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Home My WebLink AboutE2024-0674 - PermitsPoo O City of Newport Beach Community Development Department- �" �IIQIII�IIIIIIIIIII�III�I�I�I� Electrical Permit: E2024-0674 Building Division Plan Check No : PC2022.2962 r 100 Civic Center Drive, Newport Beach, CA 92660 Work Class : Other u > 2 Permit Counter Phone: (949) 718-1888 Issued Date: 10/09/2024 Cq�FQA��P newp6tbeachca.gov/civic Final Date: Permit Status: Issued Inspection Area:8 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3IYEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WOK ON SUNDAY AND HOLIDAYS IN ALL AREAS Jab Address: 321 PIRATE RD Legal Desc : N TR 1220 BLK COT 50 Description: ELEC INSTALL 200ATEMPORARY FjOWER POLE (XR2022-3097) Owner: CONNELLYJAMES.MTR. - _ Contractor: MADISONIJLCO Address : 321 PIRATE RD NEWPORT BEACH, C 92663 Address: 24682 DEL PRADO #230 DANA POINT, CA 92629 Phone: (949) 633-4501 - Phone; (949) 212-6I= Con State Lic : 672668 -11 Applicant : D'ARCY CHARLES Lic Expire : 06/30/2025 , Address : 18 TECHNOLOGY DR, 161 IRVINE, CA 92618 Bus Lic:- BT300801' 3 Phone: (949) 407-7760 Bus Lic Expire: l2/31=24'I Workers' Compensation Insurance Owner/Builder: Carrier: OHIO SECURITY INSURANCE COMPANY Address ; - Policy No : . XW560277669 Phone: - Oil. C. Expire.; 1I1f1/2025- Code Edition: 2022 - - - - - Fire Hazard Zone: NO . Type of Construction : Occupancy Groups Building Setbacks: Front: 20, Side: 4, Side: 4, Rear. 10 Flood Zone : X Use Zone: R-1 - Single -Unit Residential PROCESSED BY: I .. I Ir o 0 u onto no „ n nnn�n:i I I o quo of o00 , 0o n 000 a co u 0000. 000na... OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors Stale License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable Items) ;action 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 e permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Slate 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 of more than five hundred dollars ($500). 11, as 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 (Secticin 70". usiness and Professions Code: The ContractorsSlate License Law does not apply to an owner of property who, through employees' ar personal effort. builds or improves the property, Provided that the Tprovements 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 twas 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 7D44, Business and Professions Code: The Contractors' State Lican;e 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). I am exempt from licensure under the Contractors' Stale License Law for the following reason: _ y 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 p i , cannot legallj all 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 ofthe 1113 f as and professions Code, is available upon request when this application is submitted or at the following Web site:http://cow•w•.leginfo.ca.gov/calav,.html. ignature of Property Owner or Authorized Agent Date _ .ICENSED CONTRACTOR'S DECLARATION TI 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, andmy lice}rl' �a is. in full force nd effect. License Class License No Date /0/9/2 �/ Contractor Signature� VORKERS' COMPENSATION DECLARATION , DARNING: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100.01 1,11 A DDI-TION TO THE DST 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: 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; LaI xi Code, for th erformance of the work for which this permit is issued. Policy No. DI 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 coal I compansatiol isurance carrier and policy number are: :artier Policy Number Expiration Date lame of Agent Phone H E� ]I 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 f [ is. and agre ial, if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. lilinature of Applicant pC./ I _ _ _ _, Dale Imby 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). rder's Name Lenders Address my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners 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 stale laws relating to building construction. I authorize representatives of this city or county to an erne above -identified property for inspection purposes. .. r o,...., •.,.,o ,— nr „� A,ah11,1 Ananl �r Print Property Owners or Authorized Agentor Name r 0 ACTV7N DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403 P-PMIT EXPIRED Eli SUBMITTED ASBESTOS NOTIFICATION TO PEPMITCANC'LLED CPA P PMrT EXTENDED_D �OMIT fINAi 1 r' PPFI—T ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO PROPOSED DEMOLITION I OCCUPANCY SSIJ D 4YX V SIGNATURE: