HomeMy WebLinkAboutE2021-0250 - PermitsCity of Newport Beach Building Division IIIIIIIIIIIIIIIIIIIIIIIIIII��III�IIIIIIII�III II
100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 2 1 0 2 5 0
Permit Counter Phone (949)644-3288
Job Address: 25 CALAIS Bldg: 1 Floor: Suite:
Description of Work: ELEC/A/C DISCONNECT (H2O21-0249)
Inspector Area:
Legal Description:
Owner: CHANG/HUANG
Contractor:
Address: 25 CALAIS
Address:
NEWPORT COAST CA 92657
Phone:
Phone:
Carrier: OHIO SECURITY INS CO.
Con State Lic:
Issued Date:04/09/2021
Lic Expire:
Motors/Transformers (HP/KVA)
Bus Lic:
Processed By:
Lic Exp Date:
New Construction
Residential
Multi -Family:
1-2 Family:
Service
0-600V up to 20OA: 0
0-600V over20OA: 0
Over 600V or 1000A: 0
O/H to U/G 0
Fee :
1ST CHOICE HEATING B A/C
20371 LAKEFORESTDR STE A-5
LAKE FOREST, CA 92630
949-305-5754
1006824
08/31/2021
BT30064046
08/31/2021
Electrical Permit: E2021-0250
Project No:
Inspection Requests Phone (949)644-3255
Code Edit: 20192
4A
FEES
Worker's Compensation Insurance
M
Carrier: OHIO SECURITY INS CO.
Policy No: XWS2262377720
Expire: 02/15/2022
0
Motors/Transformers (HP/KVA)
Plan Check Fee:
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
Receptacle/Switch/Outlets
Motors/Transformers (HP/KVA)
Receptacles/Outlets:
0
$0.00
0 to 1 HP/KW/KVA:
0
$0.00
Temp Underground:
0
$0.00
$0.00
Fixtures:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
0
$0.00
$0.00
Sep Circuits:
1
$7.00
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
Signs
Over 100 HP/KW/KVA:
0
$0.00
Record Mgmt Fee:
$0.00
$0.00
Branch Circuit:
0
$0.00
Plan Check Fee:
$0.00
$0.00
Each Add Circuit:
0
$0.00
Piggy Back/Temp Power:
0
$0.00
Investigation Fee:
$0.00
$0.00
Time Clocks:
0
$0.00
Temp Power Pole:
0
$0.00
Issuance Fee:
$37.00
$0.00
Additional Fee:
$0.00
Supplemental Fee:
$0.00
Plan Check Fee:
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.
)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
ie 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 penally of
of more than five hundred dollars ($500).
1 I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) 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).
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).
7 I 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
Irofessions Code, is available upon request when this application is submitted or at the following Web site:hltp://www.leginfo.ce.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penally 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
nd effect. /
icense Class License No Date Contractor Signat G
VORKERS' COMPENSATION DECLARATION
ARMING: 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 ($/00,000), IN ADDITION TO THE
OST 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:
7 1 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 IN
e jormance 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 performance of the work for which this permit is issued. My workers' compensatior
trance card policy nurp are:
Tier "ZIN, n r e 1oil bar Expiration Date
TIe of Agent _ V Phone #
certify 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 agree
I, if I should become a bject to the VAawfol-corrTenaktion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. G
nature of Applicant
CLARATION REG*DINTUONJTnPTfiDN LENDING AGENCY
Ireby affirm under plenalty of perjury t at 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 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 county toe er a deRN' erty for inspection purposes.
nature of PrODertv Owner or Authorized Aaent Print Property Owner's or Authorized Agent's Na f� _2f 2/
AC77ON DATE BY LNZ. r Ilun ur UVWU-UMVI-C mrn uuvrvr
FEDERAL REGULATIOJVSPA17T 0106 TIILE40 AND
PERMITEXPIRED AQ111401RIQLEI40!
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PERMIT CANCELLED :.13 •EPA • . • • ,'
PERMfTEXTENDED ' ❑ * AQMD
❑ ASBESTOS M07IRCATIONIS NOT APPLICABLE TO
PERMIT FINAL
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CERTIFICATEOF �� ••� •�•
OCCUPANCYISSUED SIGbA!URF• i •• •• -