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HomeMy WebLinkAboutE2019-0806 - PermitsCity of Newport Beach - Building Division A 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 219 EVENING STAR LN Bldg: 1 Floor: Suite: Description of Work: ELEC/TEMP POWER POLE IIII11111111111111111111111111111111111111111 Ill ElectricalE2019-0806111111111Project No or2D16 Inspection Requests Phone (949)644-3255 Inspector ' N S 1 QCT® R Area: 3 Code Edit: 2019 Legal Description: N TR 4224 LOT 139 Owner: JONES JR. CLIFTON S Contractor: OWNER/BLDR Worker's Compensation Insurance Address: 21 E G STAR LN Address: Carrier EWPORT EACH CA 92660 Policy No: Phone: 949-456-066 Phone: Expire Con State Lic: O/B Issued te:12/04/2019 Lic Expire: Bus Lic: m m Processed ' Lic Exp Date: me m mm v eaao E m © O BO?O m O p 00 O O[90 New Construction Receptacle/Switch/Outlets FEES Motors/Transformers (HP/KVA) moom m - Residential Multi -Family: 0 $0.00 Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0C $0.00 Temp Underground: O1 ;�.°��Q $g).00° 1-2 Family: 0 $0.00 Fixtures: Sep Circuits: 0 $0.00 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 Sub Panel 0 $D,QQ ° 10 to 50 HP/KW/KVA: 0 $0.00 ° m0 $U°QQ Service Low Voltage 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 ° °"° °0 $0.00 0-600V up to 20OA: 0 $0.00 Signs Branch Circuit: 0 $0.00 Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00 0-600V over 20OA: 0 $0.00 Each Add Circuit: 0 $0.00 Piggy Backrremp Power: 0 $0.00 Plan Check Fee: Investigation Fee: $0.00 $0.00 Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 1 $39.00 Issuance Fee: $0.00 O/H to U/G 0 $0.00 Additional Fee : $0.00 Supplemental Fee: $10.00 TOTAL Fee: $49.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : S49.00 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. INER-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) ction 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 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 fessions 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 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, ;iness 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 rovements 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 roved for thepurpose 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 �Iv to an owner of property who builds or improves thereon, and who ContI the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State Lie By my signature below I acknowledge that, except for my pe r sell a structure that I have built as an owner -builder if it h not I Professions Code, is available upon request when this lioapi( Signature of Property Owner or Authorized Agen LICENSED CONTRACTOR'S DECLARATIO I hereby affirm under penalty of perjury that I am lii4ensed under and effect. License Class • • • ... License No reason: I at have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal irety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and f (lowing Web site:http://www.leginfo.ca.gov/caiaw.html. /`2^y _ Y Date 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force Date Contractor Signature ""ERS' CPMRr;NSATION DECLARATION INd•. FAILUR%.TQSE(:JRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3'(00,000), IN ADDITION TO THE QF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. i4laffirm un(%r penalty of perjury one of the following declarations: .,n Frage and•vyi42tntain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations asrovided for b Section 3700 of the Labor Code, for t P Y rmance of the work for which this permit is issued. Policy No. We and will Auntain workers' compensation insurance, as required b 5 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatioi aE ner apd policy number are: 1 6 / Policy tuber Expiration Date _,•,,,,, j' Phone# irtt}Ig pgrformance o" Ytn rk I 1 '11 111 h thi rmit is issu d, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree lieaome sub'ect to��he rkers' oJhpei provisions Section 3700 of the Labor Code, I shall forthwith comply with those provisions. x0 Date CL RATION REGf RDIN - 'IKUL[nun LMrvulnv u �...� penalty of that the Isla constrn le Ing agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). :r y affirm under pe Lender's Address Ider's Name my signature below, I certify to each 04he follow , g: I am the property owner or authorized to act on th rty owner's behalf. I have read this application and the information I have provided is corre . I agree to comply with all applicable city and county ordinanca laws Id I g to b tiling construction. rrrty ay I authorize representatives of this city or county o enter ✓ o for ins action purposes. nature of Property Owner or Authorized Agent int Property Owner's or Authorized Agent's Name I TION OF COMPLIANCE tNiTNCODEOF FOR O! ACTION DATE Y REGULATIONS PART 61 OF TITLE40AND VARULE1403. PERMITEXP/RED MfTTEDASBESTOS NOTIFICATION T0: PERMdTCANCELLED ❑ EPA [I AQMD PERMIT EXTENDED ❑ ASBESTOS N07ITTCATIONtS NOF APPLICABLE TO PERMITFINAL Ib 202e S PROPOSED DEMOLITION. CERTIFICATEOF SIGNATURE: OCCUPANCYISSUED