HomeMy WebLinkAboutE2017-0506 - Permits(9)
City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 36 GANNET LN Bldg: 1 Floor: Suite:
Description of Work: ELEC SUB PANEL 80 AMPS
Inspector Area: 8
Legal Description: N TR 12529 LOT 19
Owner: SCHIPSI ROBERT
Address: 36 GANNET LN
NEWPORT BEACH, CA 92660
Phone: 949-497-8681
Issued Date•=9/2017
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:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
II�IIIIIIIIIIIIIIIIIIII�IIIIIIII�IIII II Electrical Permit: E2017-0506
E 2 0 1 7 0 5 0 E Project No : 2047-2017
Inspection Requests Phone (949)644-3255
Code Edit: 2016
OWNER/BLDR Worker's Compensation Insurance,,:
Carrier
Policy No:
Expire
O/B
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
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
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
Plan Check Fee :
Temp Underground:
0
$0.00
Sub Panel:
1
$25.00
0
$0.00
0
$0.00
Record Mgmt Fee:
$0.00
Plan Check Fee:
$0.00
Investigation Fee:
$0.00
Issuance Fee:
$33.00
Supplemental Fee:
$0.00
e at Permit Issuance :
$58.00
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.
)WNER-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)
Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, pdorto its issuance, also requires the applicant for
is 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
rofessions 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
o mare than five hundred dollars ($500).
owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness 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
nprovements 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
nproved for the purpose of sale).
I, 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
pply 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 ST. exempt from Ilcensure under the Contractors' State License Law for the following reason:
Vy my signature beljwl acknowledge that, except for my personal residence in which I st have resided for at least one year prior to completion of the improvements covered b this permit, I cannot legally
ell a structure that I have built as an owner -builder if i as not been con ucted in its tirety by licensed contractors. I understand that a copy of the applicable law, Section 7 of the usines "and
irc.`essians Code, is available upon request when th' application is or a o Web site:htt :// .ca.gov/calaw.htmi. `--7
lignature of Propartv �wner or Authorized Agent DaKeard
` �/
ICENSED Cb\TR/.CTOR'S DECLARATI
hereby affirm urd,r pcnalty of perjury that I am licensed un er provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co my license is in full force
r,d eYact.
ice,3j Class _ License No Date Contractor Signature
'J:,nf:CRS' COMPENSATION DECLARATION
ARNING.FAILURE lG SEUt IRE 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
09r nF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
aemh,' affirm under penalty of perjury one of the following declarations:
I 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 the
erformance of the work forwhich this permit is issued. Policy No.
71 have 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' compensation
Isurance carrier and policy number are:
Policy Number Expiration Date
lame of Agent Phone #
3 certify that, in the perfo ante of the w k for whichthis permit is issued, I shall not employ any person in any manner so as to become subject to theworkers' compensation la s of California, and agre
tat, if I should becomes ject to the om nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provision
signature of Applicant Date
IECLARATION REG RDIN LENDING AGENCY
hereby affirm under enalt o perjury that t ere is a construction lending agency for the performance of the work for which this permit is issued ection 3097, Civil Code).
Ender's Name Lender's Address
ly my signature below, I certifyto 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 co�ty ordin CBS and. to laws relating to building construction.
I authorize representatives of this city or county7tc eeAn ove' nt" ro a nspection purposes. inn h— of 0,n A., name, nr ai d6nrlserV A—+ / /1 od..� o.,..,eM„ n,.,.,e.� .,, n�ah,..',wa e,.e.,v�
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODEOF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OFTITLE40AND
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PERMITEXPIRED
❑ OMI SUBMITTED ASBESTOS NOTIFICATION TO:
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PERMIT EXTENDED
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PERMITFINAL
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CERTIFICATEOF
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SIGNATURE:
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