HomeMy WebLinkAboutE2003-1940 - Permits•Expbe Date:07/o1/2004
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City of Newport Beach
Building Department ELECTRIAL Permit No: E2003-1940
PO Box 1768 Newport Beach, California 92658-8915
Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR Bldg: 1 Floor:
Inspector Area: 7
Owner:
Address:
Code Edit: 2001
HOAG HOSPITAL
1 HOAG DR
NEWPORT BEACH CA 9
Phone:
Issued Date:
Processed By:
New Construction
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
Suite:
Legal Description:
Contractor:
Address:
Phone:
Cori State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
BRIGGS ELECTRIC INC
16662 MILLIKAN AVE
IRVINE CA
949-863-9901
297836
08/31 /2005
BT01013033
12/31/2003
Receptacle/Switch/Outlets
Receptacles/OWets: 0
Fixtures. 0
Sep Circuits: 0
Signs
Branch Circuit:
Each Add Circuit:
Time Clocks:
0
0
0
TOTAL: $103.75
$0.00
$0.00
$0.00
Soo
$0.00
$0.00
Description of Work: ELEC/(2) TRANSFORMERS/(3) SUB
2926-2003
FEES
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA: 0
1 to 10 HP/KW/KVA:
10 to 50 HP/KW/KVA:
50 to 100 HP/KW/KVA:
Over 100 HP/KW/KVA:
2
0
0
0
Inspector Notes:
//�l/s_7 4bC ZD
$0.00
$20.00
$0.00
$0.00
$0.00
Piggy Back/Temp Power: 0 $0.00
Temp Power Pole: 0 $0.00
PAYMENT:
$0.00 BALANCE:
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
$103.75
0 $0.00
3 $45.00
0 $0.00
0 $0.00
$0.50
$16.25
$0.00
$22.00
$0.00
�'• SED CONTRACTORS DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions code,
and my license is in full force and effect.
License No: 297836 Class: Date: Contractor: BRIGGS ELECTRIC INC
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers compensation, as provided for by Section 3700 of the labor code, for the performance of the work for
which this permit is issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the tabor code. for the performance of the work for 441jthi$perrr4t is 'wed.
My workers' corr@ensation insurance carrier and policy nunoer is:
Carrier: AMERICAN GUARANTEED Policy number:930512601
(This section need not be completed if the perrrlt is for one hundred dollars MOO) or less. • • • • •
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in an nn so as la beco su lect to the workers' corrtpensa}tion
laws of California, and a ree that if I should become subject to the workers' corpensation provisiops of Sec' n of the labor c e, all forthwith comply with those provisions.
Da t /2/ O 3 Applicant Signatur
arming: Failor���ggq((((((o secure rkers' compensation coverage is unlawful. and shall subject an employe criminal pen
($100,000), in addition to the cost of compensation,damages as provided for rn Section 3706 of the labor code, intert, yid attorneys ( • • • • • •
••• • • • •••
I hereby acknowledge that I have read this application: that the infomwlion given is correct; and that I am the owner, or duly authorized agent of the owner.•I agree to
comply with city and state laws regulating construction; and in dyilg the work authorized thereby, no person will be employed in violation of th labor code of the state of
California relating to workmen's co, erRatyn insurance.
Permittee Name (Print)/
Signature of perm"'
Address :
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Approvals
Grounding Electrode
Underground
Under Slab/Floor
Rough Conduit Walls
Rough Wiring Ceilings
Rough Sevice
• Temp Power
• Utility Company Notified
Final
Inspector/Date
'1/4_0(161
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR
LAST VALID INSPECTION.