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Home My WebLink AboutE2019-0475 - Permitst City of Newport Beach - Building Division 11IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII it Electrical Permit: E2019-0475 04 100 Civic: Center Drive, Newport Beach, CA 92660 E 2 0 1 9 0 4 7 5 Project No : 1579-2019 Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Job Address: 4701 SURREY DR Bldg: 1 Floor: Suite: H Description of Work: ELEC OUTLETS FOR BBQ 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. m Inspector Area: 5 Code Edit: 2016 a yryppbb m, o m • Leg01'159%cription�, N TR 3519 LOT 67 Receptacle/Switch/Outlets '� ° c Residential Receptacles/Outlets: 2 Ow4ieT: PLE�MAANLLE RD PTRS Contractor: PARKS MITCHELL Worker's Compensation Insurance Temp. Underground: 0 AdFe%tP` 1 CORPORATE PLAZA DR#110 Address: 11 ALLYSSUM Carrier: EXEMPT Fixtures: 0 "°"m". NEWPORT BEACH CA 92660 1 to 10 HP/KW/KVA: RSM CA 92688 Policy No: Sub Panel: 0 Phdrte:`° o' "® Phone: 949-279-7193 Expire: oma m •mmmoo m $0.00 Con State Lie: 838091 $0.00 0 IssuddDate:07/1$370'1099 Lie Expire: 05/31/2020 m mo.mmoc 0 0 r Bus LIC: BT30058994 - $0.00 :`°m • ° m • ""O O Processd`d By: ao Lie Exp Date: 05/31/2020 Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: o o 0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 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. FEES New Construction Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) Residential Receptacles/Outlets: 2 $2.00 0 to 1 HP/KW/KVA: - 0 $0.00 Temp. Underground: 0 $0.00 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 Back/Temp Power: 0 $0.00 Investigation Fee: $0.00 Over 600V or 1000A: 0 $0.00 Time Clocks:, 0 $0.00 Temp Power Pole: 0 $0.00 Issuance Fee: $35.00 O/H to U/G 0 $0.00 Additional Fee: $0.00 Supplemental Fee: $0.00 TOTAL Fee: $37.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $37.00 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. DWNER-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 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 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 acivil penalty of not 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 U 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 improvement,% Irp 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 improved fowth. gU pose of sale). ❑- Ip as owner o); thvP property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not Alft ?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). •• ❑ram exempt from licensure under the Contractors'. State License Law for the following reason: %.Wr 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 sell a structur,�,t ot.1have 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 oe?t e.gdsiness.811'0 ° ° Firo{essions Code, Wavailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm]. • • °° °� Silifature of Qp�oop� sedywner or Authorized Agent Date •+• •. LSCEjJSEDLONAA.CTOR'S DECLARATION .°. I fiefty affirm ueder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wit Sect! 7 00) of Division 3 of the Business n r f Co a my lic4nse is in fu V. fc„rce, aa0l effect • . r • •• •noon° Lfben& Class, ..... License No Date / Contractor Signatu �y MORKERS' QQMP.ENSATION DECLARATION <° V4F G: FAILURE ''jLQQ $$EbURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TONE HUNDRED THOUSAND DOLLARS (1100,006), IN ADDITION TO THE :OST OF COMPENQAOA, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. • • o • b 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 IlPthe Labor CZe1e,,°fnrth( )erformance of the work for which this permit is issued. Policy No. • •+•• ° :11 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. MS''Afters' compensatior nsurance carrier and policy number are: 7arr'er Policy Number Expiration Date Kat',' of Agent Phone # rtify that, in the perfoVS for w ' is per ' issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree I should bacomesubsatin visions of Section 3700 of the Labor Code, t shall forthwith comply with those provlslarts.//Jsignature of Applicant Dated)ECLARATION REGARD UCTION LENDING AGENCY hereby affirm under pen Ity 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 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. correcI I have read this application and the information I h agree to comply with all applicable city and cou ordina laws Son re Ifg to building construction_ videdis I authorize representatives of this city or county en arty for inspection purposes. mature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's NameVv �• Ci < �" Date ACTION DATE BY DECLARATO.OFCOMPLIANCEMTNCODEOF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE40AND AQMD RULE 1403. PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED P€RMIT:FXTENDED ASBESTOS NORFICARONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERANTFINAL - [ CERTTFICATE OF OCCUPANCYISSUED SIGNATURE: