HomeMy WebLinkAboutE2018-0753 - PermitsCity of Newport Beach - Building Did gig 1, IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINIIIIIIIIIIIIIIIIIIIIIIII
100 Civic Center Drive, Newport Beach, CA 92660 V R Electrical Permit: E2018-0753
ti Permit Counter Phone (949)644-3288 Project No: 2728-2018
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Inspection Requests Phone (949)644-3255
Job Address: 2612 VISTA DR Bldg: 1 Floor: Suite:
Description of Work: ELEC /CIRCUIT TO PORTABLE SPA
2728-2018 (ASTM COVER REQ)
Inspector Area: 2
ECTOR
Legal Description: N TR Code Edit: 2016 1102 LOT 40 III
Owner: DAVIS JOSHUA Contractor: OUTDOOR CONCEPTS %
Address: 26E BEAC CA 92663 12 V DR Address: 28241 CROWN VALLEY PKWY, F293 Worker's Compensation Insurance °
NORT Carrier :BENCHMARK INS CO ' °".. ° ° • ° ° an
Phone: LAGUNA CA 92677 Policy Phone: 949-363-7932932 y No: CST5013017
Con State Lic: 831378 Expire: 06/18/2019 • ° a
Issued Dat :11/20/2016 Lic Expire: 02/28/2020 °
Processed Bus Lic: BT30060506
Lic Exp Date: 09/30/2019 .... ......
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New Construction Receptacle/Switch/Outlets
Residential 0to1P/KW KVA:Motors/Transformers (HP/KVA)
Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0 $0.00
Multi-Family: 0 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA: p Temp Underground: 6
1-2 Family: 0 $0.00 $0.00 $0.00
Sep Circuits: 1 $7.00 10 to 50 HP/KW/KVA: 0 Sub Panel: 0 $0.00
Service Low Voltage 0 $0.00 50 to 100 HP/KW/KVA: 0 $0 00 0 $0.00
Signs Over 100 HP/KW/KVA: 0 $0.00 0 $0.00
0-600V up to 200A: 0 $0.00 Branch Circuit: 0 $0.00 $0.00 Record Mgmt Fee:
0-600V over 200A: 0 $0.00 Each Add Circuit: 0 Plan Check Fee: $0.00
Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 Piggy Back/Temp Power: 0 $0.00 $0.00
O/H to U/G $0.00 Temp Power Pole: 0 Investigation Fee: $0.00
0 $0.00 Additional Fee : $114.50 $0.00 Issuance Fee: $35.00
TOTAL Fee: $156.50 Supplemental Fee: $0.00
Plan Check Fee: $0.00 Fee Due at Permit
CPERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
onstruction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m.
iSection
P a
pplicable item s
NER-BUILDER DECLARATION
State License Law (Chapter mencing with Section 7000) of D 3 of the Business and
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the reasons) indicated below bcheckmark s I have laced next app
permit Alon oo fi , a signed ,usinessstatement that he oand Professions rsheAs licensed purny city or euan1 to the requires a Permit to
of the Contractors'alter,State Lic ,demolish, or repaistructure, prior to its issuance, aluires the applicant for
fe t Cade) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by pplicant for a permit subjects theant to a civil penalty of
more than five hundred dollars ($500). will do (_) all of or (_) portions of the work, and ructure is not intended or offered e (Section 7044,
1, as owner of the property, or my employees with wages ns their sole compensation,
� ness and ere not intended Code
o deoThe Contr;r offered for sale. Sfahowever, theabuildagnortimprlovement ay to an nsoldfw then one year of comp) tioln, the Owner -Builder ffw I hauort te the burden of provingds or improves theproperty, that i was provided
ot built oe
(roved for the purpose of sale).
>l1, to an owner 1, as owner of the
property,
who exclusive overs thereon, licensed Contractors to construct the project (Section 7044., Business and and who contracts for the projects w th a licensed Cont act r pursuant to Contractors' State License ions Code: The rLatw)g Sicense Law does no
uilds or
It
I am exempt from licensure under the Contractors' State License Law for the followimust have Te_�Ti_ded ng reason:
I a structure
my tune below i Dave built le aneownere-bueder if k has not belen clonstructed idence in n it I entirety by licensed (contractors. I understand thapy of theapplicable aw,tSection s covered f the Buhis lsiness andt, I cannot lega
(kation is submitted or at the followingWeb site:http://www. leginfo.ca.gov/calml. Date
3fessions Code, is Available upon request when this app
lVature of Propertj Owner or Authorized Agent
CEASED CONTRACTOR'S DECLARATION 1l
siness a
prell affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing 00) of ivisoContr Sn 3 of the ign tura nd ofe ions Code, license is in u force
Dat
enffect.se s!, '.' License No t
pfM4ERS' CpX9ENSATION DECLARATION
)$T1l FAIL ENSATION, DAMAGES AS WORKERS' COMPENSATION
FOR IN SECTION COVET7708GE 10E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. PENALTIES AND CIVIS UP TO ONE HUNDRED THOUSAND DO 5700,000), IN ADDITION TO T
F.11
StdURE
telghXaffrm under penalty of perjury one of the following declarations:
I�`�1aae and'WiR Maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial eions as provided for by Section of the Labor Code, forth
Srfptmance of the work for which this permit is issued. Policy No.
I e and v1ilLirainiain 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 I
sur ce carrier and policy number are: Expiration Date
Policy Number phone #
a r
ec
ame of Agent
]I cf t 1 sfy hould b�the performat to of the w wO rs' o reco
which this ermit is issued,ons of Section113not 700 of employ
he person
hall orthwith complybwith hose pme I ovtis ons. to the workers' compen at �18� fCalifornia, an agr
at,
an
Dat i GL/ C
ignature of Applicant
iECLARATION REGA DIN TRUCTION LENDING A
hereby affirm under p nalty of perjury that there is a construction lending agency for Lendeer's Address of the work far which this permit is issued (Section 3097, Civil Code).
end r'sam Name
ly 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 he ided is correct.
I agree to comply with all applicable city and county rdina ces and state laws relating to building construction. Date
I authorize representatives of this city or cou�ty to t above-i'dentif Party for inspection opertp Owner's or Authorized Agent's Nam ryp
nnu v
ACTION I DATE 1� BY
❑ I sUBIW iTED AsBEsTOS NOTIFICATION Ta:
❑ EPA
❑ AQMD
aASBESTOS N0ITION-DON/S NOT APPLICABLE TO
CERTrftCATEOF
/ ` `� ` SIGNATURE.
OCCUPANCYrSSUED
Glcr-I'll S
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