HomeMy WebLinkAboutE2008-0580 - PermitsJoh Address: 1
City of Newport Beach
Building Department ELECTRICAL Permit No: E2008-0580
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
HOAG DR Bldg: 1 Floor:
Inspector Area: 7 Code Edit: 2007
OF LOT
Owner:
Address:
Phone:
Suite
Contractor:
Address:
Phone:
Con State Lic:
Issued Date: 11/ 2008 // Lic Expire:
Bus Lic:
Processed By: Lic Exp Date:
HOAG MEMORIAL HOSPITAL
500 SUPERIOR AVE #300
NEW PORT BEACH CA 92663
949-764-4486
Description of Work: ELECT/ INSTL UPS SYSTEM
2213-2008
Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
Q pe COA St,e JS -E
ELECTRICAL FINAL
3—L-I-09 -flerk,-114XN
DATA SPECIALTIES INC
8400 KASS DRIVE
BUENA PARK CA 90621
714-523-8489
622395
06/3Dl200�i�\
Inspector/Date
1
\- s-act -
New Construction V
Residential
Multi -Family: 0 $0.00
1-2 Family: 0 $0.00
Service
0-600V up to 200A: 0 $0.00
0-600V over 200A: 0 $0.00
Over 600V or 1000A: 0 $0.00
O/H to U/G 0 $0.00
TOTAL Fee: $308.85
D CONTRACTORS DECLARATION:
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing With Section 7000) of Dvision 3 of the Business and Professions code,
and my license is in full force and effect.
License No: 622395 Class: - Date: Contractor: DATA SPECIALTIES INC
Receptacle/Switch/Outlets
Receptacles/Outlets: 0
Fixtures: 0
Sep Circuits: 0
Low Voltage 0
Signs
Branch Circuit: 0
Each Add Circuit: 0
Time Clocks: 0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEES
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA:
1 to 10 HP/KW/KVA:
10 to 50 HP/KW/KVA:
50 to 100 HP/KW/KVA
Over 100 HP/KW/KVA:
a Soso
a woo
0 50.00
0 $0.00
2 $179.00
Piggy Back/Temp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Plan Check Fee : $0.00
Temp Underground:
Sub Panel:
0
0
0
0
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
Fee Due at Permit Issuance : $308.85
$0.00
$0.00
$0.00
$0.00
$53.00
$44.75
$0.00
$32.10
$0.00
WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the labor code. for the performance of the work for
ich this permit is issued.
eve and will maintain workers' compensation insurance, as required by Section 3700 of the labor code, for the perfomrance of the work for which this permt is issued.
My markers' compensation insurance carrier and policy number is:
eviler: INSURANCE CO OF THE WEST Policy number:WSD216018103 Expire Date: 09/01/2009
(This section need not be completed if the permit is for one hundred dollars ($100) or less.
I 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
of California, aqd agree teat if I should become subject to the workers' cprtffetsation provisions of Section 3700 of the labor code. I shall forthwith comply with those provisions.
as Ua _AppliLgt•51g {a tore: Q . 6r
Warning: Failure to secure workers' compensation coverage is unlawful. and shall su666666iect an employer to ainina! penalties and civil fines up to one hundred thousand dollars
($100,000), in addition to the cost of compensatian,danages as provided for in SeciNg706 pf the labor lode, �ttr`st, and attorneys fees.
••• ••• • • • • •
• •
I hereby acknowledge that I have read this application; that the inmmytiop given is merest; itelha`I aroo the owner, or duly authorized agent of the owner. I agree to
comply with city and state laws regulating construction; and in doing the *Lark attho ze: thereby, no peh8# col? employed in violation of the tabor code of the state of
California relating to workmen's compensation insurance. • • • : • • • •
PermitteeN e(Print) f21 e. MAXSc -I Address: all Ou L4$$ bit �j(AfNA
` - Q--_ - • •• ••• •• LAST VALID INSPECTION.
Signature 'lee: vim' -• • • • • • • • . D - 1) 7-6)O3 ei dLY t
• • ••
• • •• •
••• •.• '•• • • ••• ••
Ft) 2 . c h PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR