HomeMy WebLinkAboutE2013-0027 - Permits(1)
City of Newport Beach Building Division ELECTRICAL Permit No: E2013-0027
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 2639 BUCKEYE ST Bldg:
1 Floor: Suite:
Description of Work: ELEC-CIRCUIT TO FOUNTAIN
Inspector Area: 4
Legal Description: N TR 4892 LOT 80
Owner: SWENSSON DEBRAANN
Contractor:
Address: 2639 BUCKEYE ST
Address:
NEWPORT BEACH, CA 92660
Phone:
Phone:
Con State Lic:
Issued Date:01/24/2013
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 20OA:
0
$0.00
0-600V over 20OA:
0
$0.00
Over600V or1000A:
0
$0.00
O/H to U/G
0
$0.00
TOTAL
Q S LANDSCAPE INC
3018 JEFFERY DR
COSTA MESA CA 92626
949-285-8326
956158
04/30/2013
BT30041494
11/30/2013
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
Code Edit: 2010
Worker's Compensation Insurance
Carrier: HARTFORD UNDERWRITER
Policy No: 76WEGVV4919
Expire : 03/01/2013
0
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
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Temp Underground:
0 $0.00
Sub Panel:
0 $0.00
0 $0.00
0 $0.00
Record Mgmt Fee:
$1.00
Plan Check Fee:
$0.00
Investigation Fee:
$0.00
Issuance Fee:
$34.00
Supplemental Fee:
$0.00
Fee Due at Permit Issuance: $41.00
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 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 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).
U I am exempt from licensure under the Contractors' State
By my signature below I acknowledge that, except for my pe.
sell a structure that I have built as an owner -builder if it he
est Professions Code, is available upon requwh t is plif
Signature of Property Owner or Authorized Agent
LICENSED CON TRACTOR'S DECLARA
I hereby affirm under penalty of perjury that I am licen u
Pnd efle:t.
License Class License No _
COMPENSATION DECLARATION
Law for the following reason:
idence in which must have resided for at least one year prior to completion of tl
rutted in its entirety by licensed contractors. I understand that a Copy of the
;t b ifted or at the following Web site:http://www.leginfo.ca.gov/calaw,htm].
law, Section 7044 of the Business and
-� Date
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession 8 Code, and my license is in full force
Date
Contractor Signature
rARNING: FAILURE'.0 SECJRE 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 :OMPENSAPON, IIAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNETS FEES.
hereby affirm order penalty of perjury one of the following declarations:
D I have and wil; .r.a;ntain 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
erformance of the work for which this permit is issued. Policy No.
hav= and wi-, 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'
ranee carrier and palicy number are:
Policy Number
of Agent
Date
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 of California, and
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant Date
CLARATION REGARDING CONSTRUCTION LENDING AGENCY
:reby 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).
Ider's Name Lender's Address
my signature below, I certify to each of the following: t
I am the property owner or authorized to act on the property Wners behalf.
I have read this application and the information I have591110fBintified
t.
I agree to comply with all applicable city and c unty oa laws relating to building construction.
I authorize representatives of this city or countyy to en property for inspection purposes. 1 n
of Property Owner or Authorized
Owner's or Authorized
Date O
ACTION
DATE
DECLARATION OF COMPLIANCE MTH CODE OF
, FOR OFFICE USE ONLY
I
FEDERAL REGULATIONS PART 61 OF TITLE40 AND
AQMDRULE1403.
PERMITEXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION T0:
❑ EPA
❑ AQMD
PERMITC4NCELLED
PERMITEXTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
07/03/(
e,1
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED