HomeMy WebLinkAboutF2011-0179 - PermitsCity of Newport Beach
Job Address: 1 (20) HOAG DR NB
Inspector Area: \ PARE
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
Building Division FIRE COMBO Permit No: F2011-0179
PROJECT NUMBER : 0809-2011
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 .. •
HOAG HOSPITAL FD & C
500 SUPERIOR N300
NEWPORT BEACH CA 92663
949-764-4486
DETECTION LOGIC (SEYED)
7605 N SAN FERNANDO RD
BURBANK CA 91505
818-683-1552
Code Edit : 2010
Type of Construction: I-A-SPR
Occupancy Group: S-2
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories:
No of Units :
Flood Zone:
Bldg Sprinklers:
6
0
X
Y
Legal Description:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
INSPFCTOR
CAsi
Description: FIRE ALARM/ RJR 39 DEVICES "NORTH PARKING STRUCTURE"
0809-2011 DOL �1 { 1 tJ
( QAYaalGlhlEt STYi,UC.7VP26
CHUBB FIRE & SECURITY CA INC
7605 N SAN FERNANDO RD
BURBANK CA 91505
818-683-1552
713099
10/31/2011
BT01072507
06130/2011
Worker's Compensation Insurance
Carrier: INS CO STATE OF PA
Policy No: 061967369
Expire: 04/01/2012
Issued Date: 06/21/2011
Setback- Front -
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
Stale Lic:
SAMAVATI HALLEH
7605 N SAN FERNANDO
BURBANK CA 91505
818-683-1554
•
„ 0
Construction Valuation: $13,800.00
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 FEE:
$190.51
E0.00
$0.00
E0.00
$0.00
$190.51
$0.00
$0.00
$414.22
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 :
$190.51 Fee Due at Permit Issuance :
$33.20
$0.00
$0.00
$223.71
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
OTHER DEPARTMENT:
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
OWNER -BUILDER DECLARATION
. 1 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).
0 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).
0 I, as owner of (he 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 legall
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:L/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 Business and Profg ions Code, anddrny license is in full force
and effect. License Class _CIA C 1
l (j License No �� Z,_�L'f 1�' Date i _ ! _ 1 1 ntraclor Signature
WORKERS' C(IMPENSATION DECLARATION ✓
WARNING: FAILURE TO SECnRE WORKERS' COMPENSATION COVERAGE I5 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE
LOST OF'.:OMPENt/.T:O N, CAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I L.e:cly affirm under penally of perjury one of the following declarations:
G'i'tiat'e 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
4117.1 lance of 1,e MA: for which this permit is issued. Policy No.
Oa�o and wit' �mairtain 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' compensation
ur ce carrier,and,d,Micy number are:
mer,.
Policy Number Expiration Date
Name of Agents Phone #
13I Certify that, ir, the' performance e work for whic this 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 agree
DECLARATION REGA G ONST TI• LE DING AGENCY
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
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 hay rovided is correct.
I agree to comply with all applicable city and county dinances and s to laws relating to building construction.
I authorize representatives of this city or county a -I I ified grope inspection purposes.
jgnature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Name
Date6
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE40 AND
AQMD RULE 1403,
FOR OFFICE USE ONLY
PERMIT EXPIRED
■ I SUBMITTED ASBESTOS NOTIFICATION TO:
• EPA
• AQMD
PERMIT CANCELLED
PERMIT EXTENDED
• ASBESTOS NO7IFICATIONIS NOT APPLICABLE To ,
PROPOSED DEMOLITION.
SIGNATURE:
PERMIT FINAL
�..�.�j a
M O'�,? ��
CERTIFICATE OF
OCCUPANCY ISSUED