HomeMy WebLinkAboutE2014-0557 - PermitsCity of Newport Beach - Building Division III�IIIIIIIIIIIIIIIIIIIII II
o� 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 4 0 5 5 7
F Permit Counter Phone (949)644-3288
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Job Address: 2826 IRVINE AVE Bldg: 1 Floor: Suite:
Description of Work: ELEC/100 AMP SERVICE PANEL
Inspector Area: 3
Legal Description: TR 3068 LOT 1 POR OF LOT
Owner: NATIONWIDE CAP GRP INC
Contractor:
MEDALLION ELECTRIC
Address: 2826 IRVINE AVE
Address:
15380 ASH STREET
NEWPORT BEACH, CA 92660
- HESPERIA CA 91345
Phone:
Phone:
626-926-6595
Con State Lic:
293441
Issued Date:11/1412014
Lic Expire:
05/31/2015
Bus Lic:
BT30049106
Processed By:
Lic Exp Date:
11/30/2015
Electrical Permit: E2014-0557
Project No :
Inspection Requests Phone (949)644-3255
Code Edit: 2013
E`
Worker's Compensation Insurance
_
Carrier: EVEREST NATIONAL INS
�
Policy No: 7600012572141
'
r,
Expire : 01/01/2015
FEES
New Construction
Receptacle/Switch/Outlets
0 $0.00
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA: 0
$0.00
Temp Underground:
0
$0.00
Residential
Multi -Family:
0
$0.00
Receptacles/Outlets:
Fixtures:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
0
$0.00
1-2 Family:
0
$0.00
Sep Circuits:
0
$0.00
10 to 50 HP/KW/KVA:
0
$0.00
0
0
$0.00
$0.00
Low Voltage
0
$0.00
50 to 100 HP/KW/KVA:
0
$0.00
Service
Signs
Over 100 HP/KW/KVA:
0
$0.00
Record Mgmt Fee:
$0.00
0-600V up to 20OA:
1
$40.00
Branch Circuit:
0
0
$0.00
$0.00
Piggy Back/Temp Power:
0
$0.00
Plan Check Fee:
Investigation Fee:
$0.00
$0.00
0-600V over 20OA:
Over 600V or 1000A:
0
0
$0.00
$0.00
Each Add Circuit:
Time Clocks:
0
$0.00
Temp Power Pole:
0
$0.00
Issuance Fee:
$0.00
O/H to U/G
0
$0.00
Supplemental Fee:
$0.00
TOTAL Fee:
$40.00
Plan Check Fee: $0.00
Fee Due at Permit Issuance :
$40.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
INER-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)
ction 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
fessions 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
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 J portions of the work, and the structure is not intended or offered for sale (Section 7044,
;mass 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 Owner -Builder will have the burden of proving that it was not built or
roved 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
ly 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),
LJ I 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 thi
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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm1.
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 Professions Code, and,my
and effect.
License Class License No Date �r/ Contractor Signatur9( ! _
WORKERS' COMPENSATION DECLARATION
Business and
is in full force
NARNING: 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
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
Trance off ththe work for which this permit is issued. Policy No.
have an will Intain 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'
rance carrl an policy number
ier (Y) J A i TKcy NgrpbA _ Expiration Date
ie of AgenC J '1 �-�
Certify that, in the performance of the work for
if I should become subject to the workers' ca
latureofADolicant
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
,ions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. _ /J
Dat ll�l �
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 3097, 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 have provided is correct. !)
1 agree to comply with all applicable city and county ordinances and state-1'a _ - lating to building construction.
I authorize representatives of this city or countXto en jb3 abov�ertflfled property for inspection purposes.
nature of Property Ov
ACTION
PERMITEXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATEOF
OCCUPANCYISSUED
Owners or Authorized
DATE BY UECLAKA I WN UI- CUMPUANCL t49TN CODE OF
FFDERAL REGULATIONS PART 61 OF TITLE 40 AND
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