HomeMy WebLinkAboutE2022-0221 - Permitsr,.wrok� City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949�644-3288
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Job Address: 330 LA JOLLA DR Bldg: 1 Floor:
Description of Work: ELEC-BBQ
Inspector Area: 3
Legal Description: N TR 444 OT
Owner: PATRICK ED
Address: 330 LA JOLLA DR
NEWPORT BEACH CA
Phone: 949-375-2755
Issued Date:05/05/2022
Processed Bv:
Suite:
111�111 11111111111111111111111111111111111111111111 111� 11Electrical Permit : E2022-0221
E 2 0 2 2 0 2 2 1 Project No : 1186-2022
Date. 1 I /11//r Z
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- Phone: 949-233-0927
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ate Li §7 2` t 'ireT 9}l7/ / 2 W, m
Inspection Requests Phone (949)644-3255
If appiicabl@�de Edit: 2019
❑ 80% or ❑ 100% refund
Worker's Compensation In
to Whom: __Qw4e. �.
Policy No: (NO EMPLC
New Construction
Wdl;1W t *3vAtctf4AAl@Wa I •
MotWOFM'anstormers (HP/KVA;
Residential
Re epta es/ utl
$3.50
0 to 1 HP/KW(no:work sta
Multi -Family:
0
0.0 .
Fi NV 1 spar c�
$0.00
1 to 10 HP/KW/KVA: 0
1-2 Family:
0
0.00
Sep Circuits: 0
$0.00
10 to 50 HP/KW/KVA: 0
Note:
Low Voltage 0
$0.00
50 to
Service
Over 100 HP/KW/KVA:
0-600V up to 200A:
0
.00
Branch Circuit: 0
$0.00
Insp.
0-600Vover 200A:
0
Pi Back/T
Over 600V or 1 000A:
0
$
emp ower Pole: 0
O/H to U/G
0
$0.00
Additional Fee :
$0.00
TOTAL
Fee
: $41.50
Plan Check Fee : $41.50
nce;
Expire
R
r`
$0.00
$0.00 Issuance Fee:
Supplemental Fee:
Fee Due at Permit Issuance:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Monday - Fridav 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
$38.00
$0.00
NER-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) I.have placed next to the applicable items)
:tion 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
'essions 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
more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
iness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Own burden of proving at it.was not built or
roved for the purpose of sale). 'F
I, as owner of the property, am exclusive[ ontracting with licensed ntr ctor o c struct the project (Section 7044, Business and ssioqq��s (Code: The Contractors' State: icen$e Law does not
ly to an owner of property who builds or im roves thereon, and who c�n[�1t_f0her�cts with a licensed Contractor pursuan''�o� Prof�lt�06e§tate License Law). {'
LJ I am exempt from Iicensure under the Con
By my signature below I acknowledge that, ex
actot;r011 -
pt for my personal resid nce in which I must have resided for at least one year priorltG-Icq�r II r t e Ed eD� ed y
is permit, I cannot legal[YI�
Business
sell a structure that I have built as an owner-b
Ider if it has not been constructed in its entirety by licensed contractors I understand�tfTet`�L`opy o{{the applicable law, Section 7044
f the and
Professions Code, is available upon request w
n th fldh is submitted or at the following Web site-. http//www.laglnfo-ca.gov/calaw.html.
Signature of Property Owner or Authorized Ag
t _.. 4`s Date
LICENSED CONTRACTOR'S DECLARA
hereby affirm under penalty of perjury that I a
ION
lice -antler provlslonh'a}J'ter 9'o mencing withSection7000) of Division 3 of the Business and P scions , a
/ Iicerr/ae is in full force
and effect.
License Class
icenssee No _ .—:-.... Date :' "`.*�'� ':> .� %.� Contractor Signatur
+t.
4
WORKERS' COMPENSATION DEC LA
10 -
AND SHALL SUBJECT AN EMPLOIER TO CRIMINAL. PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (
0o,U0�i IN ADDITION TO THE
NARNING: FAILURE TO SECURE WORKERS' COMPENSA
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR
N C R EIS UNLAWFUL,
SEC 06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
lthe:',y,Cirabor
hereby affirm under penalty of perjury one of t
folio arations.
:.
❑ I have and will maintain a certificate of c
sent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for Section 3700
Code, for the
performance of the work for which this permit is
P P
❑I have and will maintain workers' compensa
irsni rance carrier and policy number are:
\ I
sued. Policy No.
Y [ 1_ ar IPnSI'iS i3
.byu9 Ion oT�bor Code, fo the rto a c Lg!' r h '{"` I sued. M
n inn".2-31
_ ��$$
/_. :d
wp ers' compensation
n
':t
yf
ofAget VVUII\ aLalLc. J Phone#rtify that, in the perfor anc of or f ich this permit is issued, I shall not employ any person in any manner so as to become subject to the
I should become su Iact t e we rs' atiArt provisions of Section 3700 of the Labor Code I shall forthwltl+ S.
nature of Applicant
CLARATION REGARDI G C TRUCTIO ENDING AGENCY
Ireby affirm under penalt f perjury that they 1 ency or a performance of the wor
Ider's Name
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner' half.
I have read this application and the information provid s corr ct.
I agree to comply with all applicable city and cVoe
as an tale ws relating to building construction.
I authorize representatives of this city or counte a e-id led property for inspection purposes.
nature of Property Owner or Authorized Agen_ Print Property Owner's or Authorized Agent's Name
and
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDFR IL kEGULATrONS PART 690+= TITLE 40 AND
AQh ZULE:403,
PERMIT EXPIRED
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Zv
❑ : S7B.AITTEDP.SPESTOS NOTIFICATIC'N TO:
[J EPA
❑ AQMD
PERMiTCANCELLEO
PERMIT EXTENDED
❑ ASBESTOS NO771FICAPON IS NOT APPLICABLE TO
PROPOSED DFMOUTiON..
PERMIT FINAL
CER7 F9CA TF O F
SIGNATURE:
OCCUPANCYISSUED