HomeMy WebLinkAboutE2003-1808 - PermitsCity of Newport Beach
Building Department ELECTRIAL Permit No: E2003-1808
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:
Suite:
Code Edit: 2001 Legal Description:
HOAG HOSPITAL
1 HOAG DR
NEWPORT BEACH CA 92660
Phone:
Issued Date: 02/25Hi(64
Processed By:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
BRIGGS ELECTRIC
16662 MILLIKAN AVE
IRVINE CA92606
949-863-9901
297836
08/31/2005
BT01013033
12/31/2004
Description of Work: BATTERY BACKUP LIGHTING
2790-2003
Inspector Notes:
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 S0.00
Receptacle/Switch/Outlets
Receptacles/Outlets: 0
Fixtures: 8
Sep Circuits: 0
Signs
Branch Circuit:
Each Add Circuit:
Time Clocks:
0
0
0
TOTAL: $32.50
FEES
Motors/Transformers (HP/KVA)
$0.00 0 to 1 HP/KW/KVA:
$8.0a 1 to 10 HP/KW/KVA:
$0.00 10 to 50 HP/KW/KVA:
50 to 100 HP/KW/KVA:
Over 100 HP/KW/KVA:
$0.00
$0.00
$0.00
Piggy Back/Temp Power:
Temp Power Pole:
PAYMENT:
$o.00
$0.00
$0.00
$0.00
Sam
S0.00
50.00
55.90 BALANCE:
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
$26.60
0
0
0
0
$0,00
$0.00
$0.00
$0.00
$0.50
$2.00
$0.00
$22.00
$0.00
LI�FyN D CONTRACTORS DECLARATION
C(GE h reby 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,
a my license is in full force and effect.
e No: 297836 Class: Date: - 4 Contractor: BRIGGS ELECTRIC
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 conpensabon, as provided for by Section 3700 of the labor code, far the performance of the work for
Q,- which this pemm issued.
have and will maintainin workers' compensation insurance, as required by Section 3700 of the labor code, for the performance of the wank for which this permit is issued.
My workers' compensation insurance carrier and policy number is:
Carrier: AMERICAN GUAR Policy number:930512601 • anise Date: 03(01/2004
(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 tataYe•ra/ss compensation
laws of ifomia, and agree that if I should become subject to the workers' compensation provisions of Sectio 700 of the labor code, 1 shall Oita co*•npI? thlhgs ravisians.
Da : 2 .._ 2 S O c{ Applicant Signature!
W ing: Failure to secure workers' corrpensatian coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars
($100,000), in addition to the cost of compensabon,damages as provided for in Section 3706 of the labor code, interest, and allorney sfes• •• • •• • • • •• • • • `• t
•••. • • • • • •
• • • • • • • • • • • • •
I hereby acknowledge that I have read this application: that the information given is correct; and that I am the comer, or duly a•tho•'zed agent of Irk owner. I agrest• • • • •
comply with city and stale laws regulating construction: and in doing the work authorized thereby, no person will be employed in ilatat%of lbTa jatuor •t of thE Site dt • • • • • • • •
California relating to workmen' compensation insurance. i
Permittee Name (Prim/,B/✓ C'c / /C •ru.J Address :
A • ••• •• ••r t••
Signature of permittee: /FC/� „- tg • •• • = •
(J • • • • • • • • •
• • • • •
••••••••• •• •
Aoorovals
Grounding Electrode
Underground
Under Slab/Floor
Rough Conduit Walls
Rough Wiring Ceilings
Rough Sevice
Temp Power
Utility Company Notified /
Final
Inspector/Date
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR
LAST VALID INSPECTION.