HomeMy WebLinkAboutE2021-0829 - Permits(§)-
City of h 9each - Build.ing Division
100 Civic Centel Jnve, Newport Beach, CA92660
Permit Counter Phone (949)644-3288
Job Address: 500 CAGNEY LN Bldg: 1 Floor: 3 Suite: PH-4
Description of Work: ELEC EV CHARGER
Inspector Area: 2
Legal Description: TR 10587 LOT 1 UNIT 16 OF PROJECT LOCATED
TOGETHER°"
'E2021-0829* Electrical Permit : E2021-0829
Project No :
1�) Inspection Requests Phone (949)644-3255
y
Code Edit: 2019
appllcapkD �oQ% refURd
�o�0 of
op�Owner: LOPEZ ABE o 4;��HUNTI
-HO ICES INC $ Worker's C won I surance
Address: 500 CAGNEY LN PH4 A 63 HAMILT ner : NORGUARD
OD
NEWPORT B A 92663 5 A 9264k0 vpliAOm Policy No: AHWC2133
Phone: h me: 94 4 -44 3 Expire : 03/0712022
®ate' im
St c: A
Issued Date:12/07/2021 xp. 1 2 •,
Bus T3 073576
Processed By: ate: 11/30120
FEES �� r
New Construction cep ch/ utlets MotoaPIK
rm� d
Residential ept es/Outlets: 1 $1.75 0 to 1K 0Tem dergro nd: 0 $0.00Multi-Family: 0 $ 00 ures: 0 $0.0 1to1/KV�Q iJrK $0.00 S 0 $0.00
1-2 Family: 0 $ 0 Sep Circuits: 1 10 to 50 HP/KW/ 0 $0.00 0 $0.00
4AIld
to a �r(1 0� 50 to 100 HP/KW/KVA: 0 $0 0 $0.00
Service ' ` .t\ Over 100 HP/KW/KVA: $0.00 ,��Sax. rd $0.00
0-600V up to 20OA: 0 $0.0 I uit: Sta�te4.00 �nSp• eck Fee: $0.00
0-600V over 200A 0 $0.00Ad� 0 $0.00 Pi emp Power: $0.0 Investigation Fee: $0.00
Over 600V or 1000A: 0 $0.00 Cloaks: 0 $0.00 emp Power Po 0 .00 Issuance Fee: $38.00
O/H to U/G 0 $0.00 ditional Fee : 0 Supplemental Fee: $0.00
rI, Al E__ . xec >c . �,.40. n cha .. _ 90.00 Fee Due at Permit Issuance : $46.75
ITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicate
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolis
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law
Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section
not more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the t
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, thr 2th�
improvements are not intended or offered for sale. If, however, the building or improvement is sold within o completi(
improved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Confractor5T construct the proi�ct n 7044, Bue
apply to an owner of property who builds or improves thereon, and who contracts for the projegtF �yit �l�d ontra�c�to{r' yput
I am exempt from licensure under he Contract rs.69tatt; �lcense Law for the following rea n r
By my signature below I acknow edge - - for my personal residence —in �wleh I must have rg�I d%�I®I one year
sell a structure that I have by I1�`," w9Rrlilder if it has not bee rutted in its entirety I. y I �1�Cd contractors. I under:
Professions Code. isyalableUo o6ebt yfhe0 this on is submitted of. altta,illifollowing Web site:http://www.leginfo._q
he Eby al
Ind effect.
that I
K'JRKER CU'fo ATION CL , IONS"" a
ARNING FAIL .<61U5E E WORKERS' SATION COVERAGE IS UNLAWRUL; ' SR
CS- OF COMP L SATI C I DAMAGES .S PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE
hnraby affirrovjnder�pe' natty of perjury one &IWIlowing declarations
I have and ill maint tP a rbhcae of consent to self -insure for workers'
E rfcnnance of, e e� or whi` thls permit is issued.>..oltsy No.
11
have and Wit mal In work rs' compensation Insurance, as required by 5
s Drsdce carrier IT 'c 'are:
garner Policy Npmj2r
me of Agent
I certify that, in th perfoperfo . o0 wd� icwd� is
t, if I should beco a su j�t t 'I ... pe
mature of Applican
CLARATION REG DI NSTR N LEN[
=reby affirm under p nalty of perjury that there is a c
tder's Name
my signature below, ce tQQ��' ch o owing
1 am the property o e dti�iorized to act on the
have read this apple tion and the infor
I agree to comply with 11 a e cIt
I authorize represent at as o or cou `
with Section 7000) of
AN UPLOYER TO CRIMINAL PENALTIES
D RNEY'S FEES.
compensation, issued by the Director
Clio
nf SIe 1�1 rl -IfW't e
is issued, I shall not employ any person in any
lions of Section 3700 of the Labor Code—jsNaY
agency for the
correct.
laws relating to building construction.
property for inspection purposes.
Print Property Owner's or
below by the checkmark(s) I have placed next to the applicable item(s)
or repair any structure, prior to its issuance, also requiro the applicant for
hapter 9 (commencing with Section 7000) of Division 3 of the Business and
31.5 by any applicant for a permit subjects the applicant to a civil penalty of
&-andtTie tructure is not intended or offered for sale (Section 7044,
!ees' or pe ona1 effort, builds or improves the property, provided that the
the Owner wilder will have the burden of proving that it was not built or
:ss and P of sions Code: The Contractors' State License Law does not
afttao rectors' State License Law).
for to completit of the improvements covered by this permit, I cannot legalh
not that�y V the applicable law, Section 7044 of the Business and
Rv/Maw.htmL
Date
on 3 of the Busin s an^d/Proffe on Code, and/Jy license is in full force
Contractor Signet re 'X
D CIVIL FINES UP TO O HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
for by Section 3700 of the Labor Code, for
for wl5ch this permit is issued. My workers'
compensation laws of California, and
permit is issued (Section 3097, Civil Code).
Date
ACTION
DATE
BY
DECLARATION OF COMPLIANCE IMTHC
DE OF
OROFFICEUSEONLY
FEDERAL REGULATIONS PART 51 OF TIt
AQMD RULE 1403.
E40AND
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION
❑ EPA
AQMD
TO:
PERMFTCANCELLED
PERMIT EXTENDED❑
❑ ASBESTOS NOTIFICATION IS NOT AI
PROPOSED DEMOLITION.
PLICABLE TO
PERMIT FINAL
CERTIFICATEOF
SIGNATURE:.
OCCUPAhlCNSSUED