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Home My WebLink AboutE2018-0391 - PermitsCity of Newport Beach - Building Division 04 U� 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 E'L1ylYi'�4 Job Address: 504 AVENIDA LADERA Bldg: 1 Floor: Suite: Description of Work: ELEC/DISCONNECT TO A/C Inspector Area: 8 Legal Description: TR 5692 (L.L.84-214027) PAR 23 Owner: BACKLUND JIM & NICOLD Contractor: Address: 504 AVENIDA LADERA Address: NgWFPORTQ_EACH, CA 92660 Phone: Issued Processed 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 over 20OA: 0 $0.00 Over 600V or 1000A: 0 $0.00 O/H to U/G 0 $0.00 Phone: Con State Lie: Lie Expire: Bus Lie: Lie Exp Date: II E 2�� 0�� 1�� 8�� 0�� 3�� 9�� 1 II AIRWEST A/C & HEATING INC 1886 SO SANTA CRUZ ST ANAHEIM CA 92805 714-978-7877 733715 03/31/2019 BT30057337 05/31/2019 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 Fixtures: 0 $0.00 Sep Circuits: 1 $6.00 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 Electrical Permit: E2018-0391 Project No : Inspection Requests Phone (949)644-3255 LkaTOR Code Edit: 2016 Worker's Compensation Insurance Carrier: NORGUARD INS Policy No: AIWc857477 Expire : 11114/2018 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 Temp Underground: V,. $O.JO Sub Panel: 0 $0.00 9' $0.6c ' ' 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 11 TOTAL Fee: $39.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $39.uu I� 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. DWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law forthe 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, 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 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 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 hot 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). ❑ 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 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 CONTRACTOR'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 rote s n Code, and my license is in full force and effect. License Class License No Date 6 Contractor Signatur 4iZ FY.ERS' COMPENSATION DECLARATION WARNING: FAILURE TG SE07JRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE ^OFT Or COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I herel.y affirm unaer penalty of perjury one of the following declarations: r 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 Ice of the work for which this permit is issued. Policy No. and ?vilf marotain 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' compensa carrier and policy number are: �1 A/S&"rlyo Policy Number i¢//�G 7Z2G3S Expiration Date e of Agent Phone # I^ertify that; in :he performance of e w o 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 agree eat, if I should tie ;nrne subject to the orkers pensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ignature of Applicani —T� Date �4&- g IECLARATION REGARDING CONSTRUCTION LENDING AGENCY / / hereby 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 304, Civil Code) Ender's Name Lender's Address y 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 ha rovi d is correct. I agree to comply with all applicable city and coun or an and state laws relating to building construction. I authorize representatives of this city or county t nter khe arty for inspection purposes. _ lionature of Prooerty Owner or Authorized ADent I - ove-identified propPrint Property Owner's or Authorized Agent's Name\ti_'O-AIJ22� ACTION DATE I BY uct-t»rwrrury ur wmruHrvr.r vrun wuc yr rurc UMuat urvu FEDERAL REGULATIONS PART 61 OF TITLE40AND AQMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMIT EXTENDED ❑ ASBESTOS N077RCADONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMITFINAL - CERTIFICATE OE SIGNATURE: OCCUPANCY15SUFD