HomeMy WebLinkAboutE2007-0580 - PermitsCity of Newport Beach
Building Department ELECTRICAL Permit No: E2007-0580
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 1
Description of Work: ELEC/CONDUIT ONLY & PULL BOXES
FOR FUTURE LOW VOLT CABLE
Inspector Area: 7 Code Edit: 2004 Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
OF
Owner: HOAG MEMORIAL HOSPITAL Contractor: BRIGGS ELECTRIC INC S4�C1PyE ECTRICAL FINAL
Address: 301 N NEWPORT BLVD Address: 16662 MILLIKAN AVE Q 0�
ORANGE
IRVINE CA
Issued Date: 06129/ 007 CA 92869 CoLio State
Lic: 2909 3836 Phone: 0 Phone: 0700 92606 $
U�3^�vl t� Nil
o /� Bus Lic: BT01013033 ri"
Processed By: l�1 /_t y Lic Exp Date: 12/31/2007
HOAG DR Bldg: 1 Floor: Suite:
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
Receptacle/Switch/Outlets
Receptacles/Outlets: 0
Fixtures: 0
Sep Circuits: 0
Low Voltage 10
Signs
Branch Circuit: 0
Each Add Circuit: 0
Time Clocks: 0
TOTAL: $41.00
FEES
Motors/Transformers (HP/KVA)
$0.00 0 to 1 HP/KW/KVA:
$0.00 1 to 10 HP/KW/KVA:
$0.00 10 to 50 HP/KW/KVA:
$12.00 50 to 100 HP/KW/KVA:
Over 100 HP/KW/KVA:
$0.00
$o-00
$d.00
Piggy Back/temp Power:
Temp Power Pole:
PAYMENT: $0.00
Inspector/Date a-\01 .-O%
Located baWei Ch: 14 obLe i -t Bldg
4-&vr '. •
Con -tact: Graz* 7RI- 1412- (ate
$0.00
$0.00
$0.00
$0.00
$o.00
Soso
$0.00
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
BALANCE: $41.00
0 $0.00
0 $0.00
0 $0.00
0 $0.00
$0.50
$3.00
$0.00
$25.50
$0.00
D CONTRACTORS DECLARATION:
eby 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,
my license is in full force and effect. II n n
No: 297836 Class: - Date: AG/ M b7 Contractor: BRIGGS ELECTRIC INC
WORKERS' COMPENSATION DECLARATION: 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, as provided for by Section 3700 of the labor code, for the performance of the work for
44) ich this permit is Issued.
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.
y workers' compensation insurance carrier and policy number Is:
U.S.FIDELITY Policy number:D123W00125 Expire Date: 07/01/2007
(This section need not be completed if the pemtll is for one hundred dollars ($100) or Tess.
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in anyRner so as to bec�I- subject to the workers' compensation
laws of California, and agree that if I should become subject to the workers' compensation provisions of Sect00 of the labor •/, 'shall forthwith comply with those provisions.
Date: / 9167 • • • • •• Appllcapt Signature:
Warning: F ilure to secure workers•corspel=sain cove'? is unlaMul, ane shall sebjecl an employe b criminal per- ie .nd dvil r(>Es up 10 one hundred thousand dollars
($100,000), in addition to the cost of co•pe••ation/amagea asrproyideQ fojtn Sec&oy 3706 of the labor code, int f t, and attorneys fees.
• • •1 • • • • • • •
I hereby acknowledge that I have reaff This a1,yllcation; that the inlbrmalion Gillian istArtct; and that I am the owner, or duly authorized agent of the owner. I agree to
comply with ety and state laws regulating construction; and in doing the work authorized thereby, no person will be employed in violation of the labor code of the state of
California relating to workmen's ,corrpengaepn insurance.
Permittee Name (Print) i
Signature of permittee:
• 1
•
•
•
• Address:
•
•
••
Date: / c/e /O 7
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR
LAST VALID INSPECTION.
J 2— 2c 0r C