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HomeMy WebLinkAboutF2015-0267 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit CounterPhone (949)644-3288 I0I1112h11I I IIh11 I IIII II 111111111 FIRE Permit : F2015-0267 Project No : 0936-2015 Inspection Requests Phone (949)644-3255 Job Address. 1 HOAG DR NB Inspector Area: FIRE OF LOT Owner: HOAG MEMORIAL HOSPITAL Address: 1 HOAG DR NEWPORT BEACH, CA Phone: 9497644624 Applicant: STAPLETON COLLIN Address: 9531 MILLIKEN AVE RANCHO CUCAMONGA CA 91730 Phone: 909-390-8392 Code Edit : 2013 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : Flood Zone: Bldg Sprinklers: II-A-SPR B 0 0 3 0 X N Birth 9Lf I. 3 y C) Description: COMM F/A SYSTEM (5) DEV "NEUROSCIENCE INSTITUTE" X2015-0$15. Legal Description: 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: TRL SYSTEMS INC 9531 MILLIKEN AVE RANCHO CUCAMONGA CA 91730 909-390-8392 413747 11/30/2015 BT02071605 06/30/2015 Worker's Compensation Insurance Carrier: CALIFORNIA INS Policy No: 7389507301 Expire: 10/01/2015 Issued Date: 05/20/2015 Setback- Front: Rear: Left: Right: Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: State Lic: u" .<o wove State Lic: STAPLETON COLLIN a> 9531 MILLIKEN AVE a =cam RANCHO CUCAMONGA CA 91730,,,, 00 °' t0Qcoo 0 4 9 ' o Construction Valuation: $4,635.00 Building PC Fee : Building Overtime PC Fee: Building Extention Fee : Building Investigation Fee : Fire Plan Check Fee: Fire Permit Fee : Building Permit Fee : TOTAL FEE: $0.00 $0.00 $0.00 $0.00 $134.00 $166.00 $0.00 $304.00 FEES Fire Residential Alarm PC Fee : Planning Counter Review : Planning Zoning PC Fee : Public Works PC Fee : Public Works Traffic Plan Check Fee; Plan Check Fee : $0.00 $0.00 $0.00 $0.00 $0.00 Records Management : $4.00 $0.00 $0.00 $134.00 Fee Due at Permit Issuance : $170.00 PROCESSED BY: ZONING APPROVAL: FIRE APPROVAL : OTHER DEPARTMENT: PLAN CHECKED BY:: APPROVAL TO ISSUE: PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION AI /( 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 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 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of.Ftfi ty Owner or Authorized Agent Date LICENSED G+ettTRACTOR'S DECLARATION : .1.1-6e 3y affirm•u: d@r penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7Q00) of Division 3 of the Business and Profession ode, m license is in full force • and effect. : •• (/� '£ice�lse Class . License No D S I �' (C Contractor Signa • • WORKERS' GOM.RENSATION DECLARATION WARNING: FAILUR;. 7o sr•CURE 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 Cl%T3•F COMPENii�11Oj4, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I•t.e.4%by affirm• .nWenalty of perjury one of the following declarations: • i Aave 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 ice of tile wok 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 ee carrier end policy number are: •... Policy Number Expiration Date me of Agent Phone # ❑I certify that in the performance of he 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 California, and agree 9—OlC that, if I should beco e subject to orker ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thoseprrooVsions. J / Signature of Applica' `-` Datr'" DECLARATION REGARDING TR CTION LENDING 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 owners behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordin ces and state laws relating to building construction. I authorize representatives of this city or countxx to nter h ab idec?tified property for inspection purposes. Signature of Property Owner or Authorized Agent I / Print Property Owner's or Authorized Agents Nam Moivior flAt+V(asz; Dane/ Sipe - ACTION BATE �" sr DECLARATION OFCOMPIJANCEWITH CODE OF FEDERAL REGULATIONS PART 61 OF 11ILEAC AND MAID RULE 1403. FOR OFFICE U3E ONLY PERMIT JCPlRED ■ 1 SUBMITTED ASBESTOS NOTIFICATION ID: ❑ EPA • AQMD PERM!T CANCEIIE© PERMIT MENDED ■ ASBESTOS NOTIFICATION IS NOTAPPIJCAELF ID PROPOSED DEMOLITION. SIGNATURE; PERMIT FINAL ((l a 3I IL( (L,10 'ALAS C} PF/CTE OF OCCUPANNCY ISSUED