HomeMy WebLinkAboutX2015-0619 - 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 - CIP ELEC MECH PLUM
IIII11IIII11I II IIIIIII11
COMB Permit : X2015-0619
Project No : 0485-2015
Issued Date : 04/29/2015
Inspection Area : 7
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Job Address: 1 HOAG DR NB St: 2 FI: 3 Unit: 340
Description: COMM - TI "NEUROSCIENCE INSTITUTE" 1091 SF
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
9497644624
MARCHETTA MARIE
5161 CALIFORNIA 3100
IRVINE CA 92617
949-769-6246
Code Edit : 2013
Type of Construction: II-A-SPR
Occupancy Group: B
Added /New sq.ft. Bldg: 0
Added /New sq. ft. Garage: 0
No of Stories: 3
No of Units : 0
Bldg Height: 0
Bldg Sprinklers:
Flood Zone: X
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
D BAC INC
101 SHIPYARD WAY #100
NEWPORT BEACH CA 92663
949-723-0147
637651
02/29/2016
BT00016282
10/31/2015
Worker's Compensation Insurance
Carrier STATE COMP
Policy No: 9117372
Expire: 11/11/2015
Building Setbacks
Use Zone:
Rear: /
Front: /
Left: /
Right: /
Parking Spaces:
0
Architect: WOOD JACK FREDERICK III
Address: 5161 CALIFORNIA
IRVINE CA 92617
Phone: 949-769-6240 State Lic:C015130
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
Fire Hazard Zone
N
State Lic:
Construction Valuation: $48 016.00
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 :
$712.00 Excise Tax:
$512.64 Additional Fee :
$0.00
$0.00 Grading PC Consultant :
$58.00 Grading Permit Fee:
$55.00 Grading PC Fee:
$0.00 WQ Insp. Fee :
$81.00
$0.00 Electrical %:
$2.00 Mechanical %:
Plumbing %:
TOTAL FEE : $1,8�3.511)
$171.45
$146.96
$122.46
Plan Check Fee :
$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
$32.00
$0.00
$0.00
$0.00
Fire Department
Fire Inspection:
Fire Plan Rev
Demolition Fee
Building Dept Adm
General Service
Refund Deposit
$752.19 Fee Due at Permit Issuance :
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,141.32
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
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).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (, 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).
❑ 1, 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 1 acknowledge that, except for my personal residence in which 1 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
Profession•Codepis available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of•PrSrerty Owner or Authorized Agent Date
• II L ENSEE•EQNTRACTOR'S DECLARATION
:• 1 heteby affirm•Lt9tl2r penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 00)9t Div ion 3 of the Business and Pr orxs a�(�� Il�,erjs is in ffull force
• an4 ffect. Lioense'Class License No Date 4 .51-L5 Contractor Signatur�r/s CoU lc,e �
W®RKERS'•C9t4PENSATION DECLARATION
• WARNjNG: FAILUR! TO tECURE 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
• e OF COMPEAATIOAI, DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
• Ielvieby affirr- v ii jy? penalty of perjury one of the following declarations:
• -' Ita - 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.
••••••
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
e carrpi end eolicy number are:
• •
• ••
Name of Agent
❑1 certify that, in the performance
that, if I should become subject to
t /
Signature of Applic
DECLARATION REG DING COAST' . 10 L SING • i. CY
Policy Number
of he work for which this permit is is
,- .•kerstcom.y,-a provisi.
w
Expiration Date
Phone #
ed, I shall not employ any person in any manner so as to become subject to the work' compensation laws of California, and agre€
s of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Dae tZ1riS"
I hereby affirm underenalty of perjury that\Q-ere is a construe lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name
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 e r t e abo id�}ti ie r perty for inspection purposes.
I Signature of Property Owner or Authorized Agent Y fl MI / Print Property Owner's or Authorized Agent's N
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Lender's Address
DECLARATION OF COMPLIANCE f HI CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE AND
AMID RULE 1413.
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