HomeMy WebLinkAboutE2021-0839 - PermitsCity of Newport Beach - Building Division *E2021-0839*
.+. 100 Civic Center Drive, Newport Beach, CA 92660
w .. Permit Counter Phone (949)644-3288
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Electrical Permit: E2021-0839
Project No
Inspection Requests Phone (949)644-3255
Job Address: 2301 CHANNEL RD Bldg: 1 Floor:
Suite:
',-
Description of Work: ELEC A/C DISCONNECT
Inspector Area: 1
Code Edit:2019
Legal Description: N TR 518 BLK E LOT 20
•
° ° ° °,
Owner: STJOHN ROBERT M & SANDRA L
Contractor:
NEXGEN A/C INC
°°°•
Worker's Compensation Insurance ......
° •
Address: 2301 CHANNEL RD
Address:
700 N VALLEY ST STE K
Carrier: OLD REPUBLIC GEN INS CO
NEWPORT BEACH, CA 92661
ANAHIEM CA 92801
° Q°
Policy No: A1CWA0011502
Phone:
Phone:
657-208-1987
Expire : 03/01/2022
°°°°•
Con State Lie:
1011173
Issued Date:12/09/2021
Lie Expire:
0212812022
° ° °
• °
Bus Lie:
BT30055503
° ea
°°••°;
Processed By:
Lie Exp Date:
06/3012022
° ° ° ° ° •
°
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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 1 000A:
0
$0.00
Time Clocks:
0
$0.00
O/H to U/G
0
$0.00
Additional Fee :
$0.00
TOTAL Fee: $67.00
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 Backrremp 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:
Fee Due at Permit Issuance
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.
.00
$0.00
$29.00
$0.00
$0.00
$0.00
$0.00
$0.00
$38.00
$0.00
LDER 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 U 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 eloperty, 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).
• S t"exempt *o m aieensure under the Contractors' State License Law for the following reason:
By my signature Wow 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
s %p structure tha`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
ProfeSSions Codes available upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.html.
Signatere of Property owner or Authorized Agent Date
I:ICrNgED COWMCTOR'S DECLARATION
I.herQW affirm edt6p&alty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000 of Division 3 of the Business and Profe 'node, a e Is I�cens'—n full force
License Class • License No Date '% Contractor Signature
�``)r.y'ORK�RS' gGNI�IVSATION DECLARATION
iYNR 4"FAILURE "SECORE 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 LOMPENSpTION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
�J Hereby affirm 17rfd'eP I7A•nalty 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 the
performance 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
Date
ame of Agent Phone #
I 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 he workers' compensation laws of California, and agre
lat, if I should becomefsubject to the workers' con�pease provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prom ns.
ignature of Applican i\'�/ I Iq NY
ECLARATION REG ST TION LENDING AGENCY
hereby affirm under penadgro pe uquq ry that there is a construction lending agency for the performance of the work for which this permit is issued (Sect n 3097, Civil Code).
ender's Name Lender's Address
y 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 cou ordina s and state laws re ' (Ruction. �I /
I authorize representatives of this city or countenter a above-i property for inspection purposes.
ACTION
DATE
BY
DECLARATION OF COMPLIANCE IMTH CODE OF
y FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART 61 OF TITLE40 AND
AQMDRULE 9403.
PERMITEXPIRED
❑ I SUBA07TEO ASBESTOS NOTIFICATION TO:.
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERP✓RTEXTENDED
❑ ASBESTOS M07IRCA77ON IS NOT APPLICABLE TO
PROPOSED DEMOLITION:
PERMITFINAL
'Z— ,LL
CERTIFIC4TEOF
SIGNATURE:
OCCUPANCYISSUED