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Home My WebLink AboutE2021-0518 - Permits(9) City of Newport Beach - Building Division 111�111 11111111111111111111111111111111111111111111 11� 11Electrical Permit: E2021-0518 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 2 1 0 5 1 6 Project No Permit Counter Phone (949)644-3288 Job Address: 351 HOSPITAL RD Bldg: 1 Floor: 6 Suite: 610 Description of Work: COMM ELEC OUTLETS (4) Inspector Area: 7 Legal Description: IRVINE SUB LOT 169 ELK 2 POR OF LOT Owner: NEWPORT LIDO MEDICAL Contractor: Address: 351 HOSPITAL RD #307 Address: NEWPORT BEACH, CA 92663 Phone: 949-645-0500 Phone: Con State Lic: Issued Date:09/01/2021 , f Lic Expire: Bus Lic: Processed By: \ Lic 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 over20OA: 0 $0.00 Over600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 TOTAL Fee : $51.09 AMPED ELECTRIC 123 S CORNELL AVENUE FULLERTON CA92831 7141204-0728 911942 01/31/2022 BT30063022 04/30/2022 Rece ptac I e/Switch/Outlets Receptacles/Outlets: 4 $7.00 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 Inspection Requests Phone (949)644-3255 CC Code Edit: 2019 O Worker's Compensation Insur ■ , . Carrier: MID CENTURY Policy No: B09485131 Expire : 0412512022 (n 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 Piggy Back/Temp Power: 0 $0.00 Temp Power Pole: 0 $0.00 z Temp Underground: 0 Sub Panel: 0 0 0 Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: Fee Due at Permit Issuance : 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. OWNER -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 item(s) ;Sect'iun 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 :he 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 professions 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 rot 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 work, and the structure is not intended or offered for sale (Section 7044, Business 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 improvements 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 improved for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CO.NTPACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force Ind iseffect. icense Class License No Date -I � ri v! Contractor Signature Vvt Ivy WORKERS' COMPENSATION DECLARATION V'ARN:V7: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSA ❑ON, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. l,he,ebv affirm under penalty of perjury one of the following declarations: n 5nve and !v'11 n_ iitain 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 th Reffa.mrance of the work for which this permit is issued. Policy No. and will, 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' compensatio ikyUT2nc- carrier and pclicy number are: Policy Number aTE Cf Agent ' Date certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre t, if I should become subject to the work rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisiooryc /� �1'I q' nature of Applicant / :K/ I Date ( -` [x v` CLARATION REGARDING CONSTRUCTION LE DING AGENCY areby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). 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. rye,• -(�, y� I authorize representatives of this city or county tc��t�� tft� abeq�_i fi d property for inspection purposes. ��S' W� I Il Q % o • \ Date / •`� I� nature of Property Owner or Authorized Agent // /�/I Print Property Owner's or Autha7izq<Agent's Name ACTION DATE BY OF COMPLIANCE WITH CODE DELO FOR OFFICE USE ONLY FEDLATIONS PART 6I OF TITLE 40A AQ3. PERMIT EJIPIRED ❑D ASBESTOS NOTIFICATION TO: N0T7RCAi(ONIS NOTAPPLICABLE O P MOLITION.CERTIFICATEOFOCCUPANCYfSSUEOSIGN PERMITCANCELLED PERMITEXTENDED PERMIT FINAL •�'L� C