HomeMy WebLinkAboutE2021-0696 - Permits. City of Newport Beach - Building Division 11lill 111111111111111111111111111111111111 Im 1111 Jill
100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 2 1 0 6 9 6
n, Permit Counter Phone (949)644-3288
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Job Address: 210 29TH ST Bldg: 1 Floor: Suite:
Description of Work: ELEC -OVERHEAD TO UNDERGROUND & NEW 200 SERVICE (2 SUBPANELS)
Inspector Area: 1
Legal Description: LAKE TR BLK 128 LOT 6
Owner: CARLSON KENNETH E Contractor:
Address: 1750 WHITTIER AVE #79 Address:
COSTA MESA, CA
Phone: Phone:
Con State Lic:
Issued Date:10/13/2021 Lic Expire:
Bus Lic:
Processed By: Lic Exp Date:
CONTORELLI CONSTRUCTION INC
17686 METZLER LANE
HUNTINGTON BEACH CA 92647
949-290-4630-�
319552
08/31/2022_r'-"
BT30065552 `
01/31/2022
Electrical Permit: E2021-0696
Project No :
Inspection Requests Phone (949)644-3255
Code Edit: 2019
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9164910
Expire : 03/15/2022
FEES
New Construction
Receptacle/Switch/Outlets
Motors/Transformers (HP/KVA)
Residential
Receptacles/Outlets:
0
$0.00
0 to 1 HP/KW/KVA:
0
$0.00
Temp Underground:
0
$0.00
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
0
$0.00
1-2 Family:
0
$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
Service
Signs
Over 100 HP/KW/KVA:
0
$0.00
Record Mgmt Fee:
$0.00
0-600V up to 20OA:
1
$47.00
Branch Circuit:
0
$0.00
Plan Check Fee:
$0.00
0-600V over 20OA:
0
$0.00
Each Add Circuit:
0
$0.00
Piggy Back/Temp Power:
0
$0.00
Investigation Fee:
$0.00
Over 600V or 1000A:
0
$0.00
Time Clocks:
0
$0.00
Temp Power Pole:
0
$0.00
Issuance Fee:
$38.00
O/H to U/G
1
$47.00
Additional Fee :
$0.00
Supplemental Fee:
$0.00
TOTAL
Fee:
$132.00
Plan Check
Fee : $0.00
Fee Due at Permit Issuance:
$132.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Mo lday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m.
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)WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) 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
ie 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).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Usiness 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).
7 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).
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, I cannot lega11,
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:http://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 I am licensed under provisions of Chapter 9 (commencing with Section 7000) �QiySion 3 of the Business and Prof ssi n ode, and my license is in full force
nd effect. ._���/JJjj
icense Class License No Date Contractor Signature /
1IORKERS' COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
ra
affirm under penalty of perjury one of the following declarations:
e 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
nce of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
Policy Number
Date
Name of Agent Phone #
I certify that, in the perfo ce of the ork 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 agre
that, if I should become su eme ct to thWC!2'.compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant Date V CIVI I 1
DECLARATION REG NG C CTION LENDING AGENCY �I-
I 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).
Lender's 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 ha eded�s correct.
1 agree to comply with all applicable city and cou y 1 Lances'and state laws relating to building construction.
I authorize representatives of this city or count o nter the si entified property for inspection purposes. A c �`eq6a-�41ClSignature of Property Owner or Authorized Agenj Print Property Owner's or Authorized Agent's Nam
ACTION
DATE
BY
DECLARATION OF COMPLIANCE MTH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART 61 OF THLEQN-AND
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