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Home My WebLink AboutX2012-0634 - PermitsCity of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Combination Type - BLDG/ ELEC/ r / COMB Permit No: X2012-0634 PROJECT NUMBER: 0143-2012 Inspection Requests/Telephone (949)644-3255 Job Address: 1 (38) HOAG DR NB Description:NEW (8) LIGHT STANDARDS 10' MAX & RELOCATE (3) LIGHT STANDARDS 26' MAX Inspector Area: 7 OF LOT Owner: Address: Phone: Applicant: Address: Phone: HOAG HOSPITAL FD & C 500 SUPERIOR AVE #300 NEWPORT BEACH, CA 92663 949-764-4486 RODRIGUES MICHAEL 2220 UNIVERSITY DR NEWPORT BEACH CA 92660 949-574-1325 X760 Code Edit : 2010 Type of Construction: VB Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: N Flood Zone: Issued Date: 04/17/2012 Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: Address: Phone: Con State Lic Lie Expire: Bus Lic: Lic Exp Date: Worker's Compensa Carrier: Policy No: Expire: Building Setbacks B S D BUILDERS INC 8826 REHCO ROAD STE A SAN DIEGO CA 92117 858.657-9186 879719 06/30/2012 - t l 4:► BT30033668 ci Lk ot 2_1s 04/30/2013 W39 tlon Insurance EVEREST NATIONAL 7600002685111 07/01/2012 Use Zone: Parking Spaces: Rear: Front: Left: Right: 0 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: REGIER D RANDY 2220 UNIVERSITY DR NEWPORT BEACH CA 92660 949-574-1325 State Lic:CO23842 INSPECTOIq GI-IARITSAUS EDMOND T 300 N LAKE AVE 14TH FLR PASADENA CA 91101 626-463-2800 State Lic:S-002942 Special Conditions: 110 P' 2_0r(l Fire Hazard Zone N r, 0 Construction Valuation: $20.000.00 Building Permit Fee: Plan Check Fee: Overtime Plan Ck: Investigation Fee: Record Management Energy Compliance: CA Seismic Safety : Disabled Access : $365.56 $263.20 $0.00 $0.00 $1.00 $55.00 $0.00 $0.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : $0.00 Building Green Fee : $1.00 TOTAL FEE : $729.77 Solar System PC: Excise Tax: Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: $44.01 $0.00 $0.00 Plan Check Fee : $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 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 $0.00 Fee Due at Permit Issuance : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $729.77 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: AL 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 (he 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 U 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,...lectio4nce70:4 of the Business and Professions Cole, is at:ailable upon request when this application is submitted or at the following Web site:hllp:/Avww.leginfo.ca.gov/calaw.html. ignature of Property Owner or Authorized Agent e .iGENSED C'ON1 RACTOR'S DECLARATION I hereby affirm untie,' penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profess' d a • y license is in full force cnd elle a. �/ License Class License No to 7" /7—/Z. ConQaCtor Signature ; WCRKCRS' COMPENSATION DECLARATION WARNING: FAILURE TO LEO:IRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,000), IN ADDITION TO THE CGS roc COMPEN):A7,ON, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I ha.tby affirm under penalty of perjury one of the following declarations: r,i'hai'e and wall 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 $erf ance of 'did ,Ardrk for which this permit is issued. Policy No. ( ..II hay and will mahbain 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 ins ra carrier and pclicy number are: Carrier Policy Number Name of Agent ❑l certify that, in the performance of 1 that, if I should become subject to th�'g Signature of pi icant work for orkers' Expiration Date Phone # h 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 nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DECLARATION REGARDING Co 'S UC ".N 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 provi. is correct. I agree to comply with all applicable city and county ordin. ! -s and sta laws relating to building construction. I authorize representatives of thi city or county to en l_ .0'- - • -. .. .. roperty for inspection purposes. Signature of Property Owner or A o ized Agent 7 Print Property Owners or Authorized Agent's NI /7- /2_ ACTION DATE • BY ' DECLARATION OF COMPLIANCE WITH CODE OF w FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. ' FOR OFFICE USE ONLY PERMIT EXPIRED ■ 1 SUBMITTED ASBESTOS NOTIFICATION TO: • EPA • AQMD PERMIT CANCELLED - PERMIT EXTENDED • ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMIT FINAL (b ! / S j 17--- (")--rS CERTIFICATE OF OCCUPANCY ISSUED