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HomeMy WebLinkAboutE2017-0315 - PermitsCity of Newport Beach - Building Division i00 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 II III IIIIIIIII1111 II11IIIIIIIIIII IIIIIII 1 II Electrical Permit : E2017-0315 Project No : 1328-2017 Inspection Requests Phone (949)644-3255 Job Address: 1 HOAG DR Bldg: 1 Floor: Suite: Description of Work: COMM ELEC - EMERGENCY POWER "BLDG 21 HEART INSTITUTE" Inspector Area: 7 Legal Description: OF LOT Owner: Address: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH, CA 92663 Phone: Issued Date:06/26/2017 Processed By: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: BRIGGS ELECTRIC INC 14381 FRANKLIN AVENUE TUSTIN CA 92780 714-544-2500 297836 08/31/2017 BT01013033 12/31/2017 Code Edit: 2016 Worker's Compensation Insurance Carrier: TRAVELERS PROPERTY "_ Policy No: 9C577781 Expire : 07/01/2017 New Construction Residential Multi -Family: 1-2 Family: Service 0-600V up to 200A: 0-600V over 200A: Over 600V or 1000A: O/H to U/G 0 $0.00 0 $0.00 2 $82.00 0 $0.00 0 $0.00 0 $0.00 TOTAL Fee : $319.11 Receptacle/Switch/Outlets Receptacles/Outlets: 7 Fixtures: 8 Sep Circuits: 1 Low Voltage 0 Signs Branch Circuit: 0 Each Add Circuit: 0 Time Clocks: 0 Additional Fee : $7.00 $8.00 $6.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEES Motors/Transformers (HP/KVA) 0 to 1 HP/KW/KVA: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 Over 100 HP/KW/KVA: 0 $0.00 Piggy Back/Temp Power: 0 $0.00 Temp Power Pole: 0 $0.00 Plan Check Fee : $133.11 Temp Underground: Sub Panel: • Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: 0 $0.00 2 $50.00 0 $0.00 0 $0.00 $0.00 $133.11 $0.00 $33.00 $0.00 Fee Due at Permit Issuance : $186.00 PERMITSEXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m, to 6:00 p.m. 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 licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ I am exempt from Vicensure under the Contractors' State License Law for the following reason: By my signature b%bw.l acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally s$Ija Srlicture that, p§ve 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:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent LSCENStD CONTRACTOR'S DECLARATION I hereby affirm uyaer pajjalty of perjury that I am licensed under provisions of Chapter 9 (commencing with fiction 7000) of Division 3 of the Business and P essions Code, and my license is in full force and ttfetet. • • • License Class - .• •• License No Date - CClntractor Signature CL3, , r Date NWQMMK@RS' COMPENSATION DECLARATION WARNING: FAILURE TOSECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO 6NE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE CMCMIOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby 2ffirm utlMBfl ©alty of perjury one of the following declarations: LI have and will reeiwtain 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 • pe ormance of the work for which this permit is issued. Policy No. ve 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 surance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # 01 certify that, in the pe ormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to tl}e workers' compensation laws of California, and agreE that, if I should become ublect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisi s. Signature of Applicant r DECLARATION REG RDING CONSTRUCTION LENDING AGENCY I hereby affirm under enalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issue (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances add state law relating to building construction. I authorize representatives of this city or county j(i enter the above -identified roperty for inspection purposes. Print Property Owner's or Authorized Agent's Name Signature of Property Owner or Authorized Agent Date I D ACTION DATE / , „— BY DECLARATI{iNOFGOMPLIANCE WITH CODE OF / FEDERAL REGttLTtTFONS PART 51 OF TTTLE40AND AQb4DRLILE 7403. FOR OFFICE USEONI/ PERfvIIT EXPIRED ■ I SUBMIT I ED ASBESTOS 140TIFICATION TO: • EPA PERMIT CANCEiLED • AQMD PERMIT EXTENDED IN ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PEt7l4TITFtNAt 9 Pei - fl CERTIFICATE OF O'CCUPANCYISSUED