 91016 Construction Valuation:', Building PC Fee : Building Overtime PC Fee: Building Extendon Fee : Building Investigation Fee : Fire Commercial PC Fee: Fire Commercial Permit Fee : Fire Residential Permit Fee.: Fire Residential Alarm Fee : TOTAL FEE: $2,670.00 $0.00 $0.00 $0.00 $0.00 $27.81 $77.26 $0.00 $0.00 $108.17 FEES Fire Residential Alarm PC Fee : $0.00 Planning. Counter Review :. $0.00 Planning Zoning PC Fee :. $0.00 Public Works PC Fee : $0.00 Public Works Traffic Plan Check Fee; ' $0.00 Plan Check Fee : prdsfvlanagernent: $0.00 Fee Due at Permit Issuance : $0.00; $0.00 $108.17 PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL : • ••• ••• • ••• ••• • • • • • • • • ••• • • • • : • • • • • • • • • • •• • •• •• • • • • • • • ••• . • • ••• •• • • • •.• • • • • • • • • • • • • • PE/�MIT€XPIR $ 110p4:1.,A«R ISSUANCE OR LAST VALID INSPECTION •• OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: p„e2Ato3q 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 thealleged 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 U all of or f l 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. li, 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). El I, 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 iimmproves thereon, and who contracts for the projects with -a licensed Contractor pursuant to the Contractors State License Lw CI) 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:http://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 provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busin ass and Professions Code, and my license is in fujI force and effect. Li pile Class C-tie LiceNo. re /- - 2-✓Y 11 Cor tact Signature 1. %�/l�'►�/ WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL', AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVR FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR D,1 SECTION9700 OF THELABORCODE; INTEREST, AND ATTORNEWS-FEES. I hereby affirm under penalty of perjury one of the following declarations: ❑ I have andwill 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 Poicy o. have and will maintain workers' compensation insurance, as required. by. Section 3700 of the Labor Code, for the rmance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: . artier Policy Number - Expiration Date Name of Agent - Phone # ❑ I certify that, in the pedomtance of the work for which this permit is issued, I shall not employ anyperson in any manner so as to become subject to the worke compensation la of California, and agree that if I houldbecome subject to the workers' compe -tio r . rovisto lion 700 oft r Code, I shall forthwith comply w h those provisions. Signature ofA. DECLARATI • REGAR G CONSTRUCTION LENDING AGENCY 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 (section 3097, Civil Code). Lender's Name - - Lender's Address - - - - ACTION DATE: BY: • 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 applicationand the. information 1 have provided is correct. - - • • - • • - •- I agree to comply with all applicable city and county ordinances and state laws relating to building construction. • • I authorize representatives of this city or county to enter the ve-identifiedpro p// for inspection purpose Signature of Property Owner or Authorized Agent '%C.�de'%' v v - Date a/ 4:: • / • • • • • • • ' Print Property Owner's or Authorized Agent's Name:. J� �J - �� l'- •_ PERMIT EXPIRED, PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL 3 CERTIFICATE OF OCCUPANCY ISSUED r• • • • • • • • r • • • • • • • •• • • • • • • • • • • • • • • • • FOR OFFICE USE ONLY 01/01/2009