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Home My WebLink AboutE2019-0761 - Permits➢tea City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 'F Permit Counter Phone (949)644-3288 c. Job Address: 4500 ROXBURY RD Bldg: 1 Floor: Suite: Description of Work: ELEC - TEMP POWER POLE (X2019-3642) Inspector Area: Legal Description: N TR 3357 LOT 11 Owner: ROWSHAN KASRA Contractor: Address: 4500 ROXBURY RD Address: CORONA DEL MAR, CA 92625 Phone: Phone: Con State Lic: Issued Date:11/13/2019 Lic Expire: Bus Lic: Processed By: Lic Exp Date: New Construction Residential Multi -Family: 1-2 Family: Service 0-600V up to 20OA: 0 0-600V over20OA: 0 Over600V or1000A: 0 O/H to U/G 0 TOTAL IIIIIIIIIIIIIIIIII1illillillillillillgliililiiii II GABAY DAVID JOHN JR 31726 RANCHO VIEJO RD SAN JUAN CAP CA 92675 949-370-0478 529750 06/30/2020 BT30033857 12/3112019 Electrical Permit: E2019-0761 Project No: 2687-2018 Inspection Requests Phone (949)644-3255 Code Edit: 2016 Worker's Compensation Insurance Carrier: CALIFORNIA INSURANCE Policy No: 468264410 Expire : 04/01/2020 FEES Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) vgsy Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0 $0.0 Temp Underground: 0 $0.00 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 Sub Panel: 0 $0.00 $0.00 Sep Circuits: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 0 $0.00 Low Voltage 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 0 $0.00 Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00 $0.00 Branch Circuit: 0 $0.00 Plan Check Fee: $0.00 $0.00 Each Add Circuit: 0 $0.00 Piggy Back/Temp Power: 0 $0.00 Investigation Fee: $0.00 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 1 $39.00 Issuance Fee: $35.00 $0.00 Additional Fee: $0.00 Supplemental Fee: $0.00 Plan Check Fee: Fee Due at Permit Issuance : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction flours: Monday - Friday 7.00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. oa ° o° o 0 oo• ooe o0 0 • __ a °o • o 0o c ° e •oo °Oo o 0 �o ° 'NER-BUILDER DECLARATION 1 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) ction 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 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 'essions 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 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, iness 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 rovements 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 roved 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 ly 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). LJ 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 prior 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 f the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm]. 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 Busines d- Code, and m cerise is in full force and effect. License Class License No Date Contractor Signat WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: - 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 thJ parmance of the work for which this permit is issued. Policy No. ve 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 insur nce carrier and policy number are: rier Policy Number Expiration Date Name of Agent I Phone # I certify that, in the performance of the work for which th 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 that, if I should become subject to workers' compensati n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /12 Signature of Applicant Date Lt DECLARATION REGREWG'VONTIOWEND GENCY t hereby affirm under penalty of erjury that there is a constru ion lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lenders 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 owners behalf. I have read this application and the information I have ract. I agree to comply with all applicable city and cou ordinanc and state laws r ating to building construction. I authorize representatives of this city or coun t a er the bove-identifi ._... IG Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam C P�°t l� lj Date t l ACTION DATE BY DECtAiWION OF COMPLIANCE 141TN CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE 40AND AOMO Rt W 1403. PERMITEXPIRED ❑ • I:§UBeI TED ASBESTOS N07IFICATION TO. • • s'SQMD PERWHTC4NCELLEDiEFTI ••• • PERivI1TEXTENDED • : :❑ A BESTOS NO7IRCARONIS NOT APPLICABLE TO PROPOSED DEMOLITION, SLGMkr UR[E. PERMITFINAL CERTiFfCATE OF OCCCIPANCYISSUED c b o 0 0 o `cc °oo