HomeMy WebLinkAboutE2021-0149 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 1940 TERESITA LN Bldg: 1 Floor: Suite:
Description of Work: ELELC TEMP POWER POLE (X2019-3625)
Inspector Area: 3
Legal Description: N TR 1806 LOT 49
Owner:
CONN ROBERT & PT
Contractor:
Address:
1940 TERESITA LN
Address:
NEWPORT BEACH, CA 92660
Phone:
Phone:
Con State Lie:
Issued Date
2/23/2021
Lie Expire:
Bus Lie:
Processed
Lie 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 over 20OA:
0
$0.00
Over600V or1000A:
0
$0.00
O/H to U/G
0
$0.00
TOTAL Fee:
*E2021-0149*
SHEAR CONSTRUCTION
31 BLAKEMORE DR
LADERA RANCH CA 92694
714-615-6108
760853
07/31/2022
BT30049686
01/31/2022
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
Electrical Permit: E2021-0149
Project No: 2488-2019
Inspection Requests Phone (949)644-3255
Code Edit: 209 INS(z P r i.,
°
Worker's Compensation Insurance °°°'
Carrier: OHIO SECURITY
Policy No: XWS61231341°' • °
Expire : 04/11/2021
9 p .
FEES
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA:
0
$0.00
Temp Underground:
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:.
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
Record Mgmt Fee:
Plan Check Fee:
Piggy BackfTemp Power:
0
$0.00
Investigation Fee:
Temp Power Pole:
1
$41.00
Issuance Fee:
Supplemental Fee:
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.
0
$0.00
0
$0.00
0
$0.00
0
$0.00
$0.00
$0.00
$0.00
$37.00
$0.00
INER-BUILDER 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) 1 have placed next to the applicable item(s)
ction 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
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
cessions 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
more than five hundred dollars ($500). j
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portion:
siness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throe
)rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of c
)roved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 71
Ay to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contu
I am exempt from licensure under the Contractors' State License Law for the following reason:
my signature below I acknowledge that, except for my personal residence in which I must have resided for at least c
I a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors.
)fessions CA%,'is available upon request when this application is submitted or at the following Web site:hftp://w .1
mature of PrOpS Owner or Authorized Agent
:EASED CONP41ACTOR'S DECLARATION
sret?y affirm wWer penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with_Section 70C
Class License No
ERS' MOPIENSATION DECLARATION
z
: FAILUI7- TO SECURE WORKERS' COMPENSATION COVERAGE Is UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
COMPENSATON, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
f9 ff
' affirm under penalty of perjury one of the following declarations:
and voll tTWntain a certificate of consent to self -insure for workers' compensation, issued by the
e oNhe wo$ for which this permit is issued. Policy No.
VM and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for
aRce carrier Vid figlicy number are:
er Policy Number
e of Agent
;ertify that, in the performs a of the work f hich this permit is issued, I shall not employ any person in any m
if I should,p' c ecome su t rke the wocorn ensation provisions of Section 3700 of the Labor Code, I shall f(
CLARATION REGARDING CONSTRUCITION LENDING AGENCY
)reby affirm under penalty of perjury that there is a construction lending agency for the performance of the work
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 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 tFy"; cit�X o�eunty en r the a%ofeldaNtified property for inspection purposes.
of the work, and the structure is not intended or offered for sale (Section 7044,
Ih employees' or personal effort, builds or improves the property, provided that the
impletion, the Owner -Builder will have the burden of proving that it was not built or
Business and Professions Code: The Contractors' State License Law does not
pursuant to the Contractors' State License Law).
a 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
linfo.ca.gov/calaw.htmi.
Date
of Division 3 of the Busrness andXWssions WAS, and Inv license is in full force
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
so as to become subject tq4he workers' compensation laws of California, and agre
i comply with those provi ons.
r this permit is issued (Section 3097, Civil Code).
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ON
FEDERAL REGULATIONS PART 61 OF T17LE49 AND
AQMD RULE 1403
PERMITEXPIRED
❑ ISUBMITTEDASBESTOS NORFICATION TO:.
❑ EPA
❑ AQMO
PERMITCANCELLED
PERMfTEXTENDEO
[3 ASBESTOS NORFICATION IS NOT APPLICABLE TO
PROPOSEDDEMOLITION.
PERMIT FINAL
CERTIFICATE OF
SIGNATURE:
OCCUPANCYiSSU€D