HomeMy WebLinkAboutF2023-0181 - Permit ApplicationWorksheet for Fire Permit Application o4�
Print Form
City of Newport Beach -Building Department
Please print 3 copies
Associated Building Permit # XC2022-1929 r Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
17 Corporate Plaza, Newport Beach, CA 92660
Tenant Name Newport Center Surgical Suite 120
2. Description of Work
installation of new control relay and pilot control relay to shut CSFDS, removal of existing
smoke detector and replace with blank cover plate if necessary
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft 1,980
F— New r Add r Alter r Demo
Check Appropriate Box for Applicant/Notification Information
Floor Suite No
120
...
#Units
Use
Valuation $ 1,463
# Stories 12
(— 3.Owner's Name Last Lange
First William
Owner's Address
Owner's E-mail Address
17 Corporate Plaza, Suite 200
City Newport Beach
State CA
Zip 92660 Telephone (949)706-6121
r 4. Architect/Designer's Name Last Ramirez First Gary Lic. No. 905493
Architect/Designees Address
Architect/Designer's E-mail Address
1354 S. Parkside PI.
gramirez@hcisystems.net
City Ontario
State CA
Zip 91761 Telephone (909)628-7773
r 5. Engineer's Name Last
First— Lic. No.
Engineer's Address
Engineer's E-mail Address
Cityr
�
State F_
ZipTelephone
hone� P
r 6. Contractor's Name Last Gomez
First Miriam Lic. No. 9075493 Class c7c10c16
Contractor's Address
Contractor's E-mail Address
1354 S. Parkside Pl.
Eng5@hcisystems.net
City Ontario
State CA
Zip 91761 Telephone (909)628-7773
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $