HomeMy WebLinkAboutE2021-0080 - Permits9City of Newport Beach - Building Division 11111111111111pllllp111111111lpllp111Jill 11 i� Electrical Permit: E2021-0080
+3 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 2 1 0 0 8 0 Project No: 1899-2020
r~ Permit Counter Phone (949)644-3288
r"du��* Inspection Requests Phone (949)644-3255
Job Address: 317 APOLENA AVE Bldg: 1 Floor: Suite:
Description of Work: ELEC/TEMP.POWER POLE
Inspector Area: 2
Legal Description: BALBOA ISLAND SEC 3 BILK 16 LOT 28
Owner: APOLENA WATERPOINTE LLC
Contractor:
Address: PO BOX 34B
Address:
NEWPORT BEACH CA 92662
Phone: 949-706-1984
Phone:
Con State Lie:
Issued Date:02/03/2021
Lie Expire:
Bus Lip:
Processed By:
Lie 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 Fee:
WATERPOINTE CUSTOM HOME
3500 E COAST HWY #110
CORONA DEL MAR CA 92625
949-644-8900
947494
05/3112022
BT30036114
06/31/2021
Receptacle/Switch/Outie
Receptacles/Outlets:
0
$0.00
Fixtures:
0
$0.00
Sep Circuits:
0
Low Voltage
0
Signs
$0.00
Branch Circuit:
0
$0.00
Each Add Circuit:
0
$0.00
Time Clocks:
0
$0.00
Additional Fee:
Code Edit: 2019
cc
0
Worker's Compensation Insurance
Carrier: STATE COMP INS
P y
Policy No: 1952335
V
Expire: 0510112021
z
is
FEES
a
Motors/Transformers (HP/KVA)
$0.00
0 to 1 HP/KW/KVA:
0
$0.00
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
$0.00
10 to 50 HP/KW/KVA:
0
$0.00
$0.00
50 to 100 HP/KW/KVA:
0
$0.00
Over 100 HP/KW/KVA:
0
$0.00
$0.00
$0.00
Piggy Backfremp Power:
0
$0.00
$0.00
Temp Power Pole:
1
$41.00
$0.00
Temp Underground:
0 $0.00
Sub Panel:
0 $0.00
0 $0.00
0 $0.00
Record Mgmt Fee:
$0.00
Plan Check Fee:
$0.00
Investigation Fee:
$0.00
Issuance Fee:
$37.00
Supplemental Fee:
$0.00
Fee Due at Permit Issuance:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Monday - Friday 7:00 a.m.•to ft:3Q p.m. and Saturday from 8:00 a.m. to 6:00 p.m
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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
is 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
'rofessions 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
of more than five hundred dollars ($500).
1, 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,
lusiness 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
nprovements 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
nproved 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
pply 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).
7 I am exempt from licensure under the Contractors' State License Law for the following reason:
ly 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, 1 cannot legall,
ell 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
'rofessions Code, is available upon request when this application is submitted or at the following Web site:hftp://www.leginfo.ca.gov/calaw.htmi.
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that 1 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
nd effect.
.icense Class License No Date Contractor Signature
VORKERS' COMPENSATION DECLARATION
IARNING: 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 I$100,0001, IN ADDITION TO THE
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.
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'
rance carrier and policy number are:
Policy Number
of Agent
Date
certify that, in the performance of the work for which 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
, if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
lignatum of Applicant Date
IECLARATION REGARDING CONSTRUCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (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 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 state laws relating to building construction.
I authorize representatives of this city or county to enter the above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agents Name _
ACDON
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFRCE USE ONLY
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