HomeMy WebLinkAboutE2018-0496 - Permits1 City of Newport Beach - Building Divis
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 437 ACACIA AVE Bldg: 1 Floor: Suite:
Description of Work: ELEC -TEMP POWER POLE'CHG OF
Inspector Area:
Legal Description
5
N TR 682 LOT 51
Owner: ACACIA PROPERTIES LLP
Contractor:
Address: 437 ACACIA AV
Address:
CORONA DEL MAR CA 92625
0
Phone:
Phone:
0
Con State Lic:
Issued Date:07/31/2018
Lic Expire:
$0.00
Bus Lic:
Processed By: `
Lic Exp Date:
New Construction
Residential
Multi -Family:
1-2 Family:
Service
0-600V up to 20OA: 0
0-600V over 20OA: 0
Over 600V or1000A: 0
0/H to U/G 0
II IIS IIIIIIIII 0IIII 1IIII IIII MINI 0IIII 4IIII IIID SII II
JR COMPANY
218 2 KANEOHE LN
HU TINGTON BEACH CA 92646
Receptacles/Outlets: 0
$0.00
Fixtures:
0
$0.00
Sep Circuits:
0
0¢¢
m
Low Voltage
0
O
soe
Signs
• P
• e
e
$0.00
Branch Circuit:
0
$0.00
Each Add Circuit:
0
$0.00
Time Clocks:
0
$0.00
Additional Fee:
$0.00
$0.00
$0.00
Plan
Electrical Permit: E2018-0496
Project No: 00p3 -21578•®e
® e a m o o a m
a a e o• o¢ • m
Inspection Requests Phone (949)644-3255
Code Edit: 2016
Worker's Compensation Insurance
Carrier: EXEMPT
Policy No: no employees
Expire : p
k Fi a'1
�+r
FEES
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA:
0¢¢
m
e
m D
e
O
soe
6
m
om•
• P
• e
e
Code Edit: 2016
Worker's Compensation Insurance
Carrier: EXEMPT
Policy No: no employees
Expire : p
k Fi a'1
�+r
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 BackfTemp 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:
Fee Due
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Monday - Fridlay 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m.
4
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
3WNER-SUILDEA4 Dom.: L�elrt�y rt��ry
I he' -b' affirm, under paugk$df�peldory that I am exempt from the Contractors' State License Law for the reason(s) in
'Section 7011.5, duslrlass and PrafessMnt Code: Any city or county that requires a permit to construct, alter, improve, de
the permit to file a signed statement that he or she is Iigen$ed pursuant to the provisions of the Contractors' State License
Professions Code) or that nr: or she is ex�mptfrom licensure and the basis for the alleged exemption. Any violation of Sem
not more than five hundred Iffa's (sepi .0.
13I, as aVner'of tM prt�perty-or fiy errVljea3 with wagas as their sole compensation, will do (_) all of or (_) portions o1
Bus
me& and hundred
Cd LA The CoatrdG(drs' State License Law does not apply to an owner of property who, througt
improventents'dr4 not mlende or offered for sale. If, however, the building or improvement is sold within one year of con
ErIm roved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 704,
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contract
❑ I 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
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I I
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leg
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
and effect.
License Class License No Date
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN,
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director
performance of the work for which this permit is issued. Policy No.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
insurance carrier and policy number are:
Carrier Policy Number
Narn_q of Agent
in the performancpof
permit is issued, I shall not employ any person in any
I provisions of Section 3700 of the Labor Code, i shall
ligrialtureof Applich
IECLARATION RE A Val NST TI LE DING AGENCY
hereby affirm underd natty 'perju that there is a construction lending agency for the performance
.ender's Name der's Address
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 have pr ' ed 1 o e
I agree to comply withal applicable city and county o In no
a a ws relating to building
I authorize representatives of this city or county to t t ab led y for inspec
Unmhve of Pmnerty Owner or Authorized Agen� Print Pr
ACTION I DATE
OCCUPANCYISSUED
BY I I FEDERAL
of the work for
construction.
In purposes.
ooertv Owner's
I SDBUTTEDASBESTOS NU
❑ EPA
❑ AQMD
❑ AS13ESTOSNORRCARONIS
PROPOSED DEMOLITION.
SIGNATURE:
licated below by the checkmark(s) I have placed next to the applicable item(s)
nolish, or repair any structure, prior to its issuance, also requires the applicant for
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
lion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
the work, and the structure Is not intended or offered for sale (Section 7044,
employees' or personal effort, builds or improves the property, provided that the
oletion. the Owner -Builder will have the burden of proving that it was not built or
Business and Professions Code: The Contractors' State License Law does not
pursuant to the Contractors' State License Law).
ar prior to completion of the in
erstand that a copy of the appl
I. ca. g ov/ca law. htm I.
Division 3 of the Business and
! Contractor Signature 3
IES AND CIVIL FINES UP TO ONE HCI
ments covered by thi
law, Section 7044 of
Date
Business and
license is in full force
DOLLARS ($100,000), IN ADDITION TO THE
Industrial Relations as provided for by Section 3700 of the Labor Code, for
of the work for which this permit is issued. My workers'
Date
o as to become subject to the workers' compensation laws of California, and agre
comply with those provisions. _ /
Dt
this permit is issued (Se tion 3097, Civil Code).
Im
APPLICABLE TO
/i