HomeMy WebLinkAboutX2014-0481 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive. Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Combination Type - BLDG ELEC
Job Address: 1 HOAG DR NB
Description:COMM - SITE IMPROVEMENTS
Inspector Area: 7 Legal Desc.:
OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG HOSPITAL FD&C
500 SUPERIOR AVE #300
NEWPORT BEACH, CA 92663
949-764-4486
ORWIG VERNON
1800 QUAIL ST #120
NEWPORT BEACH CA 92660
949-552-2061
Code Edit : 0
Type of Construction:
Occupancy Group:
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:
Flood Zone:
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I
IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lie:
Lic Exp Date:
DEB CONSTRUCTION INC
2230 E WINSTON ROAD
ANAHEIM CA 92806
714-632-6680
372419
03/31/2015
BT30044728
09/30/2014
Workers Compensation Insurance
Carrier: TRAVELERS IDEMNITY
Policy No: UB9072C011
Expire: 01/01/2015
Building Setbacks
Use Zone:
Rear: I
Front: /
Left: I
Right: I
Parking Spaces:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
COMB Permit : X2014-0481
Project No : 0446-2014
Inspection Requests Phone (949)644-3255
Issued Date : 04/09/2014"-
WOOD JACK FREDERICK III
1800 QUAIL ST #120
NEWPORT BEACH CA 92660
949-552-2061 State Lic:C015130
Special Conditions:
0 Fire Hazard Zone : N
State Lic:
000
0
Construction Valuation: _ $27,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Fee Increase: Fee:
Additional Fee :
$470.00
$338.40
$0.00
$0.00
$28.00
$0.00
$0.00
$81.00
$0.00
$0.00
Hazardous Mat: $0.00
Building Green Fee : $2.00
TOTAL FEE : $1,103.99
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
8
Excise Tax:
Grading PC Consultant
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
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
$56.59
$0.00
$0.00
P/W Plan Check :
San Dist:
NMUSD Fee:
$0.00
$0.00
$0.00
$128.00
$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 : $362.09 Fee Due at Permit Issuance :
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$741.90
PUBLIC WORKS APPROVAL: ett-
%t) T"t�h
PLAN CHECK BY: LJt 1)
APPROVAL TO ISSUE:
PERMITS EXPIRE 160 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 ($500).
❑ I, as ownerroltheaproperty, or my employees with wages as their sole compensation, will do U all of or (i portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business and*Plofesslons Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
i praments,wg jlot intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
Improved for the garpgse of sale). .
O I!is owner o;the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
appiy.to an ownerivf.property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
O IV exenT4Lrinelicensure under the Contractors' State License Law for the following reason:
By sag' signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
s�l,a,structure.tila3l l ve built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Prgtte$ions Cob@,Vavailable 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
CIZI MSSED C®Ns jACTOR'S DECLARATION
I hereby affirm under ?enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 6 o IWSio 3 of the Business and Pr. —s io v , -nd -nse is in full force
5 ett ct. License Class License No Da � dl Contractor Signa
8i2�CERS' COMPENSATION DECLARATION
ARNING: 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
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
7 1 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
performance of the work for which this permit is issued. Policy No.
I have and will 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
Insurance carrierandpolicy rwimbbeer, re: �f , F��'7 \
Carrier T�V�� k2Po� It
t V olicy Number 11 �f �,1 Expiration Date �7� ��
Name of Agent Phone #
of the wor for
to the wo rs' . o
I certify that, in the performan
that, if I should become s -.je
nature of Applica
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
ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
D.ZCLARATION REG DID.- CO' UCTION LENDING AGENCY
I hereby affirm and r enalty .f 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 Lenders Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have pr. - .eds correct.
I agree to comply with all applicable city and co
I authorize representatives of this city or coun
Signature of Property Owner or Authorized Age
ACTlf31'd
DATE U
my o .inanc and state laws relating to building construction.
o to abov; entif ....erty for ins.- ction purposes. I�
Print Property Owners or Authorized Agent's Nam'
RY
PF MFT F.JGFPEfi
PEWIT.ERTENDED
PEWIT TM1AL 7 ' I S• I L}
CERTIFICATE CF
OOCOPAidr" %ISSUED
OECLAI?AT(Or1OFCOM PATH CO QE OF
FEGCERAL fiEGULM'flWS PA12TAI OF TITLE4OA
ACM RULE I4
❑ ! SIFRMI rl DA.S@s ST12S T1r1CATION TO:
❑ EPA
ACIME
0 ASfFSTOS NO71ACAR NI@S NOT APPLICAPJ FTO
PROPOSED DEMCIUTIOLL
SIGNAL to &:
V
&Ls ►i��`l�lri
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