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Home My WebLink AboutE2018-0722 - Permits0r City of Newport Beach - Building Division I�IIIIIIIIIiIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II Electrical Permit: E2018-0722 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 8 0 7 2 2 Project No: ,, Permit Counter Phone (949)644-3288 �q4#Nl4�tF Inspection Requests Phone (949)644-3255 Job Address: 113 VIA QUITO Bldg: 1 Floor: Suite: Description of Work: ELEC/DISCONNECT TO AIC H2O18-0696 Inspector Area: 1 Code Edit: 2016 Legal Description: TR 907 LOT 133(AND SWLY 17 FT LOT 132 Owner: JOHNSEN RANDE Address: 113 VIA-03MO Phone: Issued New Construction Residential Multi -Family: 1-2 Family: Service 0-600V up to 200A: 0 0-600V over20OA: 0 Over 600V or1000A: 0 O/H to U/G 0 Contractor: SHALOM HEATING & AIR Address: 9191 VIA BALBOA CIR CA 92663 BUENA PARK, CA 90620 Phone: 714-866-2021 Con State Lie: 967182 Lie Expire: 10/31/2019 Bus Lie: BT30065018 Lie Exp Date: 11/30/2019 Worker's Compensation Insurance Carrier: NORGUARD Policy No: JOWC945078 Expire : 04/11/2019 FEES Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 $0.00 Fixtures: 0 $0.00 $0.00 Sep Circuits: 1 $7.00 50 to 100 HP/KW/KVA: Low Voltage 0 $0.00 0 Signs $6.00 Branch Circuit: 0 $0.00 $0.00 Each Add Circuit: 0 $0.00 $0.00 Time Clocks: 0 $0.00 $0.00 Additional Fee: $0.00 Worker's Compensation Insurance Carrier: NORGUARD Policy No: JOWC945078 Expire : 04/11/2019 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 Backrremp Power: 0 $0.00 Temp Power Pole: 0 $0.00 Temp Underground: Sub Panel: Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: TOTAL Fee: $42.00 Plan Check 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. •o•eoo e 000000 0060 • e sooe 00 a e e ®e .eee 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $35.00 $0.00 )WNER-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 is 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 Irofessions 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 got more than five hundred dollars ($500). 1 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, lusiness 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 nprovements 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 nproved for the purpose of sale). 1 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 pply 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: ly 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 legally ell 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 'rofessions 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 .ICENSED03MYttACTOR'S DECLARATION hereby affirm u nderpenalty 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 Ad tlect. ...... i QjK RS' ' License No Date �(,(, U� Contractor Signature I►Lj�KERS' COMPENSATION DECLARATION 6// / I TARNCfjJ;;: FAILUPP fS AECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE QrSTby COMPENSAFRON, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. heleby affirm underpenalty, of perjury one of the following declarations: have and OAI m9intain 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 thl eIMPragoe of the work for which this permit is issued. Policy No. ••• ha and w/1tl.masxtaln 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 (sura carrier and { blicy number are: 3Lrier• Policy Number Expiration Date of Agent ,ertify 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 if I should becomq subje wgrlcers' com ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 'a CONSTRUCTION LENDING AGENCY hereby affirm under pe�lalty 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). ender's Name I Lender's Address y 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 count"ter the abboo/-'d tilled property for inspection purposes. innahrte of Pmnertv Owner or Authorized ADent 7`J/y7. Print Prooertv Owner's or Authorized Agent's Name I�iY`rl l�Er'i �fJIdJ/ Date of AC77ON I DATE PERMITFINAL CERT FWATE OF OCCUPANCYISSUED FEDERAL REGULATIONS PART 61 OF TI JLE40AND AGMD RULE 1403. ❑ ISUBMITFEDASSESTOSNOTIFICATIONTO: ❑ EPA ❑ AQMD ❑ ASBESTOS NORRCAHONIS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: