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Home My WebLink AboutE2020-0218 - PermitsCity of Newport Beach - Building Division o „A 100 Civic Center Drive, Newport Beach, CA 92660 -e n; Permit Counter Phone (949)644-3288 e' .dtaynp�~ Job Address: 609 JASMINE AVE Bldg: 1 Floor: Suite: Description of Work: ELECITEMP POWER POLE X2019-3450 Inspector Area: 5 Legal Description: CORONA DEL MAR BILK 636 LOT 9 Owner: MILLER LINDA Contractor: Address: 609 JASMINE AVE Address: CDR MAR CA 92625 PhonrsedBy:: Phone: Con State Lic: Issue4/2020 Lic Expire: Bus Lic: Proce Lic Exp Date: New Construction Residential Multi -Family: 0 $0.00 1-2 Family: 0 $0.00 Service 0-600V up to 20OA: 0 $0.00 0-600V over20OA: 0 $0.00 Over600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 TOTAL Fee: $49.00 IlPiiiiiiii1iii II BURKHART BROTHERS CONSTR 12 BALBOA COVES NEWPORT BEACH CA 92663 949-375-6725 905510 10/31/2021 BT30026859 03/31/2021 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 Fixtures: 0 $0.00 Sep Circuits: 0 $0.00 Low Voltage 0 $0.00 Signs Branch Circuit: 0 $0.00 Each Add Circuit: 0 $0.00 Time Clocks: 0 $0.00 Additional Fee: $0.00 Plan Electrical Permit: E2020-0218 Project No : 2538-2019 Inspection Requests Phone (949)644-3255 Code Edit: 2016 I P 1 n aaoo a . Worker's Compensation Insurance aoo• Carrier: SECURITY NATIONAL INS..:. ° Policy No: SWC1275103 a ; ° , •a Expire : 02/01/2021 a • ° ° ° ° o o eo o aaa e o o•° o as:a ooaao o a ooco• o eases � oa aae•a• Dose• 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 Back/Temp Power: 0 $0.00 Temp Power Pole: 1 $39.00 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: $0.00 Supplemental Fee: $10.00 Due at Permit Issuance : PERMITS EXPIRE 130 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 9:00 a.m. to 6:00 p.m. OWNER -BUILDER DECLARATION I hereby affirm under penalty -of perjurythatl. am exempt from the Contractors' State License Law for the. reason(s) indicated below by the. checkmark(s) I have placed next io the applicable item(s) (Section 7031.5, Business and Professions Code: Any city or county:that requires a permit to construct, alter, improve,demolish, on 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 (Chapter9 (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 ($500). ❑ 1, as owner of the property, or my employees with Wages as their sole compensation, will do U all of or U. portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property;provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below 1 acknowledge that, except for my personalresidence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legall: sell a structure thabltlete built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code: "mwtlable upon request when this application is submitted or at the following Web site:httpa/www.leginfo.ca.goWcalaw.html. SiQn jtlt� pf ProppU pwner or Authorized Agent Date LISENSED CONTMTOR'S DECLARATION I hereby effirm under.penalty o edury that I am licensed under provisions of Cha ter 9 (commencing with Section - 0 � ivisign 3 of the Business and Pr sgions. de' ap(i my licen �in full force an4 e$gG'* License Class License No �� pSsPe� Date d Contractor Signature `� r)�_ NORKBRS' COMPEN6ATION DECLARATION NARNINGt J:MLURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSA41C(Q,pAMAGES AS PROVIDED FOR IN SECTION 37os OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. •...• hereby affirm underp0nolty of perjury one of the following declarations: ,,, J J13YE 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 thI jeWany2 of the&orjc'far which this permit is issued. Policy No. reend 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' compensatior ner �cN v rt.t- Policy Number --)� W k— I L -1 a t V -5 ExpiretiorrLD�ate �- i t 1-4 neofAgent 16it oL7UrYI'; Phone#800-3oal-T-iII certify that, in the performan a work Ichthis p it 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 if I should become subject t th work com nsati p Islons of Section'3700 of the Labor Code, I shall forthwith comply with those provisions. r Iature of Applicant jK — - Datev "f 12 t- -e & JLARATION REGA5DING9WKSTRUQP0NTENDINb AGENCY �reby affirm under penalty of perjury that there is a construction lending agency for the performance of the work forwhich this permit is issued (Section 3097, Civil Code). Ider's Name Lender's Address my signature below, 1 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 vided is c I agree to comply with all applicable city and county o "Inc d state wsArelio building construction. I authorize representatives of this city or co o e e eb -:den' ed pr inspectionpurposes. nature of PTOperty OWrler of AUthDrized AOePrintPmnerty rlwner'e nr AuthnrioaA.AnonYc Nhmc� �lli S. i IGh /w ACTION I DATE I BY PERMITEXPIRED DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERM17EXTENDED - ❑AQMD PERMITFINAL ASBESTOS NOTIFICATION iS NOT APPLICABLE TO CERTIFICATE OF -fi'w Imo''`' PROPOSED DEMOLITION OCCUPANCYISSUED OVA' SIGNATURE: O FOR OFFICE USE ONLY