HomeMy WebLinkAboutE2019-0213 - Permitsjty at
iob civ%"� DVvJ Beach,CA l92660 g Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIII
i Pa�� itcounter Rhdn; `(9g4)644-3288
Job Address: 54V SLAW D M • Bldg.' -Flbbr: Suite:
Description of Work: ELEC TO BBQ
Inspector Area: 5
Legal Description: N TR 1237 LOT 105
Owner: ESTRADA ORLI AND JUAN Contractor:
Address: 549 SEAWARD RD Address:
CORONA DEL MAR, CA 92625
Phone: Phone:
Issued Date:04/11/2019 Con State Lic:
Lic Expire:
Processed By: A
Bus Lic:
Lic Exp Date:
FREE CREATION INC
5478 WILSHIRE BLVD UNIT 214
LOS ANGELES, CA 90036
(323) 879-9060
1003352
06/31/2019
BT3005822
04/30/2019
Electrical Permit: E2019-0213
Project No: 2954-2016
Inspection Requests Phone (949)644-3255
Code Edit: 2016
Worker's Compensation Insurance
Carrier: MIDWEST
Policy No: BNUWC0141655
Expire : 09/14/2019
Mom...
New Construction
Residential
Receptacle/Switch/Outlets
FEES
Motors/Transformers (HP/KVA)
Multi -Family:
0
$0.00
Receptacles/Outlets:
Fixtures:
2
$2.00
0 to 1 HP/KW/KVA:
0
$0.00
1-2 Family:
0
$0.00
Sep Circuits:
0
0
$0.00
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Service
Low Voltage
0
$0.00
10 to 50 HP/KW/KVA:
50 to 100 HP/KW/KVA:
0
0
$0.00
$0.00
0-600V up to 20OA:
0
$0.00
Signs
Branch Circuit:
0
$0.00
Over 100 HP/KW/KVA:
0
$0.00
0-600V over20OA:
Over 600V or t 000A:
0
0
$0.00
$0.00
Each Add Circuit:
Time Clocks:
0
$0.00
Piggy Back/Temp Power:
0
$0.00
O/H to U/G
0
$0.00
Additional Fee:
0
$0.00
$0.00
Temp Power Pole:
0
$0.00
TOTAL Fee:
$37.00
Plan Check Fee: $0.00
Temp Underground:
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
at
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.
0
0
0
0
.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$35.00
$0.00.
JWNER-BUILDER DECLARATION Cs) aver � .
I hereby affirm under penalty of perjury that I am exempt Code: Any city or e item(s)
aomy that requires a perm tte lto construct, cense Law for the
improve, demolish, or repair any structure n,rVloPtO'its issuanoeeaisp Textoto gFQ'gs the aapplicant far
(Section 7031.5, Business and Professions the Contractors' State
the Professions er 9 (coma
permittofile a, signed Code) or that hastatement
that he ois exemptr she is from liusiness and
oensusd and the basis for pursuant to the helallegedfexe exemption. Any violationlof Section 7031.5 tby any applicant orva permit subjeith Section cts th0) ofe applicant to a civision 3 of the ivil I penalty of
not more than five hundred dollars ($500). portions of the work, and the structur4ie not ihtenBed Jr offered or sale (*cl o 7044,
that the
❑I, as owner of the property, or my employees with wages as their sole compensation, will do r o all of or (_)
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal eT t, byiCi�t or i i8en she inifthproD8Tty, p ,
.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 df'ptovingthat it was not built or
improved for the purpose of sale).
d Contractors to construct the project (Section 7044, Business and [3 1, as owner of the to an owner of property party who exclusively
contracting
thereon, h license
who contracts for the projects with a licensed Contractor pursuant to he Contractors' State License ions Code: The Law) Contractors' State License Law does not
uilds or
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By
a structure that I have built le an cthat,
except for
f tmy has not been constructed which its entirety by licensed t have resided contractors. r at least I understand that a copy of thehappl � applicable law, Section 7044s covered by tof the Buslnesshis permit, I nandnot lega
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Date
Signature of Property Owner or Authorized Agent
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 Co n my license is in u force
and effect. �lJc�3"35�— Date y ��. Contractor Signatur
License Class License No
HE
WORKERS' COMPENSATION DECLARATION
WARNICOST NG:
COMPENSATION,ILURETOSECURE AMAGES AS WORKERS' COMPENSATION
FOR IN SECTION AGE IS UNL
THE `LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
PENALTIES AND CIVIL FINES UP TO ONE HUNG HOUSAND OOLLARe ($'IOa,000), IN ADDITION TO T
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 Industrial Relations as provided for by Section 3700 of the Labor Code, for th
erformance of the work for which this permit is issued. Policy No.
I 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' compensa Io
insurance carrier and policy number are: Expiration Date
Policy Number phone #
IS of Agent to
if I certifythat,
should bathe performance
the the work o r which this permit
is
of Section3700shall3not 700 of the Labor Code,loy any person II shall forthwith comply n any manner so as to bwith hose provisions.
onse workers' compensation laws of California, and agree
Dak�)
nature of Applica (/�
::LARATION RE RDING CONSTRUCTION LENDING AGENCY
:reby affirm under penalty of perjury that there is a construction lending agency for Lender's Address
of the work for which this permit is issued (Section 3097, Civil Code).
ess
ider's Name
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 come t.
I agree to comply with all applicable city and county ordinances nt la slatinforoinsllect on purposeding s.
I authorize representatives of this city or count/ to enter the property Print Property Owner's or Authorized Agent's Name Date
ACTION
GATE I_.,� BY
IS . UBJWITED ASBESTOS N071FICATION TD:
j3 EPA
�AQMD
c�cmc nrmrFlrBTfONiS NOT APPLICABLE TO
SIGNATURE:
OCCUPANCMfSSUED