HomeMy WebLinkAboutE2018-0274 - PermitsCity of Newport Beach - Building Division II1111111111111111111111Jill 111�1111111111111111111Electrical Permit: E2018-0274
100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 8 0 2 7 4 III Project No
Permit Counter Phone (949)644-3288
Job Address: 409 CABRILLO TER Bldg: 1 Floor:
Suite:
Description of Work: ELEC A/C DISCONNECT
Inspector Area: 5
Legal Description: N TR 1237 LOT 70
Owner: O'DONNELL MACKEY JAMES
Contractor:
Address: 409 CABRILLO TER
Address:
CORONA DEL MAR, CA 92625
Phone:
Phone:
Con State Lic:
Issued Date:04/23/2018
Lic Expire:
Bus Lic:
Processed By: l� „Lic
Exp Date:
KEMNITZ A/C & HEATING INC
188 TECHNOLOGY SUITE C
IRVINE CA 92618
949-453-8500
695874
09/30/2018
BT30010593
07/31/2018
New Construction
Receptacle/Switch/Outlets
Residential
Receptacles/Outlets:
0
$0.00
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
1-2 Family:
0
$0.00
Sep Circuits:
0
$0.00
Low Voltage
0
$0.00
Service
Signs
0-600V up to 20OA:
0
$0.00
Branch Circuit:
0
$0.00
0-600V over 20OA:
0
$0.00
Each Add Circuit:
0
$0.00
Over 600V or 1000A:
0
$0.00
Time Clocks:
0
$0.00
O/H to U/G
0
$0.00
Additional Fee :
$0.00
TOTAL Fee:
Inspection Requests Phone (949)644-3255
Code Edit: 2016
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Worker's Compensation Insurance
Carrier: NORGUARD INS
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Policy No: KEWC888452
Expire :0210112019
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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 Backfremp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Temp Underground:
0 $0.00
Sub Panel:
1 $25.00
0 $0.00
0 $0.00
Record Mgmt Fee:
$0.00
Plan Check Fee:
$0.00
Investigation Fee:
$0.00
Issuance Fee:
$33.00
Supplemental Fee:
$0.00
Fee Due at Permit Issuance :
PERMITS EMPIRE 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.
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 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 (_) 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' orlpersonal 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).
❑ 1, 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 ffdrfi ligensure under the Contractors' State License Law for the following reason:
B,y my signature Mm? 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 legal)
saa.structure th®t ).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, j43vailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
!�iggatdrg of Prope(y Owner or Authorized Agent Date
L•ICE#ISED CONTRACTOR'S DECLARATION
I herebya affirm undePpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing wi Section 7000) of Division 3 of the Business d Profe;,5j s Code and my license is_in full force
and ei fect.
Ljgepgg Classy _ ' _ License No Dat �S Contractor Signat e
WQRKERS' Ct9MME SATION DECLARATION
VffWWQ:.FAILURE TeSECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMP YER TO CRIMINAL PENALTIES AND CIVIL FINES UP T ONE H ORED THOUSA O'OOLLARS ($700,0001, IN ADDITION TO THE
00" OF OOMPENSAVION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
Irereby affirm under penalty of perjury one of the following declarations:
....
b 4 and WRI.M2iptain 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 th
performance of the walk for which this permit is issued. Policy No.
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' compensatio
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
I certify that, in the perf9ftnance of the worKiopwfth this permit is issued, I shall not employ any person in any manner so as to become subject to to workers' compensation laws of California, and agre
that, if I should become bj%nCompe sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisi s.
Sig nature of Applicant Da tears
DECLARATION RE RDIN O STR LENDING AGENCY
I hereby affirm unde penalty perjuryt here is a construction lending agency for the performance of the work for which this permit is issu d (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 property owner's behalf.
I have read this application and the information I ave provided is correct.
I agree to comply with all applicable city and c my ordinances and state laws relating to building construction.
I authorize representatives of this city or coun to eQ)e a -I - tified Toparty for inspection purposes.
Signature of Property Owner or Authorized A en Print Property Owner's or Authorized Agent's Na a ���//� to
ACT1f7N #IA7€ S DECLARATION OF COMPitANCEW#TNCODEOF FOR OFFICE USE
O tY
FEDERAL REGULATlONSPARI' fit' OFT#TLE40AND
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❑ fSUBMITTED ASBESTOS JJU7#FfCA7fflNTO.
❑ EPA
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PERMlTt7CFlRED
PERMITLANC€LLED
PERMIT€XTEfVDED
❑ ASBESTOS NO7IFlCA77ON1S NOT APPUCAS7..E TO
PROPOSEDDEMDUTJDN.
SIGNATURE:
FFRMfiE1NAt
CERTIFICATE OF
LtLLUPANLYlSSUED
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