HomeMy WebLinkAboutE2006-0911 - PermitsCity of Newport Beach
Building Department ELECTRICAL Permit No: E2006-0911
PO Box 1768 Newport Beach, California 92658-8915
Job Address: 1 HOAG DR Bldg: 1 Floor:
Inspector Area: 7 Code Edit: 2004
OF LOT
Owner HOAG MEMORIAL HOSPITAL
Address: 1 HOAG DR
NEWPORT BEACH CA 926
Phone: 949/764-4488
Issued Date: 05/02/2006
Processed By:
Suite:
Legal Desaiption: IRVINE
Contractor:
Addr93:
Phon-.r
Con .:
LicE .
Bus Lic:
Lic Exp Dat
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
Over600V or 1000A: 0 $0.00
ED CONTRACTORS DECLARATION
y affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commenong with Section 7000) of Dlwsiixl 3 of the Business and Professions code.
nd my license is in full force and effect.
No: 297836 Class: - Date: 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 sell -insure fix workers' compensation, as provided for by Section 3700 of the labor code, for the performance of the work for
which this penmit is Issued.
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 compensation insurance carrier and policy number is:
Carrier: U.S.FIDELITY Policy number:0123W001006 Expire Date: 07/01/2006
(This section need not be completed If the pemit 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' compensatls4
laws of California, and agree that if I should become subject to the workers' mnpensation provisions of Section 3700 of the labor code. I shall forthwith comply with those provision
Date: 'F sebu l �6 Applicant Signature: C - •
Waming ailure to re ers' compensation coverage is unlawful, and shall subject an employer to cirri nal penalties and civil fines up to one haidrad CwunanddolOrs.'
BRIGGS ELE
16662 MILLIKAN A
IRVINE CA 92606
949/863-9901
297836
' 08/31/2007
BT01013033
12131/2006
Permit Counter Telephone (949)644-3288
Receptacle/Switch/Outle
Receptacles/Outlets: 0
Fixtures: 0
Sep Circuits: 0
Low Voltage 4
Signs N
Branch Circuit:
Each Add Circuit:
Time Clocks:
TOTAL: $34.50
Inspection Requests/Telephone (949)644-325)
yW
F
rk: ELEC/LOW VOLTAGE FOR TELECOMMUNICATIONS a4.
FEES
Motors/Transformers (HP/KVA)
to 1 HP/KW/KVA:
10 HP/KW/KVA:
HP/KW/KVA:
PMW/KVA:
MVA:
MENT:
K 1 172 POR
$0.00
$0.00
Woo
f0.00
$0.00
$0.00
i0.00
BALANCE:
a•
a
••
•
••
•
••
••. •
($100,000), in addition to the cast of conpensation,daages as provided for in Section 3706 of the labor code, interest, and attorneys fees. • • e • • • +
m+
• e
I hereby acknowledge that I have read this application; that the information given is coned; and that I am the owner, or duly authorized agent of the owner I agree to • •• • • • • •
•
con y with city and state laws regulating construction; and in doing the work authorized thereby, no person wit be employed in violation of the labor code of the stale of
California relating to workmen's compensation insurance.V�
Permittee Name (Print) / t />Cwi. - �)__ 1 ' �esst' Address :
•
Signature of pennittee: GiT% ate: S/'1- .t�
•
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••
.• •a•••
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p Underground:
anel:
Record
Plan Check F
Investigation Fee:
Issuance Fee:
Supplemental Fee:
534.50
Approvals
Grounding Electrode
Underground
Under Slab/Floor
Rough Conduit Walls
Rough Wiring Ceilings
Rough Sevres
Temp Poweretild.�
Final 4a 9pany NotiOed�
Final •c �5•0 6 .n 5;44
••
•W/
0
0
0
0
Inspector/Date
$0.00
$0.00
$0.00
$0.00
$3.00
$1.20
$0.00
$25.50
$0.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR
LAST VALID INSPECTION.