HomeMy WebLinkAboutE2011-0226 - PermitsCity of Newport Beach
Building Division
ELECTRICAL Permit No: E2011-0226
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: Suite:
Description of Work: INSTALL UNDERGROUND CONDUIT 2" - 4" PIPE APPROX 300 LF
0770-2011
Inspector Area: 7
Legal Description:
OF LOT •
Owner:
Address:
IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
HOAG MEMORIAL HOSPITAL
1 HOAG DR
NEWPORT BEACH, CA 92663
Phone:
Issued Date:04/25/2011
Processed By:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
SIMICH JOHN CONSTRUCTION INC
1400 S HARBOR BLVD
SAN PEDRO CA 90731
310-519-8203
410855
03/31/2012
BT30024974
09/30/2011
Code Edit: 2010
Worker's Compensation Insurance
Carrier : STATE COMP INS FUND
Policy No: 044-0028699
Expire : 03/10/2012
New Construction
Residential
Multi -Family: 0 $0.00
1-2 Family: 0 $0.00
Service
0-600V up to 200A:
0-600V over 200A:
over 600V or 1000A:
0/H to U/G
0 $0.00
0 $0.00
0 $0.00
0 $0.00
TOTAL Fee : $259.30
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
Fixtures: 0 $0.00
Sep Circuits: 0 $0.00
Low Voltage 1 $1.55
Signs
Branch Circuit:
Each Add Circuit:
Time Clocks:
0
0
0
$0.00
$0.00
$0.00
FEES
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA: 0 $0.00
1 to 10 HP/KW/KVA: 0 $0.00
10 to 50 HP/KW/KVA: 0
50 to 100 HP/KW/KVA: 0
Over 100 HP/KW/KVA: 0
Piggy Back/Temp Power: 0
Temp Power Pole: 0
Plan Check Fee : $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
Fee Due at Permit Issuance :
0 $0.00
0 $0.00
0 $0.00
0 $0.00
$34.65
$0.00
$0.00
$33.10
$0.00
$259.30
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PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
12- 2.111,C
OWNER -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
the 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
Professions Code) or that he or she is exempt from Iicensure 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 penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business 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
improvements 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
improved 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
apply 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).
❑ I am exempt from Iicensure under the Contractors' State License Law for the following reason:
By 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
sell 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://wwv.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent _ Date
LICENSED CONTRACTOR'S DECLARATION
I 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
and effect.
License Class License No Date /' ' " t Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
ode, and m Se is in full
G
s.
■
rf
($100,000), IN ADDITION TO THE
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 the
ance of the work for which this permit is issued. Policy No.
ave 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
urance carrier and policy number are:
arrier Po cy Number
Name of Agent
❑I certify that, in the performance
that, if I should become subject
Signature of Applicant
e
he • f
J' ich this permit i- ' ued, I shall
mpensation •rvr':ns Sf Secti
DECLARATION REGAR. NO C• ' TRUCT •N LENDIN e ' NCY
Expiration Date
Phone #
employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
700 of the Labor Code, I shall forthwith comply with those provisions.
Date,'" 1�—.74,5 ',,e
I hereby affirm under penalty • •erjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the prope 1 • ner - beh
I have read this application and the information I have
I agree to comply with all applicable city and county
I authorize representatives of this city or county to
Signature of Property Owner or Authorized Agent
wit• • construction.
ection purposes. �i
Print Property Owner's or Authorized Agent's Name Il/�. �Bafi 5War
ACTION
DATE
/ BY
t tCLARAJJON OF aalIPIJANCE IWTN CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE AND
AQMD RULE1403.
p I SUBMITTED ASBES TOS NOTIFICATION TO:
■ EPA
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PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
■ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERMIT FINAL
(� -'� - j)
CERTIFICATE OF
OCCUPANCY ISSUED
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