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Home My WebLink AboutX2012-1107 - PermitsCity of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Combination Type - BLDG/ ELEC/ COMB Permit No: X2012-1107 PROJECT NUMBER: 0143-2012 Inspection Requests/Telephone (949)644-3255 Job Address: 1 (38) HOAG DR NB Description:REV LIGHT STANDARDS, ADD'L SCOPE TO PERMIT X2012-0634 (DELTA'S 3 & 5) Inspector Area: 7 OF LOT Owner: HOAG HOSPITAL FD & C Address: 500 SUPERIOR AVE #300 NEWPORT BEACH, CA 92663 Phone: 949-764-4486 Applicant: RODRIGUES MICHAEL Address: 2220 UNIVERSITY DR NEWPORT BEACH CA'92660 Phone: 949-574-1325 X760 Code Edit : 2010 Type of Construction: Occupancy Group: U Added /New sq.tt. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: No of Units : Bldg Height: Bldg Sprinklers: Flood Zone: Issued Date: 05/15/2012 0 0 0 Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: Address: Phone: Con Stale Lic: B S D BUILDERS INC 8825 REHCO ROAD STE A SAN DIEGO CA 92117 858-657-9186 879719 Lic Expire: 06/30/2012 Bus Lie: BT30033668 Lie Exp Date: 04/30/2013 Worker's Compensation Insurance Carrier: EVEREST NATIONAL Policy No: 7600002685111 Expire: 07/01/2012 Building Setbacks Rear: / Front: / Left: / Right: / Use Zone: Parking Spaces: 0 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: INSPECTOR REGIER D RANDY 2220 UNIVERSITY DR NEWPORT BEACH CA 92660 949-574-1325 State Lic:CO23842 GHARITSAUS EDMOND T 300 N LAKE AVE 14TH FLR PASADENA CA 91101 626-463-2800 State Lic:S-002942 Special Conditions: Fire Hazard Zone : N Construction Valuation: $37,000.00 Building Permit Fee: Plan Check Fee: Overtime Plan Ck: Investigation Fee: Record Management Energy Compliance: CA Seismic Safety : Disabled Access : $567.00 $408.24 $0.00 $0.00 $29.00 $0.00 $0.00 $0.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : $0.00 Building Green Fee : $2.00 TOTAL FEE : $1,141.51 Solar System PC : Excise Tax: Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: $68.27 $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 PAN Plan Check : $35.75 San Dist : $0.00 NMUSD Fee: $0.00 $31.25 $0.00 $0.00 $0.00 Fire Department Fire Inspection: Fire Plan Rev Demolition Fee Building Dept Adm General Service Refund Deposit $1,141.51 Fee Due at Permit Issuance : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: P-V PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: f iL st- 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 structura 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 Profersions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Si ri4'ure of hlohehy Owner or Authorized Agent Date LICENSED ON'i RACTOR'S DECLARATION I 'ilereuy affirm udder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of th Business and Pro sions C , -, and my license is in full force and effect. Licel1 a Class License No ^Q e / /� J Z_ Contra c)�r igna MAKERS' COMrENSATION DECLARATION WARNIr'G: FAILUR : TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO O .:ULT OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LCn:Ly affirm under Denalty of perjury one of the following declarations: ❑ I have and' Witt '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 JdEA'o/(ngnee of,the work for which this permit is issued. Policy No. /e and v,il: 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' compensation ce carrier and policy number are: Carrier ima• o fi DECLARATION REGARDIN '. ,N - UCTION LENDING AGENCY I hereby affirm under penal , 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). Lenders Name Lender's Address art ' UNDRED T ' OUSAND DOLLARS ($100,000), IN ADDITION TO THE Policy Number Expiration Date Name of Agent Phone # Ell certify that, i the perfor f the wo f r 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 agrer that, if I s ecome subje e _ • •• • - - - provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature A licant T tDd� cr / 7— By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property ow I have read this application and the information I haveprovid I agree to comply with all applicable city and county ordina I authorize representatives of th ty or county to enter Signature of Property Owner or A oozed Agent ACTION DATE BY rs behal correc and staws relating to building construction. ection purposes. Print Property Owner's or Authorized Agent's N PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED DECLARATION OF COMPIJANCE WITH CODE OF - FEDERAL REGULATIONS PART tit OF TITLE 40 AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: O EPA ❑ AQMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: le&kf e/dew FOR OFFICE USE ONLY