HomeMy WebLinkAboutF2011-0177 - PermitsCity of Newport Beach
Building Division
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288
FIRE COMBO Permit No: F2011-0177
PROJECT NUMBER : 0807-2011
Inspection Requests/Telephone (949)644-3255
Job Address: 1 (36) HOAG DR NB
Inspector Area: \ Ft%E
Owner
Address:
Phone:
Applicant
Address:
Phone:
HOAG HOSPITAL FD&C
500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
949-764-4486
DETECTION LOGIC (SEYED)
7605 N SAN FERNANDO RD
BURBANK CA 91505
818-683-1554
Code Edit : 2010
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:
I-A-SPR
S-2
0
0
5
0
X
Y
Construction Valuation: $3,818.00
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 4
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
Legal Description:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
Description: FIRE ALARM/ R/R 17 DEVICES "SOUTH PARKING STRUCTURE"
0807-2011
CHUBB FIRE & SECURITY CA INC
7606 N SAN FERNANDO RD
BURBANK CA 91505
818-683-1552
713099
10/31/2011
BT01072507
06/30/2011
Worker's Compensation Insurance
Carrier: INS CO STATE OF PA
Policy No: 061967369
Expire: 04/01/2012
Issued Date:
Setback- Front:
Rear:
Left:
Right:
$87.55
$0.00
$0.00
$0.00
$0.00
$87.55
$0.00
$0.00
$195.80
C
06/21/2011
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 :
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer
Address:
Phone:
Special Conditions:
Moo
$0.00
Moo
$0.00
$0.00
$87.55
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
Stale Lic:
State Lic:
11'-1- S1S-Lvv ,
566
Records Management :
Fee Due at Permit Issuance :
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
$20.70
$0.00
$0.00
$108.25
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 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. 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).
❑ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Stale 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).
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below 1 acknowledge that, except for my personal residence in which 1 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:hllpl/www.leginfo.ca.gov/calaw.html.
Signature of PrGperty owner or Authorized Agent Date
j.(CPNNED CONTRACTOR'S DECLARATION
1 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 Prole ons Code, an my license is in full force
and effect.
(icense'Class Lk o
1 b License No 1130 0(01 Date-- 6.7 1 1\ ntractor Signature
WORKERS' C6M°ENSATION DECLARATION
"ARN'N3: 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 (5100,000), IN ADDITION TO THE
COST OF COMPENSRTION, LAMAGES AS PROVIDED FOR IN SECTION OTOS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penally of perjury one of the following declarations:
.1-we 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 thr
jrnce of Ilse wort( for which this permit is issued. Policy No.
and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensalior
ce carrier;9nrI.7;nlicy number are:
Policy Number Expiration Date
Name of Agent Phone #
I certify that, in the performance +f the work for which his 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 agrer
that, if I should become subject the workers' . ompe ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
re of Applicant U
CLARATION REGAR 'G CONSTRUCTION LENDING AGENCY
6 2t -‘l
ereby 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).
nders Name Lender's Address
By my signature below, I certify to each of the following:
I am the properly owner or authorized to act on the property owner's behalf.
I have read this application and the information I have prov d is correct.
I agree to comply with all applicable city and county ordi ces and state
I authorize representatives of this city or county to e
ure of Property Owner or Authorized Agent
ACTION
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
DATE
BY
11A D r2ilkS
relating to building construction.
pertpcs inspection purposes. 1, �[ (� �f
roroped)/Owners or Authorized Agent's Name r`$ E/jC(/2A'j eb _ (1 tz1 -L (
DECLARATION OF COMPLIANCE WITH CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE40 AND
AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE ID
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY