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Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Department
Ir Fire Sprinkler r Fire Alarm
(— Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1301 Dove St., Newport Beach, CA 92660 r 970
Tenant Name Ocean / West Capital Partners # Units F
2. Description of Work
Use r_—®--__
Installation of visual and audio-visual notification appliances (3 devices)
Valuation $ 1,685
Extg Sq Ft F_New/Added Sq Ft F_ Total Sq Ft
# Stories F
j— New j— Add Fx— Alter Demo
Check Appropriate Box for Applicant/Notification Information
3. Owner's Name Last De Wildt
First Fander
Owners Address
Owner's E-mail Address
130 Dove St.
City Newport Beach State A
C
Zip 92660 Telephone (213)223-7087
r 4. Architect/Designer's Name Last Valenzuela First Caezar Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
1354 S. Parkside PI.
City Ontario State CA
Zip 91761 Telephone 909-957-5200
j— 5. Engineer's Name Last
First F Lic. No. F—
Engineers Address
Engineer's E-mail Address
City State F
Zip F Telephoner--------
6. Contractor's Name Last Williams First Dominique Lic. No. 905493 Class F70006
Contractor's Address
Contractors E-mail Address
1354 S. Parkside Pl.
Eng5@hcisystems.net
City Ontario State CA
Zip 91761 Telephone 909-957-5200
OFFICE USE ONLY
PERMIT NO. 4
TYPE OF CONSTRUCTION
PLAN CHECK NO. 10"�O 2
OCCUPANCY - GROUP
�,e4710/ PLAN CHECK FEE $ - '