HomeMy WebLinkAboutE2021-0267 - Permitsw City of Newport Beach - Building Division
�y.:. 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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11ull111111111111111111111111111111111�fl11111Jil 11Pject No:Electrical Permit: E2021-0267
Inspection Requests Phone (949)644-3255
Job Address: 2200 VISTA DORADO Bldg: 1 Floor: Suite:
Description of Work: ELEC/DISCONNECT TO A/C
It `iiIL
Inspector Area: 4 Code Edit: 2019
Legal Description: TR 5741 (L.L.84-214029) PAR 19
Owner: CARD RYAN & JACKIE Contractor:
Address: 2209,/tSTA DORADO Address:
N PORT EACH CA 92660
Phone:
Issued
Processed
New Construction
Residential
Multi -Family:
0
$0.00
1-2 Family:
0
$0.00
Service
0-600V up to 20OA:
0
$0.00
0-600V over20OA:
0
$0.00
Over600V or100oA:
0
$0.00
O/H to U/G
0
$0.00
TOTAL
Phone:
Con State Lic:
Lic Expire:
Sus Lic:
Lic Exp Date:
AIRWEST A/C & HEATING INC
1886 SO SANTA CRUZ ST
ANAHEIM CA 92805
714-978-7877
733715
03/31/2023
BT30072921
09/30/2021
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
Fixtures:
0
$0.00
Sep Circuits:
1
$7.00
Low Voltage
0
$0.00
Signs
Branch Circuit:
0
$0.00
Each Add Circuit:
0
$0.00
Time Clocks:
0
$0.00
Additional Fee:
$0.00
I
Worker's Compensation Insurance
Carrier: BENCHMARK
Policy No: CST5020526
Expire: 11/14/2021
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: 0 $0.00
Plan Check Fee:
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m.
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Issuance:
0
0
0
0
30" WIDE X 36" DEPTH
REQUIRED FOR
A/C DISCONNECTS
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$37.00
$0.00
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(%)
(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 licensure and the basis for the alleged exemption. Any violation of Section 7031.6 by any applicant for a permit subjects the applicant to a civil penally 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 L) all of or U 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).
❑ 1 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 prior to completion of the improvements covered by this permit, I cannot legally
sell a structure t1lat.1.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 Cdcle,'L%JVailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
tiggnature of Propggy Owner or Authorized Agent Date
L3CERISED CONIMCTOR'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 Profes ions C d , nd my license is in full force
hnd 8(j4ct. License Class 3L]- Date License No ,/ '2/- 2/ Contractor Signature „
( 013 FRS' CWPNSATION DECLARATION
98RXW: FAILURF+pq SWIRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$100,0001, IN ADDITION TO THE
ST OFCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNETS FEES.
Vel;t`ry affirm under penalty of perjury one of the following declarations: -
�...
hage and yJlll pial"ntain 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 IN
0 orlpance of thekworK for which this permit is issued. Policy No.
• "
J1.njlg and wilCmeinlain 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' compensalior
nsurance carrier and policy number are:
ier i�%/�k/GH�7 p,7 Policy Number �.S % , G>2� ---5Z1, Expiration Date
lame of Agent rnuue 0
11 certify that, in the performance o e orq
hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
iat, if I should become subject t th work rpensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
signature of Applicant — Date
)ECLARATION REGA ING C STRUCTM LENDING AG
hereby affirm under p Silly of perjury that there is a construction lending agency for the performance of the work for which this permit is issue Section 3097, Civil Code).
ender's Name Lender's Address
ly my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners 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 state laws relating to building construction.
I authorize representatives of this city or county to e5Kthe above identified property for inspection purposes.
signature of Property Owner or Authorized Age t Print Property Owner's ulhorized A enl's Na D e
AC77ON
DATE
BY
DECLARATION OF COMPLIANCE WIT .CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULA TIONS PART 67 OF TITLE40 AND
AQMDRULE1403.
PERMITEXPIRED
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❑ ISUBMRFEDASBESTOSN017FICAFIOMTO:.
❑ EPA
❑ AQMO
ASBESTOS NOTIRCATION IS NOT APPLICABLE TO
PROPOSED. DEMOLITION.
PERMITCANCELLED
PERMITEX7ENDE0
-
01
PERMITFINAL- _
( ry /y
CERTIFICATEOF -
._
-
SIGNATURE:
OCCUPANCYISSUED