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Home My WebLink AboutE2021-0695 - PermitsCity of Newport Beach - Building Division 11111111111111111111111111111111111111111111111111 Jill 111Electrical Permit: E2021-0695 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 2 1 0 6 9 5 Project No : 1337-2021 Permit Counter Phone (949)644-3288 Job Address: 3723 PARK GREEN DR Bldg: 1 Floor: Suite: Description of Work: ELEC -TEMP POWER POLE (X2021-2766) Inspector Area: 6 Legal Description: N TR 6634 LOT 2 Owner: HOSTETLER III H FRANKLIN Contractor: Address: 3723 PARK GREEN DR Address: CORONA DEL MAR, CA 92625 Phone: Phone: Con State Lic: Issued Date:10113/2021 Lic Expire: Bus Lic: Processed By: Lic Exp Date: New Construction Residential Multi -Family: 0 $0.00 1-2 Family: 0 $0.00 Service 0-600V up to 200A: 0 $0.00 0-600V over20DA: 0 $0.00 Over 600V or 1000A: 0 $0.00 O/H to U/G 0 $0.00 TOTAL Fee: VITARELLI CONSTRUCTION INC 140 S BAY FRONT NEWPORT BEACH CA 92662 949-677-1872 485418 02/2B/2023 BT00011199 08/31/2022 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 Inspection Requests Phone (949)644-3255 Code Edit: 2019 Worker's Compensation Insurance Carrier: STATE COMP INS FUND Policy No: 0783123 Expire : 10/01/2022 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: 1 $41.00 Plan Check Fee: $0.00 t; lie-tpr-a"- � �yf �o CDa Temp Underground: 0 $0.00 Sub Panel: 0 $0.00 0 $0.00 0 $0.00 Record Mgmt Fee: $0.00 Plan Check Fee: $0.00 Investigation Fee: $0.00 Issuance Fee: $38.00 Supplemental Fee: $0.00 Fee Due at Perm PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday Z:90 a.m. to 6:30 pip. and.Saturday from 8:00 a.m. to 6:00 p.m. OWNER -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, prior to its issuance, also requires the applicant for the 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 L) all of or L) 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 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 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 legal) 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.htmi. Signature of Property Owner or Authorized Agent to 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 Profess ns and ense is in full force and effect. License Class License No Date [. l Contractor Signature WORKERS'COMPENSATION DECLARATION WARNING: 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. I hereby ffirm under penalty of perjury one of the following declarations: I he a 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 IN I nce of the work for which this permit is issued. Policy No. ave 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' compensatic s nce carrier and policy number are: arrier Policy Number Expiration Date Name of Agent Phone # ❑I certify that, in the perform an e f th forwhi this 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 that, if I should become su/¢le tot ork 'comp n provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provision .� Signature of Applicant / Date /� /1//L l DECLARATION REG DING CONSTRUCTION LENDING AGENCY I 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), Lender's Name Lender's Address By 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 r vid Is rre I agree to comply with all applicable city and county di state laws relating to building construction. I authorize representatives of this city or county to ei r ove-identified property for inspection purposes. l� Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Na "ICI ' "7z ' Data ACTION DATE BY DECLARATION OFCOMPLIANCE KITH CODE OF FOR OFFICE USE ONLY tFDERAt kEnUtATlO46PAR f590F TtTLE40AND ACvMD RULE 140C. PERMfT EXPIRED C fSL'eMITTECAS8r5'O_ .40T7FICATlONFO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMITEXTENDED ❑ ASBESTOS NOTIFICATION l5 NOT APPLICABLE TO PROPOSF.0 7EMC'UTION. PERMIT FINAL - 2-2 rL.h.. Got CERTlRCA7EOF ''tGN.AtUR=: OCCUAANCYlSSUED