HomeMy WebLinkAboutE2007-0687 - PermitsCity of Newport Beach
Building Department ELECTRICAL Permit No: E2007-0687
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:
Inspector Area: 7 Code Edit: 2004
OF LOT
Owner:
Address:
Phone:
HOAG MEMORIAL HOSPITAL
301 N NEWPORT BLVD
ORANGE CA 92869
Issued Date: 08/31/2007
Processed By:
Suite
Description of Work: ELECT/6000AMP SERVICE (4) SUB PNLS & (1) MO
1840-2007(CHILDCR CENTER BLDG50) "O
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:
WHELAN ELECTRIC INC
244 W ORANGE SHOW LANE
SAN BERNARDINO CA92408
909-889-2722
397072
06/30/2009
0tT
ELECTRICAL FINAL
- -\eN-o-
Inspector/Date
New Construction
Residential
Multi -Family: 0 $0.00
1-2 Family: 0 $0.00
Service
0-600V up to 200A: 0 $0.00
0-600V over 200A: 1 $59.00
Over 600V or 1000A: 0 $0.00
Receptacle/Switch/Outl
Receptacles/Outlets:
Fixtures:
Sep Circuits:
Low Voltage
Signs
Branch Circuit:
Each Add Circuit:
Time Clocks:
is
TOTAL: $281.00
FEES
Motors/Transformers (HP/KVA)
$0.00 0 to 1 HP/KW/KVA: 0 $0.00
$0.00 1 to 10 HP/KW/KVA: 0 $0.00
$0.00 10 to 50 HP/KW/KVA: 0 $0.00
$0.00 50 to 100 HP/KW/KVA: 0 $0.00
Over 100 HP/KW/KVA: 1 $71.00
$0.00
$0.00
$0.00
Piggy Back/Temp Power: 0 $0.00
Temp Power Pole: 0 $0.00
PAYMENT:
$0.00 BALANCE:
Temp -Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
$281.00
0
4
0
0
$0.00
$70.80
$0.00
$0.00
$4.50
$50.20
$0.00
$25.50
$0.00
CONTRACTORS DECLARATION:
ereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commendng with Section 7000) of Division 3 of the Business and Professions code.
and my license Is in full force and effect.
cense No: 397072 Class: Date: Contractor: WHELAN ELECTRIC INC
WORKERS' COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations:
ave 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
this permit is issued.
se 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 Insurance carrier and pol lcy number is:
Carrier: LEGION Policy number:WEN001987601 Expire Date: 04/17/2007
(This section need not be completed If the permit is for one hundred dollars (E100) or Tess.
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 became subject to the workers' compensation
laws of California. andnagree that if�1 should become subject to the workers compensation provisions of 3700 of the labor cod hall fo 'th comply with those provislons.
O ll/ 3 i I a '7 ��lJ�l LA-) Ap}11wnt Signature:
tog: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fings1/2 to or hundred tpousaa4dallars
(Si 0,000), in addition to the cost of corrpensationdarreges as provided far in Section 3706 of the labor code, interest, and attorneys foes* • •• • • •• •
• •
• • • • •• • • • • •
I hereby acknowledge that I have read this application; that the information given is correct; and that I am the owner, or duly authorized ayellt oRhebwner. I awe a: • • • •
comply with city and state laws regulating construction: and in doing the work authorized thereby, no person will be employed in violation of the Iaoar code ERR* stab of • • •
California relating to workmen's compensatcn insurance.
Permittee JLpme (Print) `� e_ 14.) k ti a -
Signature
••• •
se: --)-->/? 1 ,�- •k'05c'•a".•
..
••• ••• ••• • • •• • •
.••••••
Address:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR
LAST VALID INSPECTION.