HomeMy WebLinkAboutE2015-0467 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 5 0 4 6 7
Permit Counter Phone (949)644-3288
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Job Address: 12 OLD COURSE DR Bldg: 1 Floor: Suite:
Description of Work: ELECT/ INSTIL EXTERIOR OUTLETS
Inspector Area: 4
Legal Description: N TR 15388 LOT 43
Owner: SHAMROCK TRUST
Contractor:
Address: 12 OLD COURSE DR
Address:
NEWPORT BEACH, CA 92660
Phone:
Phone:
Con State Lic:
Issued Date:08/20/201
Lie Expire:
Bus Lie:
Processed By: -Lie
Exp Date:
URBAN LANDSCAPE MAINTENANCE INC
895 DOVE ST 3RD FLR
NEWPORT BEACH CA 92660
949-637-8767
962251
06/30/2015
BT30042651
05/31/2016
Electrical Permit: E2015-0467
Project No : 1799-2015
Inspection Requests Phone (949)644-3255
Code Edit: 2013�'%E
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Worker's Compensation Insurance
Carrier: REPUBLIC UNDERWRITER
Policy No: ATWO03386
Expire : 10/09/2015
FEES
New Construction
Receptacle/Switch/Outlets
Motors/Transformers (HP/KVA)
Residential
Receptacles/Outlets:
8
$8.00
0 to 1 HP/KW/KVA:
0
$0.00
Temp Underground:
0
%u.09
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
0
$u.00
1-2 Family:
0
$0.00
Sep Circuits:
0
$0.00
10 to 50 HP/KW/KVA:
0
$0.00
a
0
%u,00
Low Voltage
0
$0.00
50 to 100 HP/KW/KVA:
0
$0.00
- 0
$u.00
Service
Signs
Over 100 HP/KW/KVA:
0
$0.00
Record Mgmt Fee:
U.O.)
0-600V up to 200A:
0
$0.00
Branch Circuit:
0
$0.00
Plan Check Fee:
$0.00
0-600V over 20OA:
0
$0.00
Each Add Circuit:
0
$0.00
Piggy Back/Temp Power:
0
$0.00
Investigation Fee:
w6.'60
Over 600V or 1000A:
0
$0.00
Time Clocks:
0
$0.00
Temp Power Pole:
0
$0.00
Issuance Fee:
$u:00
O/H to U/G
0
$0.00
Additional Fee:
$0.00
Supplemental Fee:
$9.00
TOTAL Fee:
$17.00
Plan Check Fee : $0.00
Fee Due at Permit Issuance:
$17.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
)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 oh6eckmark(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
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 7b00),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).
1 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,
Iusiness 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).
1 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).
I am exempt from licensure under the Contractors' State License Law for the following reason:
Iy 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
ell 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
'rofessions 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 Date
.ICENSED CONTRACTOR'S DECLARATION
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 rofes Code, and m e ull for
nd effect. g ZG (} a\Tnd�.P
icense Class License No Da 8 Contra cto ignature \ \
COMPENSATION DECLARATION
'ARMING: 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
OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm u,tder penalty of perjury one of the following declarations:
I ! he and W1 mnintain 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 th
erfaMance of the work for which this permit is issued. Policy No.
rnd 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'
carrier and policy number are:
Policy Number Expiration Date
of Agent
aer4ty 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 o the workers' compensation laws of California, and ag re
t, if I should beccvme su act to the worker pensatio action 3700 o de, I shall forthwith comply with those proIons.
nature of Appli-•ai``t_ D
CLAFATION REGARDING ION L NG Y
ireh- affirm under penalty o Fury that the s ruction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ider's Name Lender's Address
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.
I agree to comply with all applicable city and county ordinances and state laws ref to building constructo . //�� I authorize representatives of this city, or county to r e above -id rty for i actionty to above -id for n purposes��G �- �rY �l[ D e�- �rY �l[ D e
nature of Property Owner or Authorized Agent / Print Property Owners or Authorized ATte s Name T Ti
ACTION
DATE
DECLARATION OF COMPLIANCE WITH CODEOF N
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
P€RMITCANCELLED
PERMIT EXTENDED
-CrAQMD
ASBESTOS N077FICA
PROPOSED DEMOLITION.nONISNOT APPLICABLE TO
PERMIT FINAL
17-11,
f
CERTIFICATE OF
SIGNATURE:
OCCUPANCY/SSUED