HomeMy WebLinkAboutE2019-0564 - Permitserr City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 206 ADAMS
Description of Work: ELEC -
Inspector Area: 1
1 Floor: 1 Suite: B
ECT FOR A/C INSTALLATION
Legal Description: BALBOA TR ]BILK 5 LOT 9
Owner: TALEBI TONY
Contractor:
Address: 206 ADAMS AV UNIT B
Address:
NEWPORT BEACH CA 92661
$0.00
Phone:
Phone:
$0.00
Con State Lic:
Issued Date:08/13/2019
Lic Expire:
Branch Circuit:
Bus Lic:
Processed By:
Lic Exp Date:
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 over20OA: 0 $0.00
Over 600V or 1000A: 0 $0.00
O/H to U/G 0 $0.00
TOTAL Fee: $61.00
'Ij ^°" '"Zh ?t9c-al°Permit: E2019-0564
E 2 0 1 9. 0.5 6 40 °oPr'pject'+10:° m
° 0 0
Inspection Requests Phone (949)644-3255
e o °o a OC O O
KLONDIKE AIR INC
1308 LOGAN STE E
COSTA MESA CA 92626
714-979-2070
754456
09/30/2020
BT30060482
10/31/2019
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
Fixtures:
0
$0.00
Sep Circuits:
0
$0.00
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
Code Edit: 2016
Worker's Compensation Insurance
Carrier: FALLS LAKE FIRE & CASUAL
Policy No: FLA008095-
Expire : 01/01/2020
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:
6
$0.00
50 to 100 HP/KW/KVA:
0
$0.00
Over 100 HP/KW/KVA:
0
$0.00
Piggy Backfremp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Plan Check Fee :
INS txj nj
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
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.
NO CONSTRUCTION NOISE
ON THE WEEKEND
DWNER-BUILDER DECLARATION.", "; - : --.
I hereby affirm under penalty of perjory:hatl, rr6exempt 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 VolJg:".dtybi cou°niy that-mquires 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 ($500), , ...
❑ I, as owner of the property, or my e1Tpoye4 with wages at; their VTe cc2n*nsation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business and Professions Code: The Ceiltractdjs' Statf License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
improvements are not intended or offered for sal&. If, ho$vev&ofhe bulling or imprgvement 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).
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By 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 legall)
sell 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se tion 000q) of Division 3 of the Businesand r fession d y icense is in full force
and effect. ` ' 1. I Contractor Si
License Class License No D gnat
NORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
:11 have 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 th,
3-3-88�1���..((��ormance of the work for which this permit is issued. Policy No.
have 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' compensatior
s rance carrier and policy number are: -
Policy Number Expiration Date
Te of Agent Phone #
certify that, in the pertorma e o the work w t '�.p it is is ued,I shall not employ any person in any manner so as to become subject to the workers' ompensation laws of California, and agre,
t, if I should become subje to th workers' co l!51h
a d isio of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant Date
CLARATION REGARDING CONSTRUCTION LENDING AGENCY
or—
reby 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).
Ider's Name Lender's Address
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 hav vided is c rre
I agree to comply with all applicable, and cou ,ordin nces and tate ting building construction. .yt �1 r 1
I authorize representatives of this city or county o enter . above -i pro �r'sspection purposes. —/, t
nature of Property Owner or Authorized Agen �+-- �2[jC.Properly Owner's or Authorized Agent's Name, p�j P" Y D_a`te
ACTION
DATE BY
DECLARATION OF COMPLIANCEMTH CODEOF
FOR OFFICE USE ONLY
FEDERAL_ REGULATIONS PART 61 OFTf7LE40AND
AQMD.RULE 1403.
PERMITEXPIR€D
❑ ISUBIWITEDASBESTOSN071FICATIONTO.
❑ EPA
❑ AQMD
PERMITCANCELLED
P€RMITEXTENDED
❑ ASBESTOS NOTIFICA77ONIS NOT APPLICABLE TO
PROPOSEDDEMOLITION,
PERMITFINAI
,1 L4-19
EERTIFICATEOF
OCCUPANCYISSUED
SIGNATURE: