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HomeMy WebLinkAboutE2020-0417 - Permitsvt City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 NO cs "�rFEYrtk�`- Job Address: 206 43RD ST Bldg: 1 Floor: 1 Suite: B Description of Work: ELEC/OVERHEAD TO UNDERGROUND 11IIIIIIIIIIIIIIIIIIIIIIIIIIIDII111111111111111 Proeotic l Permit: E2020-0417 Inspector Area: 1 ®/ V SA Tlj� A Legal Description: P M 175-49 PAR 1 UNIT 1 OF PROJECT LOCATED ON AP 423-296-12 A ®`� YCe TOGETHER Owner: MIDDLETON ANDREWrrERRA Contractor: Address: 206 43RD ST #2 Address: NEWPORT BEACH, CA 92663 Phone: Phone: Con State Lic: Issued Date:0811312O2O Lic Expire: Bus Lic: Processed By:dyw�_�Lic Exp Date: CONTORELLI CONSTRUCTION INC 30832 MARILYN DR LAGUNA BEACH CA 92651 949-290-4630 319552 08/31/2020 BT30065552 01131 /2021 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 Over600V or1000A: 0 $0.00 Time Clocks: 0 $0.00 O/H to U/G 1 $46.00 Additional Fee: $0.00 Inspection Requests Phone (949)644-3255 No/SE Code Edit: 2019 , 1�' •(fie ire . Workers Compensation Insurance V ) Carrier: STATE FUND Policy No: 9154910 z Expire : 0311512021 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 Plan Check Piggy Back/Temp Power: 0 $0.00 Temp Power Pole: 0 $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 aer0. to 6:30 pm. alrfcl Saturday from 8:00 a.m. to 6:00 p.m. •• a s ! a•e • •® a e o •xa ec e � o e o 0 o pe • • • • • a e e c iWNER-BUILDER DECLARATION 1.1 — 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 to 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 Iicensure 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 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). J I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section " pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Cont I am exempt from Iicensure under the Contractors' State License Law for the following reason: y my signature below I acknowledge that, except for my personal residence in which I must have resided for at least ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractor. rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www 'ignature of Property Owner or Authorized Agent .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penal of perjury that I am licensed under provisions h p er ommencing with Section 7 nd effect. icense Class License No Date VORKERS' COM NSATION DECLARATION 'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T cRIMINAL DST 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 Direc Perf ante of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for i Isurance carrier ad&Dolicv number—qm is of Agent ,r!71s4WL IN — certify that, in the performance of the if I should become su lect to t o (alum of Applicant I not employ any person in any 3700 of the Labor Code, I shall areby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for Ider's Name Lender's Address my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behalf. f have read this application and the information I have provided is corr, . I agree to comply with all applicable city and count ordinances and St a laws relating to building construction. I authorize representatives of this city or count r�to]e"the�oye4 }fjed property for inspection purposes. of Property Owner or Authorized Business and Professions Code: The Contractors' State License Law does not pursuant to the Contractors' State License Law). e year prior to completion of the improvements covered by this permit, I cannot understand that a copy of the applicable law, Section 7044 of the Business and Date in 3 of the Business and Profe ns bd lic e s " f II force Contractor Signatu ! AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO of Industrial Relations as provided for by Section 3700 of the Labor Code, for performance of the work for which this permit is issued. My workers' Date Phone # so as to become subject to the WCivilode). aws of California, and agre i comply with those pro isions. D e 1 this permit is issued (Section ACTION DATE BY DECLARATION OF COMPLIANCEMRTN CODEOF FOR OFFICE USE ONLY FEDERAL REGULA7fO17SPART 61 OF T17LE40AND AQdQR?AC 1403e ..• ❑� ©t1Plf'ff TEtIASBETTOS VT1�F1G*;lON TO. : : d c 190 RrLr�iq,%eW %CC PERMITEXPIRED PERMITCANC€LLED%• ❑ AQMD • •:• PERMITEXTENDED ❑ ASBESTOS NO77RCATIONIS NOT APPLICABLE TO PROVOSEDDEMOLITION. • •.• • • � • e • • ••• °a• PERMrT.FINAL CERTIFICATE OF OCCUPANCYISSUED SIG*•'• : : •e °° ooe