HomeMy WebLinkAboutF2004-0107 - PermitsCity of Newport Beach
Building Department FIRE PROTECTION Permit No: F2004-0107
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288
Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR Bldg:1 Floor: 1 Suite:
Inspector Area: 7
Owner:
Address:
Phone:
Applicant:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
ONE HOAG DR
NEWPORT BEACH CA 92658
949-574-4477
LOONEY SHELIA
5200 E HUNTER AVE #B
ANAHEIM CA 9280
714-993-2822
Code Edit : 1999
Type of Construction: II-1 HR
Occupancy Group: B
Added /New sq.ft. Bldg:
Added /New sq. ft. Garage:
No of Stories: 0
No of Units :
Legal Description:
Contractor:
Address:
Phone:
Con State Lic
Lic Expire:
Bus Lic:
Lic Exp Date:
ALERT FIRE PROTECTION
5200 E HUNTER AVENUE STE B
ANAHEIM CA 92807
714/993-2822
316324
04/30/2004
BT02112004
10/31/2004
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 1589876
Expire: 10/01/2004
Issued Date: 03/25/2004
Description of Work: FIRE SPRINKLERS
0649-2004 RELOCATE 7 HEADS
Architect:
Address:
Phone:
Engineer:
Address:
Phone:
Designer:
Address:
Phone:
Special Conditions:
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) (B2004-0130)"�
State Lic:
State Lic:
LOONEY SHELIA
5200 E HUNTER AVE #B
ANAHEIM CA 92807
714-993-2822
INSPECTOR
Construction Valuation: $1,000.00
Fire Plan Check Fee :
Fire Permit/Inspection Fee:
Records Management:
Investigation Fee:
FEES
$114.00
$114.00
$3.50
$0.00
TOTAL FEE : $ 31.50 TOTAL PAYMENT : $114.00 TOTAL DUE : $117.50
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PROCESSED BY:
ZONING APPROVAL:
FIRE APPROVAL :
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$0.00
$0.00
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OTHER DEPARTMENT:
PLAN CHECK BY::
APPROVAL TO ISSUE:
PERMIITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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APPROVALS
DATE
BY
COMMENTS
OWNER.BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I MA EXEMPT FROM THE CONTRACTORS
LICENSE LAW FOR THE FOLLOWING REASON (SEC. TOT 5. BUSINESS ANO PROFESSIONS CODE: ANY
CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOL'.CH, OR
REPAIR ANY STRUCTURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOB SUCH
PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSEE) PURSUANT TO THE PROVISIONS
OF THE CONTRACTORS LICENSE LAW CHAPTER 9 (COMMENCING WITH SEC. 7000) OF ON. 3 OF THE
BUSINESS AND PROFESSIONS CODE)) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS
OF SEC. 7031.5 BY ANY APPLICANT FOR A PERMIT
FIRE PROTECTION
UNDERGROUND ROUGH PIPE
THRUST BLOCKS EXCAVATION
UNDERGROUND PIPING FLUSH
UNDERGROUND HYDRO TEST
FOR THE ALLEGED EXEMPTION. ANY VIOLATION
SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500):
I. AS CANER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
COMPENSATION WILL CO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE
(SEC. 7044. BUSINESS ANO PROFESSIONS CODE. THE CONTRACTORS LICENSE LAW DOES NOT APPLY
TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK
HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PRONGED THAT SUCH
IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF. HOWEVER, THE BUILDING OR
IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER -BUILDER WILL HAVE THE
I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.1STANDPIPE
CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE
CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR
IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED
PURSUANT TO THE CONTRACTORS LICENSE LAW )
I AM EXEMPT UNDER SEC. B & P.C. FOR THIS REASON
UNDERGROUND/BACKFLOW APRV.
SPRINKLER HYDRO TEST
SPRINKLER FLOW TEST
SPRINKLER ROUGH PIPE
4„,,z___IMPROVEMENT
HYDRO TEST
STANDPIPE FLOW TEST
STANDPIPE ROUGH PIPE
CHEM SYSTEM FUNCTION TEST
CHEM SYSTEM APPROVAL
DATE OWNER
FIRE ALARM SYSTEM
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF
CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESS AND PROFESSIONS
CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS LID. NO
ROUGH WIRING
SYSTEM FUNCTION TEST
CENTRAL STATION MONITOR
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PATE Af
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/\ WORKERS' COMP 6 ISATION DECLARATION
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. AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE, FOR THE
PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY
FIRE MISC.
TANK REMOVAL
TANK INSTALLATION/TEST
TANK PIPING PRESSURE TEST
MEDICAL GAS PIPING TEST
SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH
THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POUCY
HUMBER ARE.
CARRIER
CROSS CONNECTION TEST
POLICY NUMBER
MISC. INSPECTIONS:
(THIS SECTOR NEED NOT BE COMPLETED IF THE PERMIT 15 FOR ONE HUNDRED DOLLARS
(5100) OR LESS).
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 CALIFORNIA. ANO AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 31000F THE LABOR
\/ CODE. I SHALL FORTHWTH COMPLY WNTH THOSE PROVISIONS. 1 9
JBATE••: XMPUCANT �r�`Airf(A'WVViL.
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WASNING•FASURE E0 SECURE WORKSRS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBBJJjb�SISST NLO•ER TOO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
D0 IORF TOB100f/ I iew TINTEREST,THE
ST OF ATTORNEYSCOMPENSATION,
SECT EDAMAGES AS PRONGED FOR IN
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE 15 A CONSTRUCTION LENDING
AGENCY KM THE PERFORMNR OF THE W0RR FOR WHICH THIS PERMIT IS ISSUED (SEC.3097.
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LENDER'S ADDRESS••• • • • • •
I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 15
CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS
1 xo&R>:•TO R UOPPTHF•AIOVE;IENTIONEO PROPERTY FOR INSPECTION PURPOSES.
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