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Home My WebLink AboutX2013-2519 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Combination Type - CIP MECH ELEC PLUM IIIIIII IIIII IIIIII IIIIIIUIIIIIIflIII COMB Permit : X2013-2519 Project No : 2175-2013 Inspection Requests Phone (949)644-3255 Job Address: 1 HOAG DR NB St 1 Description:COMM TI "TEMPORARY STERILE PROCESS" BLDG #11 Inspector Area: 7 OF LOT Owner: Address: Phone: Applicant: Address: Phone: Legal Desc.: HOAG HOSPITAL FD&C 500 SUPERIOR AVE#300 NEWPORT BEACH, CA 92663 REGIER D RANDY 17850 FITCH IRVINE CA 92614 949574-1325 Code Edit : 2010 Type of Construction: V-A- SPR Occupancy Group: 12.1 Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 1 0 No of Stories: No of Units : Bldg Height: Bldg Sprinklers: Flood Zone: 0 Y IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: DEB CONSTRUCTION INC 2230 E WINSTON ROAD ANAHEIM CA 92806 714-632-6680 372419 03/31/2015 BT30044728 09/30/2014 Worker's Compensation Insurance TRAVELERS IDEMNITY UB9072C011 01/01/2014 Carrier: Policy No: Expire: Building Setbacks Use Zone: Rear: / Front: / Left: / Right: I Parking Spaces: 0 Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: REGIER D RANDY 17850 FITCH IRVINE CA 92614 949-574-1325 Issued Date : 12/02/2013 State Lic:CO23842 YOUNG ROGER PAUL 18400 VON }CARMAN AVE #100 IRVINE CA 92612 949/252-1022 State Lic:S-003623 Special Conditions: JAMES IRVINE BLDG Fire Hazard Zone : N Construction Valuation: $160,000.00 Building Permit Fee: $1,428.40 _ Plan Check Fee: $1,028.45 Overtime Plan Ck: $0.00 Investigation Fee: Record Management Energy Compliance: CA Seismic Safety : Disabled Access $0.00 $93.00 $96.00 $0.00 $160.00 Fee Increase: Fee: $0.00 Additional Fee : $0.00 Hazardous Mat : $0.00 Building Green Fee : $7.00 TOTAL FEE : $3,728.58 Solar System PC . Excise Tax: Grading PC Consultant Grading Permit Fee: Grading PC Fee: WQ Insp. Fee : Electrical %: Mechanical %: Plumbing %: $343.97 $294.83 $245.68 $0.00 Planning Department - $0.00 Plan check Fee : Fair Share : $0.00 SJH Trans: $0.00 In -lieu Housing Fee : $0.00 Public Works Department - $0.00 Park Dedication : $0.00 P/W Plan Check : $0.00 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 Plan Check Fee : $1,494.70 Fee Due at Permit Issuance : $0.00 $0.00 ". $0.00 $0.00 $0.00 $0.00 $0.00 $2,233.88 PROCESSED BY: ZONING APPROVAL: GRADING APPROVAL: Pr1BL�ICWOR S APPROVAL: PLAN CHECK BY: APPROV>ALTO ISSUE: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE -OR 9.AttYALIii l&SPECTION. 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 L) all of or L) 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 structural 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.ieginfo.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) o DV ision 3 of the Business and Professio spC,�o icense is in full force and effect. License Class License No Date I-'- 2413 Contractor Signature/tic�,riei I<e� 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the ance of the work for which this permit is issued. Policy No. an. maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation d policy number are: Name of Agent ❑l certify that, in the performance of the work for which this pe that, if I should become subject t e workers' compensation pro Signature of Applicant DECLARATION REGARDING CONSTRUCT LENDING AGENCY I hereby affirmunder penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address 67 ' \\ Expiration Date IM (? rta Phone # is issued, I shall '.' employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree ons of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Data'/Qf - By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize:representatives of this city or count to enter the abo e-identified property for inspection purposes. `� Signature of Property Owner or Authorized Agent ,( Print Property Owner's or Authorized Agent's Nary$ '4tr s1Eu r4z'� A TIO)Y CT CC PL REPJ M 4TKINS PART .. ... 4fir4ms NOTIFICATION 77T: 'ACAiRONIS NOT APPLJC .ME T€1 Dat k T