HomeMy WebLinkAboutX2014-3431 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive. Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Combination Type - BLDG
II
II►IDI III II1IIDDD IIIII I DI
COMB Permit : X2014-3431
Project No :
Issued Date : 11/18/2014
Inspection Area : 7
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION,
Job Address: 1 HOAG DR NB
Description: COMM - DEMO ALL METRO PCS CABINETS, ANTENNAS AND COAX
Legal Desc.: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR OF LOT
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
1 HOAG DR
NEWPORT BEACH, CA 92663
BAETZ CAREY
2920 FOOTHILL DR
VISTA CA 92084
210-365-6500
Code Edit : 2013
Type of Construction:
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:
Flood Zone:
Construction Valuation: $5,000.00
Building Permit Fee:
Plan Check Fee:
Overtime Plan Ck:
Investigation Fee:
Record Management:
Energy Compliance:
CA Seismic Safety :
Disabled Access :
Hazardous Mat
Building Green Fee :
$144.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1.00
TOTAL FEE : $145.00
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
CIVIL SOLUTIONS INCORPORATED
2290 FOOTHILL DR
VISTA CA 92084
760-842-7976
822691
08/31/2015
BT30045234
10/31/2015
Worker's Compensation Insurance
Carrier: ZURICH AMERICAN INS
Policy No: WC427811701
Expire: 02/01/2015
Building Setbacks
Use Zone:
Excise Tax:
Additional Fee :
Grading PC Consultant :
Grading Permit Fee:
Grading PC Fee:
WQ Insp. Fee :
Electrical %:
Mechanical %:
Plumbing %:
Rear: /
Front: /
Left: /
Right: /
Parking Spaces:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
Fire Hazard Zone : N
$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
$0.00
$0.00
$0.00
Plan Check Fee :
$o.00
$0.00
$0.00
$0.00
State Lic:
State Lic:
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$0.00 Fee Due at Permit issuance :
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$145.00
sico
0 0
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 aosned 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
`aoteaora than ftv'e'hundred dollars ($500).
❑ I, as owner.0 tEcisoperty, or my employees with wages as their sole compensation, will do (_) all of or (i portions of the work, and the structure is not intended or offered for sale (Section 7044,
.ta3iag5,S' 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
jp2Rrpviements are4lot 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
im pro veld for thrupose of sale).
Lto �s owner cif tttesproperty, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not 6s ply loan 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).
l.a_m exemptrtrom ttcensure under the Contractors' State License Law for the following reason:
+Syeny 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
Qlgffa%s ons Cdtt)•iS'a'ailable 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 OONTPACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section) of Division 3 of the Business and Prof to Code, and my liceylse ' full force
and effect. License Class License No Date X/ yR —Lq'y Contractor Signature i geare:a:
WORKERS' COMPENSATION DECLARATION S'
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 ATTORNEY'S 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
rmance of the work for which this permit is issued. Policy No.
e 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
nce carrier and policy number are:
crier Policy Number Expiration Date
Phone #
Name of Agent
❑I certify 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 Califomia, and agree
that, if I should become bject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant FJgir�n�+%"v r.„ Date //-/3 —2.c'7"
DECLARATION REG RDING CONgTRUCTION L Pe NG 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 laws relating to building construction.
I authorize representatives of this city or coun o - the above-i of operty for inspection purposes.
Signature of Property Owner or Authorized Agent -j Print Property Owner's or Authorized Agent's Name
bear M 54tG/1` Date
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