HomeMy WebLinkAboutE2019-0265 - PermitsCity of Newport Beach - Building DivisionI (IlJ1111111111111111111111111111il111111111111111Jil II Electrical Permit: E2019 -0265
'f d S 100 Civic Center Drive, Newport Beach, CA 92660 Project No: 0857-2019
µ 'q n- Permit Counter Phone (949)644-3288
�we,r�iw` Inspection Requests Phone (949)644-3255
New Construction
Residential
Multi -Family: 0 $0.00
1-2 Family: 0 $0.00
Service
0-600V up to 20OA: 0 $0.00
0-600V over 20OA: 0 $0.00
Over 600V or1000A: 0 $0.00
O/H to U/G 0 $0.00
Receptacle/Switch/Outlets
Receptacles/Outlets: 1 $1.00
Fixtures:
0
$0.00
Sep Circuits:
1
$7.00
Low Voltage
Job Address: 1 RENATA Bldg: 1 Floor:
Suite:
Signs
0
$0.00
Branch Circuit:
0
Description of Work: ELEC CAR CHARGER AND SUB PANEL 125
AMPS
0
$0.00
Time Clocks:
0
$0.00
Additional Fee:
$0.00
Supplemental Fee:
$0.00
Inspector Area: 6
Code Edit: 2016
Legal Description: N TR 15488 LOT 12
Owner: GUST MADELINE &JOHN
Contractor:
OREGON CONTRACTING
Worker's Compensation Insurance
Address: 1 RENATA
Address:
421 N LYONS ST #15
Carrier: EXEMPT
,
° • ° °°
NEWPORT BEACH, CA 92657
SANTA ANA CA 92701
Policy No:
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Phone:
Phone:
714-206-2186
Expire:
°
°• °°°
Con State Lic:
953326
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Issued Date:05/02/2019
Lic Expire:
10/31/2020
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Bus Lic.
BT30067165
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Processed By:
Lic Exp Date:
05/31/2020
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New Construction
Residential
Multi -Family: 0 $0.00
1-2 Family: 0 $0.00
Service
0-600V up to 20OA: 0 $0.00
0-600V over 20OA: 0 $0.00
Over 600V or1000A: 0 $0.00
O/H to U/G 0 $0.00
Receptacle/Switch/Outlets
Receptacles/Outlets: 1 $1.00
Fixtures:
0
$0.00
Sep Circuits:
1
$7.00
Low Voltage
0
$0.00
Signs
0
$0.00
Branch Circuit:
0
$0.00
Each Add Circuit:
0
$0.00
Time Clocks:
0
$0.00
Additional Fee:
$0.00
FEES
0
$0.00
Motors/Transformers (HP/KVA)
1
$26.00
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:
Temp Underground:
0
$0.00
Sub Panel:
1
$26.00
0
$0.00
0
$0.00
Record Mgmt Fee:
$0.00
Plan Check Fee:
$0.00
Investigation Fee:
$0.00
Issuance Fee:
$35.00
Supplemental Fee:
$0.00
Fee Due at Permit Issuance:
PERMITS EXPIRE 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.
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).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) 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
ffIm
roved for the purpose of sale).
1, 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 licensure under the Contractors' State License Law for the following reason:
By my signaturg115MIJ 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 legally
sell a structure theft 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
Lg %vtons Cod4,.is evailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
ignatuh3 of Pr§prlV4Cwner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
Thera affirm undpi; penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wit Section 7000) of Division 3 of the Business d Professions Code, and may license is in full force
aryl etfEct. . 6 )! 4S(Sv (/ �_
L•icenfs Class ' License No Date _ Contractor Signatu
VyPRKERS' CdMPE'JSATION DECLARATION
WT piliriNAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPL ER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO HE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
Cbb T OF COMPENSATIdN, DAMAGES AS PROVIDED FOR IN SECTION 7706 OF THE LABOR CODE, INTEREST, AND ATTORN Y'S FEES.
I Pft6y affirm un der ppCalty of perjury one of the following declarations:
❑ I jWg and will 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 thr
par€ormaRce of tY .0ftrkJor which this permit is issued. Policy No.
..
❑I have and will main.tain 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' compensatior
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Nae of Agent Phone #
ertify that, in the perfo once of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to a workers' compensation laws of California, and agree
If I should becomes ject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisi s.
Signature of Applicant Date
DECLARATION REG DI .CONSTRUCTION LENDIN AGENC
I hereby affirm under nalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued ( ection 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 h ve provided is correct.
I agree to comply with all applicable city and cou y ordinances and state laws relating to building construction.
I authorize representatives of this city or county o enter the above -identified property for inspection purposes.
Signature of Propert Owner or Authorized Agent riot Propert Owner's or Authorized Agent's Na e n +� Date ` -2— 3
ACTION &ATE/ BY DELL RATION OF CO P ANCEtMTHCODEOF FOR OFFICE US ONLY
1 11 FEDERAL REGULATIONS PART 61 OF TITLE40AND
P€R'A4IT FINAL
C€RVRCAT€OF
OCCUPANCYISSUE&
❑ ISUBUTTEDASBESTOSNOTIFICATIONTO:
❑ EPA
❑ AQMD
❑ ASBESTOS NORRCATIONIS NOT APPLICABLE TO
PROPOSEDDEMOLITION.
SIGNATURE: