HomeMy WebLinkAboutE2018-0664 - Permits0t City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIII II Electrical Permit: E2018-0664
'' 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 8 0 6 6 4 Project No: 2374-2018
"; Permit Counter Phone (949)644-3288
�a �g4� Inspection Requests Phone (949)644-3255
Job Address: 110 VIA PALERMO Bldg: 1 Floor: Suite:01A or
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Description of Work: ELEC/TEMP POWER POLE � n );
Inspector Area: 1 Code Edit: 2016
Legal Description: TR 907 LOT 100(AND NELY 10 FT LOT 99
Owner:1nLic:
LISA Contractor: CP MC CLARY CONSTRUCTION INC Worker's Compensation Insurance
Address:ST Address: 1013 LINDEN PLACE Carrier: STATE COMP INS FUND
T BEA HCA 92663 COSTA MESA CA 92627 POIICy NO: 1300846 o e c c •° ° ° ° 0 0
Phone:557 Phone: 949-642-9264 Expire 06/0112019
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Con State Lic: 513053 ° B
Issued D8 Lic Expire: 10/31/2019 • •°•• o
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BT00004228Processed By: Lxp Date: 06/31/2019 •• o
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New Construction Receptacle/Switch/Outlets Motors/Transformers(HP/KVA)
Residential Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0 $0.00 Temp Underground: ° °',q° $0.0610
Multi -Family: 0 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 Sub Panel: 0 $0.00
1-2 Family: 0 $0.00 Sep Circuits: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 0 $0.00
Low Voltage 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 0 $0.00
Service Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00
0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 $0.00 Plan Check Fee: $0.00
0-600V over 20OA: 0 $0.00 Each Add Circuit: 0 $0.00 Piggy BackrFemp Power: 0 $0.00 Investigation Fee: $0.00
Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 1 $38.00 Issuance Fee: $35.00
0/H to U/G 0 $0.00 Additional Fee: $0.00 Supplemental Fee: $0.00
TOTAL Fee: $73.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $73.00
PERMITS EXPIRE 1810 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.
INER-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)
fiction 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
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
ifessions 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
more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
>iness 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
)rovements 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
)roved 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
)ly 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 licensure under the Contractors' State License Law for the following reason:
my signature below I 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 legal)
a structure that I have 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
,fessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
nature of Property Owner or Authorized Agent Date
TENSED (,C%TJ?ACTOR'S DECLARATION
Hetyv affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
heffect. • • • • i
snse Class• • • • • ` License No SSB Sl 3 O 5 Date \l7 'J ('� Contractor Signature
)RKERS' COMPENSATION DECLARATION
INING: FAILURP"SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,00D), IN ADDITION TO THE
IT OF COMPER$A ;I14d,•OAMAGES AS PROVIDED FOR IN SECTION STOS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
heMby affirm,ugoler penalty of perjury one of the following declarations:
3` Rave and:willl•maintain 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
W?Nance of the work for which this permit is issued. Policy No.
Vh � and �1•rL1§i(Itain 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' compensa
nce carrier and policy number are:
Policy Number
of Agent •! -
Date
]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, and agre
tat, if I should becom(e �ssubjjee�ct to the workers' compens 'orrprovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ( \
signature of Applicant�F/ l' Datryk 1 ci1 l pJ
)ECLARATION REGAfZDING CONSTRUCTION LENDING AGENCY I I
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ender's Name Lender's Address
sy 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 and state laws relating to building construction.
I authorize representatives of this city or county to ealterthe above -identified prop for inspection purposes. l .,o,,, 1
signature of Propertv Owner or Authorized Agent s _ �I Print Property Owner's or Authorized Agent's NamK L� "A c \lLa
ACTION DATE BY
DECLAPATIOAfOFCOMPLIAAfCEMTIfCODEOF
FOR OFFICE USE ON1Y
FEDERAL REGULATIONS PART 61 OF TIJLE40AND
AQMD ROLE 1403.
PERMIT EXPIRED
1 SUBMITTED ASBESTOS NOTIFICATION T0:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMITEXTENDED
[3ASB€STOS NORRCAAONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMITRNAt ,(o _ I5 /`-/�.i
cERTocATEOF
SIGNATURE:
OCCUPANCYISSUED