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Home My WebLink AboutE2015-0691 - PermitsgWNpQ o City oo Civic Center Drive, Beach sa�n6 A ding Division EI�III� 0��I 5 06 Permit Counter Phone (949)644-3288 v � � n'�yiu9'�jz Job Address: 4521 BRIGHTON RD Bldg: 1 Floor: Suite: Description of Work: ELEC/REPLACE (E) DISCONNECT Inspector Area: 5 Legal Description: TR 3357 LOT 154 AND Owner: HOFF ROI Address: 15 BLUFF Phone: Issued Date:1'2/1\5010 Processed New Construction Residential Multi -Family: 1-2 Family: Service 0-600V up to 200A: 0 0-600V over 20OA: 0 Over600V or1000A: 0 O/H to U/G 0 Electrical Permit: E2015-0691 Project No: Inspection Requests Phone (949)644-3255 e CeCode �Ed 2013 GREF,Sg"a^`� 1ME SVCS Worker's Comp ns 1 ss: ST to Vd CarEM Policy No: 4 Policy No: 43, . 94 Expire : 07101 2 Insurance SVC GROUP •z�.:v-sao c e. 09/30/20 Bus ic: Lic E p Datewoo ' O �� Allad eptacle/Switch/Outlets ' .�Pfansf f�4P1t( A) A ILIA Receptacles/Outlets' - 'n.00 ®mote, 0 $0.00 1, ' — \an: erground: 0 $0.00 Fixtures: ,,,mayy; 1$0.00 1 to 10 HP/KW/KVA: 1 u 0 $0.00 $0.00 Ser` t�gL. sa6" $0.00 10 to 50 HP/KW/KVA' " 0 $0.00 / ® 0 $0.00 50 to 100 HP VA: ,.UA 0 $0.00 �6) Ov P/KW/KVA:Record Mgmt Fee: $0.00 Bra0 $0.00 n Plan Check Fee: $0.00 b0. 1iAdd Circuit: 0 Pig a _p;P ' ec 0 $0.00 Investigation Fee: $0.00 $0.00 Time Clocks: $0.00 em ole: 0 $0.00 Issuance Fee: $32.00 to no Addition Supplemental Fee: $0.00 TOTAL Fee: $45.Ko `- � / Plan Check Fee: $0.00 Fee Due at Permit Issuance : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 ci g with Section 7000) of Division 3 of the Business and fessions Code) or that he or she is exempt from Iicensure and the basis for the alleged exemption. Any violation of Section 703 ny applicanor 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 ( i s Of the work, and the structure is of intended or offered for sale (Section 7044, siness and Professions Code: The Contractors' State License Law does not apply to an owner of who, through ggm��,,ployees' or personal effSSrt, wilds or improves the property, provided that the )rovements are not intended or offered for sale. If, however, the building or improvement' )thin e�y,ear�p`,cglbldFon, theo00w� erg-B.I�iWi11 ve the burden of proving that it was not built or )roved for the purpose of sale). . - YY`` tvs��'^'' ..tt ((j� 0 �i I, as owner of the property, am exclusively contracting with licensed - c ors to construct the proje (Section 704 ,(B�S 1e53'and Professions Code The Contractors' State License Law does not )ly to an owner of property who builds or improves thereon, contracts for the proje ith a Iicen�Gdr¢p 113Cbr pursuant to the Contrac to License Law). I am exempt from Iicensure under the Contract P' e Law for the f g reason: v c�� my signature below I acknowledge the c- ,,,ial reside which I must eoaided for at least on��ar o completion of the impr ements covered by this permit, I cannot lec a structure that I have built a er»K' a n onstructed i e - )Bad cogqtr��c(�14LhVerstand that a copy of the applica law, Section 7044 of the Business and ,fessions Code, is av pon re- th� a ion is submi d _„y^ si tt�W4lAvw.Ieginfo.ca.gov/calaw.htm]. nature of Propgr�r caner or A �,o _ �,.g Date hereby affirm unwj d and effect. ".•f„ .icense Class 't, VORKERS' COM yy&"' IARNING: FAILURE TO ScpN :DST OF COMPENSATION; J.11 hereby affirm under peg I have and will mair erfoLPnance of the work 7LARATION that I am Ii '.on 7000) of Division 3 of the Business and „e Contractor Sigri tLr y D DP- TIO KE. P y TION COVERAGE IS UNI ^' .., SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND Clv1• NIREO AS � OR IN SECTION �' .,OR CODE INTEREST, AND ATTORNEY'S FEES, perjury one of e foll '�` araflons certi o^r� u selfi sure for workers' compensation, issu �o �a�� provi �' ' h thi err' eued No. YYA l in full force DOLLARS (E100,000), IN ADDITION TO THE 3700 of the Labor Code, for I have and will maintairrr, pr rs' c insurance, as required by Ser+i"r00 of the L ode, ft�oetto prmance of the .. ,WO" - led. My workers' compensatio insurance carri r d polic um r a Carrier i'; o cv)Nu,' a I'�r i xpiratL Name of Ag I certify that, in the pa orma e the or .,oi ermit i qw+ all not employ any perso ' ny manner so as _.,ume o the workers' compensation laws of California, and agre that, if should become subject to t we Ip, as i_gq isof Section 3700 of the L ode, I shall forth mpl ose provris�ions. Signature of Applicant— DECLARATION REGAR16FNG CONS UCTION LE.NDING AGENCY ` I hereby affirm under penalty of perjury at there is a constructi Ing agency fort orm a work for which this permit is issued (Section 3097, Civil Code). Lender's Name en ress By my signature below, I certify to each th Ing: I am the property owner or authorized o act on the pr own a f. have read this application and the in f mati ave Is correct. I agree to comply with all applicable cit nd ordinances and state laws rgglating to building construction. authorize representatives of this city or unty to a4ove<Itlentified property for inspection purposes. Signature of Property Owner or Authorized Ag nt- /-- -- �-�J -- Print Property Owner's or Authorized Agent's Name (�t� i%1, A - Dat ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART Fr OF 1,1LE40 AND PERMIT EXPIRED - AQMD RULE 1403, ; ❑ I SUBMITTED ASBESTOS NOTIFICATON TO: PERMIT CANCELLED ❑ EPA PERMIT EXTENDED ❑ AQMD ❑ ASBESTOS N07IRCA170NIS NOT APPLICABLE TO PERMIT FINAL '(,.. PROPOSED DEMOLITION. CERTIFICATEOF OCCUPANCYISSUED SIGNATURE: