HomeMy WebLinkAboutE2011-0093 - PermitsCity of Newport Beach Building Department
ELECTRICAL Permit No: E2011-0093
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: i 3.6)
Description of Work: ELECTRICAL/(47) LIGHT FIXTURES @ TOP OF SOUTH PARKING STRUCTURE #38
0246-2011
Inspector Area: 7
Legal Description:
OF LOT
Owner:
Address:
Phone:
IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
HOAG HOSPITAL FD&C
500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
949-764-4486
Issued Date:02/14/2011.
0•^_ `
Processed By:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
LIGHTING TECHNOLOGY SER. INC.
2801 CATHERINE WAY
SANTA ANA CA 92705
949-428-5040
675901
08/31/2011
BT30010138
06/30/2011
Code Edit: 2010
Worker's Compensation Insurance
Carrier : COMPANINO PROPERTY
Policy No: CPCA11985
Expire : 11/02/2011
New Construction
Residential
Multi -Family: 0 $0.00
1-2 Family: 0 $0.00
Service
0-600V up to 200A:
0-600V over 200A:
Over600V or 1000A:
0/H to U/G
0
0
0
0
$0.00
$0.00
$0.00
$0.00
TOTAL Fee : $109.58
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
Fixtures: 47 $55.30
Sep Circuits: 0 $0.00
Low Voltage 0 $0.00
Signs
Branch Circuit: 0 $0.00
Each Add Circuit: 0 $0.00
Time Clocks: 0 $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 $0.00
50 to 100 HP/KW/KVA: 0 $0.00
Over 100 HP/KW/KVA: 0 $0.00
Piggy Back/Temp Power: 0 $0.00
Temp Power Pole: 9 $0.00
Plan Check Fee : $13.83
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
0 $0.00
0 $0.00
0 $0.00
0 $0.00
$7.35
$13.83
$0.00
$33.10
$0.00
Fee Due at Permit Issuance : $95.75
• ••• •
• • •
• • •
• • • •
• • • • •
•
•
• • ••• •••
• • •
•••
• • POMIt1 EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
• • •
• • • •
• • • •.• •
•
• • • •
••
• • • •
•• ••• •• • •• •
• • • ••
• • •
• • •
•• • •
• • •
••• ••
1Z-i f v$
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
Coder Any city or county that requires a permit to construct, atter, 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 licensure 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 O all of or ( ) 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).
U 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 licensure 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
pnor 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:httpl/www.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 Professions Code, and my license is in full force and effe,
Licens CI s License No.
Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANLLARS ($100,000), IN ADDITION TO THE. COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 9706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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, issued by the Director of
IndUssttnal Relations as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
ed.
y No,
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the
rmance of the work for which this permit is issued. My workers' compensation insurance carder and policy number are:
Policy Number Expiration Date
Phone #
Carrier
Name of Agent
❑ I certify that, in the
so as to become subje
workers' compensation
Signature of Applicant
erformance of the work
to the worker-' com
'ay. ions of 'on 3
ermit is issued I shall notemploy any person in any manner
California, and agree that if I should become subject to the
Code, I shall forthwith comply with those provision Date
DECLARATION REGARD! YI% ONSTFUCTIONLENDING AGENCY
I hereby affirmunder pen. f perjury that there is a constructionlending agency for the performance of the work for
is
sued this permit is (Sect - 3097, Civil Code).
Lender's Name
Lenders Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and st to laws r
I authorize representatives of this city or county to enter he above -id tti ; d
Signature of Property Owner or Authorized Agent
Print Property Owner's or Authorized Agent's Name:.
ting to building construction.
rty for inspection purposes.
Dat
ACTION
PERMIT EXPIRED
PERMIT CANCELLED
DATE:
BY:
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
••• •
•
•
••
•
•
•
•
•
FOR OFFICE USE ONLY
• •••• •ID •
• • • • •
• • • • • • •
•
• • • • •. • • •
• • •• • • • •
• • • •
• • • • • • •
OOOOO • •
• • • • •
•• • • • •
• • • • •
••• • • •• •• •
•
•
TYP_01/01/2009