HomeMy WebLinkAboutF2011-0178 - PermitsCity of Newport Beach
Building Division FIRE COMBO Permit No: F2011-0178
PROJECT NUMBER : 0808-2011
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 1 (11) HOAG DR NB
Inspector Area: V` FIRE
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL FD&C
600 SUPERIOR AVE N300
NEWPORT BEACH CA 92663
949-764-4486
DETECTION LOGIC (SEYED)
7606 N SAN FERNANDO RD
BURBANK CA 91606
818-683-1654
Code Edit : 2010
Type of Construction:
Occupancy Group:
Added /New sq.lt. Bldg:
Added /New sq. It Garage:
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
I-A-SPR
12.1
0
0
1
0
Description: FIRE ALARM/INSTL 66 NEW DEVICES "JAMES IRVINE CENTER"
0808-2011
Legal Description:
Contractor: CHUBB FIRE & SECURITY CA INC
Address: 7605 N SAN FERNANDO RD
BURBANK CA 91605
Phone: 818-683-1652
Con Stale Lic: 713099
Lic Expire: 10/31/2011
Bus Lic: BT01072607
Lic Exp Date: 06/30/2011
Worker's Compensation Insurance
Carrier: INS CO STATE OF PA
Policy No: 061967369
Expire: 04/01/2012
Issued Date: 06/0612011
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
State Lic:
SAMAVATI HALLEH
7606 N SAN FERNANDO
BURBANK CA 91606
818-683-1558
'0
ci
bti
Construction Valuation: $22,200.00
Building PC Fee :
Building Overtime PC Fee:
Building Extenlion Fee :
Building Investigation Fee :
Fire Commercial PC Fee:
Fire Commercial Permit Fee :
Fire Residential Permit Fee :
Fire Residential Alarm Fee :
TOTAL FEE:
$283.18
$0.00
$0.00
$0.00
$0.00
$283.18
$0.00
$0.00
$573.56
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 :
$283.18 Fee Due at Permit Issuance :
$7.20
$0.00
$0.00
$290.38
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
ctt7
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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).
O I. as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U 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).
❑ 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 improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
O 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 al 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://wv.leginfo.ca.govicalaw.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 Business and Profe , ons Code, and y license is in full force
and effect.
License Class License No 1130611 Date (.t1.. �p \` . Contractor Signalur
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 ($100,000), IN AODITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
1`hereby affirm under penally of perjury one of the following declarations:
LJ 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
"Flo nce of the work for which this permit is issued. Policy No.
have 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' compensatior
carrier and pol' number are:
Name of Agent c
❑I certify that, in the performance of t
(hal, if I should become subLect to th
Signature ofT Applicant
]IN STRUd �E / q�[t y
DECLARATION REGA ING • NSTRU I � EN %I G A-G�PICY
I 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
Hoy Nu5pei
Expiration Date
Phone #
ork for which his permit is issued, I shall not employ any person in ny manner so as to become subject to the workers' compensation laws of California, and agrer
700 of the Labor Code, I shall forthwith comply with those provisions.
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 provid '+ is correct.
I agree to comply with all applicable city and county ordina and state
I authorize representatives of this city or county to enter ab
Signature of Property Owner or Authorized Agent
Data 6-6-9c)(
ws relating to building construction.
e for inspection purposes.
t Property Owner's or Authorized
Date
6-Z
ACTION
DATE
RY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
DECLARATION OF COMPLIANCE WITH CODE OF ,.c<4
AQMD RULE 1403.
• I SUBMITTED ASBESTOS NOTIFICATION TO:
• EPA
■ AQMD
PROPOSED DEMOIJTION.nON IS NOT APPLICABLE TO
SIGNATURE: ,
.,, ,FOR OFFICE USE ONLY
... .. . .
... , ..
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
I 1 i 5 —I 0-
)M x Dici
CERTIFICATE OF
OCCUPANCY ISSUED
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