HomeMy WebLinkAboutE2022-0759 - Permitse ��WPo�r City of Newport Beach
Community Development Department- Building Division
100 Civic Center Drive, Newport Beach, CA 92660
s Permit Counter Phone: (949) 644-3288
m Inspection Requests Phone: (949) 644-3255
cq<rFoaN'P newportbeachca.gov/inspections
Electrical Permit
Plan Check No:
Work Class: Other
Issued Date :
Inspection Area : 1
E2022-0759
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 125 G ST Legal: Desc : N TR 518 BLK A LOT 3
Description: ELEC -DISCONNECT FOR A/C INSTALLATION
Owner: HARLOW RICHARD A JR TR
Contractor : CONTEMPORARY AIR CONTROL INC
Address : 1918 SANTA ANA AVE COSTA MESA, CA 92627
Address : ' 1599 SUPERIOR AVE B1 COSTA MESA, CA 92627
Phone :
Phone :. ,: (949) 877-0411
Con State Lie : 575613
Applicant: CONTEMPORARY AIR CONTROL INC
Lie Expire : 10131/2024
Address : 1599 SUPERIOR AVE B1 COSTA MESA, CA 92627
Bus Lie BT30036259 '.
Phone: (949) 877-0411
Bus Lie Expire:07/31/2023
Workers' Compensation Insurance
Owner/Builder:
Carrier:SIRIUS AMERICA INS CO
Address :
'. Policy No: WC75866
Phone:
W. C. Expire: '6/1/2023
Code Edition : 2019
Fire Hazard Zone : NO
Type of Construction :
- Occupancy Groups : R3/U r
Building Setbacks : Front: 10, Side: 3, Side: 3, Rear: 10
Flood Zone : X
Use Zone: R-1 - Single -Unit Residential
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PROCESSED BY:
SPECIAL CONDITIONS:
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t hereby affirm under penalty ofperury that am exempt from the Contractors"State License
action 7031.5, Business and Professions Code: Any city or county that requires a permit to ca
indicated below
demolish: or rel
I; as owner of theproperty;: or my employees with wages as their solo: compensation, will do all of or U portions of the work,
sinessand Professions Code; The Contractors' State License Law does not apply to an owner of property who; through employe
Imvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completiivl, t
)roved for the purpose of sale).
1, as owner of the property,. am exclusively contracting with licensed Contractors to.. construct the project (,Section 7044, BUS nes
)ly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursu
I am exempt from licensure under the Contractors' State License Law for the following reason: I
my sinnature below t.. acknowledge that, except for my personal residence in which I must have resided foratleast one year b`ariol
I have built as. an owner-builde
is available upon request when
of Property Owner or
I hereby under penalty of perjury that I am licensed under provisions of Chapter
and effect. License Class License No
WORKERS' GOMPENSAT€ON DECLARATION
IL
civil
and the structure is not intended or offered sale (Section 7044,
es' or personal effort,. builds or Improves the property, provided that the
ha Owner -Builder will have the burden of proving that it was built or
s and Professions Code: The Contractors' State License Law does not.
ant to the Contractors' State License Law)
tIALFINES UP
my license is in full force
TO THE II
ireby affirm under penalty of penury one of the following daclarations:
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 IN
ormance of the work forwhich this permit is issued. Policy No.
have and vnll 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' :compensatbo
ranee carrier and policy number are:
/ Policy Number._ Expiration Date
me of Agent / / Phone ft
I certify that, In the performa ice of t orkfior which this permit is Issued, I shall not employ any person in any manner so a� to becomesublectfo the workers'.compensation laws of California, and agre.
t, if I should become. subject to the r rs` compensation prrn`isions of Section 3700of the Labor Code, I shall forthwith corpply with those provisions. !i
nature of Applicant. nS D ^ L Ay `���_ll
CLARATION REGAR 0 RIiC'N0 DING AGENCt elt/_i€G_
areby affirm under penalty of perjury that theta is a construction tending agencytor the performance of the work for which this permit,is. issued (Section. 3097, Civil; Code),
idea's Name... _ — Lender's Address
my signature below, I certify to each of thefollowing:
I am the property owner or authorized to act on the pro owner's behalf.
I have read this application and the information I have toy is correct
I agree to comply with all applicable city and county car in c and state Caws relating to building construction,
I authorize rearesentatives of this city or ceuntyRd en r bo e-identified property for inspection purposes.
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C€RTiFICATEOF
OCCUPANCY ISSUED
DATE I BY
NOTIFICATION IS NOT APPLICABLE TO
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