HomeMy WebLinkAboutF2010-0162 - PermitsCity of Newport Beach
Building Department
PO Box 1768 Newport Beach, California 92658-8915
FIRE COMBO Permit No: F2010-0182
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 351 HOSPITAL RD NB St: 1 FI: 4
Inspector Area: ,J' / I.
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
NEWPORT LIDO MEDICAL
351 HOSPITAL RD #307
NEWPORT BEACH CA 92663
IBEY JERRY
8802 WATSON AVE
WHITTIER CA 90605
562-693-7581
Code Edit : 2007
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:
I -A
B
0
0
6
0
N
Description: FIRE ALARM TI "COMMON AREA" @ 4TH FLR
0927-2010 (X2009-1619)
Legal Description: IRVINE SUB LOT 169 BLK 2 POR OF LOT
Contractor:
Address:
Phone:
Con State Lic
Lic Expire:
Bus Lic:
Lic Exp Date:
IBEY JERRY A
POBOX 9106
WHITTIER CA 90608
562-693-7581
569288
05/31/2011
BT30031959
05131/2011
Worker's Compensation Insurance
Carrier: WIC EXEMPT Policy No:
Expire:
Issued Date: 07/28/2010
Setback- Front:
Rear:
Left:
Right:
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
State Lic:
State Lic:
IBEY JERRY
8802 WATSON AVE
WHITTIER CA 90605
562-693-7581
Construction Valuation: $1,633.00
Building PC Fee :
Building Overtime PC Fee:
Building Extention Fee :
Building Investigation Fee :
Fire Commercial PC Fee:
Fire Commercial Permit Fee :
Fire Residential Permit Fee :
Fire Residential Alarm Fee :
TOTAL FEE:
$66.96
$0.00
$0.00
$0.00
$0.00
$66.96
$0.00
$0.00
$134.97
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
$66.96
Records Management :
Fee Due at Permit Issuance :
$1.05
$0.00
$0.00
$68.01
PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
•••. '•
••• • ' OTHER DEPARTMENT:
•• •
• • • • • • •
• _ ' ••• • . • •• • .PLAN CHECKED BY::
APPROVAL TO ISSUE:
••-••• • • • •••
PERMIT E4O • RE§ •:8a D=t y'S AFrEiR 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 IIcensure and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant fora 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 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).
U 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
❑ ) 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 musthave 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:httpi/www.leginfo.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 provision ' ommencing with Section 7000)
of Division 3 of the Business and Professions Code, and m license is in ful eff q
License Class License N
Z/7/O Contractor
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 ATTORNEY'SFEES.
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 performance of the work for which this permit is
issued.
It2+\D'
ave and will maintain workers' compensation insurance, as requiredby. Section 3700 of the Labor Code, for the
ce of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
der - Policy Number Expiration Date
of Agent / Phone #
certify that, in the performance. of the work„i ' this permit is issued, I shall not employ a person in any manner
s to become subject to the wor - comb •; aws of California, and agree that, if f shout ecome subject to the
workers' co atio .visions .+ Sec'•4. .4;%.,P Labor Code, I shall forthwith comply with thos provisions.
Signature o Vi.. . t /� ► 4' 13 e % Zd—��!%
DECLARATION REGARR [�'• NST • C ION LENDING AGENCY
I hereby affirmunder ..natty of perjury that there is a construction lending agency for the performance of the work for
is
sued this permit is Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature below, I certify to each of the following:
1 am the property owner or authorized to act on the property owner's behalf.
1 have read this application and the information I have provided is correct.
I agree to comply with all applicable city and coup ordinances and stat
I authorize representatives of this city or co o enter
Signature of Property Owner or Auz
Print Property Owner's or Autho Agent's Name:
01/01/2009
ACTION
PERMIT EXPIRED
DATE:
BY:
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL ' (q I I l
t&&OV-VLIS
CERTIFICATE OF
OCCUPANCY ISSUED
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ating to building construction.
perty for inspection ssees.
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FOR OFFICE USE ONLY