HomeMy WebLinkAboutX2011-1955 - PermitsCity of Newport Beach
Building Division
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288
Combination Type - CIP/ ELEC/ MECH/ /
COMB Permit No: X2011-1955
PROJECT NUMBER: 1549-2011
Inspection Requests/Telephone (949)644-3255
Job Address: 1 (44) HOAG DR NB St: 1 FI: BSMT
Description:TIE-IN (N) PRESSURE & FLOW METER TO CENTRAL PLANT BMS, INCLUDING DRY WALL REPAIR
Inspector Area: 7
Owner: HOAG HOSPITAL FD & C
Address: 500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
Phone: 949-764-4486
Applicant: NEAL MICHAEL
Address: 5670 OBERLIN DR
SAN DIEGO CA 92121
Phone: 858-597-0555
Code Edit :
Type of Construction:
Occupancy Group:
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories:
No of Units :
Bldg Height:
Bldg Sprinklers:
Flood Zone:
Issued Date: 09/21/2011
2010
I I-A-SPR
B
0
0
3
0
0
Y
Legal Desc.:
Contractor: QUESTAR ENGINEERING
Address: 20062 BIRCH ST #300
NEWPORT BEACH CA 92660
Phone: 949-250-0060
Con State Lic: 933785
Lic Expire: 06/30/2013
Bus Lic: BT30015583
Lic Exp Date: 01/31/2012
Worker's Compensation Insurance
Carrier: OAK RIVER INS
Policy No: 2200055253111
Expire: 04/29/2012
Building Setbacks Rear: /
Front: /
Left: /
Right: /
Use Zone:
Parking Spaces:
0
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
State Lic:
TRZEPACZ MICHAEL
451 MONTGOMERY, 3RD FLR
SAN FRANCISCO CA 94104
415-362-5025
Special Conditions:
RCP117iT
Fire Hazard Zone : N
O O'I li
0 0
00
n 0 0
Construction Valuation: $10,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access.:
Fee Increase: Fee: $0.00
Additional Fee : $0.00
Hazardous Mat : $0.00
Building Green Fee : $1.00
TOTAL FEE : $492.60
$209.76
$151.03
$0.00
$0.00
$37.00
$0.00
$0.00.
$0.00
Solar System PC:
Excise Tax:
Grading Permit Fee:
Grading PC Fee:
WO Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
$0.00 Planning Department -
$0.00 Plan check Fee :
Fair Share :
SJH Trans :
$0.00 • In -lieu Housing Fee.:
$0.00 Public Works Department -
$0.00 Park Dedication : $0.00
$50.52
$43.29
$0.00
Plan Check Fee :
PNV Plan Check : $0.00
San Dist : $0.00
NMUSD Fee: $0.00
$0.00
$0.00
$0.00
$0.00
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$190.30 Fee Due at Permit Issuance :
J
$0.00
$0.00
$0.00
Moo
$0.00
$0.00
$302.30
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
2z 3 -at.
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECT/ON.
Rite I/Zt/Ir ContractorlSignature
WORKERS' COMPENSATION DECLARATION •/
WARNING: FAILURE ►O BBCURE 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 ADDITION TO THE
COST OF COMPENSA•Tj0• le DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
Ctiyr44affirm.ugd, penalty of perjury one of the following declarations:
I Dave and vsiliinaintain 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
-erg once of theowork for which this permit is issued. Policy No.
Pam- hav and vgitl Ia1r=tain 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
carrierrnnd policy number are:
kloop dl Agent •
ioerp'Ify that, in the performance of the work for which 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
LA, if I;should•bgGpryip, subject to th workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
;31Jnbrtas ofApgji nt ate ` /21/11
•
17ECL•ARATION OARTSI�NG CONSTRUCTION LENDING 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 have provided is correct.
I agree to comply with all applicable city and county ordinances and state law relating to building construction.
I authorize representatives of this cit or county to enter th bove-ide ified roperty for inspection purposes.
Signature of Property Owner or Authorize gent- Print Property Owner's or Authorized Agent's Name LaG
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 checkniark(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 L) all of or (_) 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,). ''„
LJ I, as owner of the prpperty, 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 ofptoperty. who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License, Law).
0 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 anowner-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 Business and Professions Code, and my license is in full force
and effect.
License Class License No
Policy Number Expiration Date
Phone #
t idea
ACTION
DATE
i3Y'
DECLARATION OF COMPLIANCE WITH CODE OF
FEDERAL REGILLA TIONSPART 61 OF TITLE 40 AND
AQMD.RULE 1403.
FOR OFFICE USE ONLY
-
PERMIT EXPIRED
M I SUBMITTED ASBESTOS NOTIFICATION TO:
■ EPA.
■ AQMD
PERMIT CANCELLED
PERMITIXTENDED
■ ASBESTOS NOTIHCATION IS NOT APPLICABLE TO
PROPOSEDDEMO11TION.
SIGNATURE
PERMIT FINAL
/24 10#
CoRTIFICATE OF
OCCUPANCY ISSUED
City of Newport Beach
Building Division
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288
Combination Type - CIP/ ELEC/ MECH/ /
COMB Permit No: X2011-1956
PROJECT NUMBER: 1549-2011
Inspection Requests/Telephone (949)644-3255
Job Address: 1 (41) HOAG DR NB St: 1 Fl: BSMT
Description:REMOVE (E) CENTRAL PLANT EQUIP, RJR (E) LIGHTING @ MECH ROOM, DEMO (E) GENERATOR PAD, DRYWALL REPAIR
Inspector Area: 7
Owner:
Address:
Phone:
Applicant
Address:
Phone:
HOAG HOSPITAL FD 8 C
500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
949-764-4486
NEAL MICHAEL
5670 OBERLIN DR
SAN DIEGO CA 92121
858.597-0556
Code Edit : 2010
Type of Construction: II-A-SPR "
Occupancy Group: B
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 3
No of Units :
Bldg Height:
Bldg Sprinklers:
Flood Zone:
Issued Date: 09/21/2011
0
0
Y
Legal Desc.:
Contractor:
Address:
Phone:
Con State Lic
Lic Expire:
Bus Lic:
Lic Exp Date:
Workers Compens
Carrier:
Policy No:
Expire:
Building Setbacks
QUESTAR ENGINEERING
20062 BIRCH ST #300
NEWPORT BEACH CA 92660
949-250-0060
933786
06/30/2013
BT30015583
01/31/2012
ation Insurance
OAK RIVER INS
2200055253111
04/29/2012
Use Zone:
Parking Spaces:
Rear:
Front:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
State Lic:
State Lic:
TRZEPACZ MICHAEL
451 MONTGOMERY, 3RD FLR
SAN FRANCISCO CA 94104
Phone: 415-362-5025
Special Conditions:
0 Fire Hazard Zone : N
INSPECTOR
•
•
•
Construction Valuation: $90,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
$975.60
$0.00
$0.00
$0.00
$1.00
$0.00
$0.00
$0.00
$0.00
Additional Fee : $0.00
Hazardous Mat : $0.00
Building Green Fee : $4.00
TOTAL FEE : $1,416.88
Solar System PC :
Excise Tax:
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing °A°:
$0.00 Planning Department -
$0.00 Plan check Fee:
Fair Share
SJH Trans:
$0.00 In -lieu Housing Fee :
$0.00 Public Works Department -
$0.00 Park Dedication : $0.00
PAW Plan Check : $0.00
$234.92
$201.36
$0.00
Plan Check Fee :
San Dist :
NMUSD Fee:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee.
Building Dept Adm
General Service
Refund Deposit
$1,416.88 Fee Due at Permit Issuance :
r
•
••••
$0II40
• $0.00
: $fling
'80:(10
SOMO
•• •
•• •
▪ .•
• soil)
•soeo
$0.00 •
• •
• •
• • •
•• •
•
• • •
••
•
•
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
•
PERMITS EXPIRE 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).
❑ 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).
❑ 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 (commenciwith Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
.L�eenee Class • License No D1 ng e /L 41 Contrect Signature L
1NC1114ERS' COMPkNSATION DECLARATION
1Nll(iNIN : FAILURP1036CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
ac j COMPENSATIOMDAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
Ishaveby affirm urter penalty of perjury one of the following declarations:
�• ••
t?lave and wilt maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the
ance of the t'ork for which this permit is issued. Policy No.
•• •
e and'41(ill trla=ntain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for. Which this permit is issued. My workers' compensation
innehtioce carrier and policy number are:
Carrllr ••__ Policy Number Expiration Date
bJaptelbf Age% • • Phone #
❑•
I certify that,.i.ihe performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
that, if I shourdAecgrfle subject to the rkers' com nation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of A ppNoa$ - '\ jlate ifyY/
DECLARATIONNR QAR - ONSTRUCTION LENDING AGENCY
LR1Atej iaffirm unar 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).
L%nder'PName• • • Lender's Address
Bymyspnature below, I certify to each of the following: - -
•l n the property owner or authorized to act on the property owner's behalf.
• I have readthis spplication and the information I have provided is correct.
• 'beiges to comply with all applicable city and county ordinances and state laws relating to building construction.
• •leuthorize rl3p$aseotatives of this city or county to enter above- entified roperty for inspection purposes.
Siyaatlire of Property dwner or Authorized Ag Print Property Owners or Authorized Agent's IQ me � GeV �a�te /1z3�I!
• •.•• ACAON •
•
•
DATE
BY
DECLARATION OF COMPLIANCEWITN WOE OF
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
ACRID RULE 140.3.
❑ I SUBMITTED ASBESTOS M7TIFICATION TO:
❑ EPA
0 MAID
FOR OFACE USE MY
' AERItITEXPIRED • -
•. -
PERMIT CANCELLED.
PERMITEXTENDED
-
■ ASBESTOS NOTIFICATION IS NOT APPLICARI F TO
PROPOSED DE4fOLITl'ON.
SIGNATURE:
PERMIT FINAL
I/Ts
/fn�
CERTIFICATE OF
OCCUPANCY ISSUED
I y