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Home My WebLink AboutE2016-0591 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 400 VISTA SUERTE Bldg: 1 Floor: Suite: Description of Work: ELEC - DISCONNECT FOR A/C (H2O16-0445) Inspector Area: Legal Description: N TR 7148 LOT 47 Owner: HUNTSMAN AMANDA Contractor: Address: 400 VISTA SUERTE Address: NEWPORT BEACH, Phone: Phone: 7__�_Lic Con State Lic: Issued Date:09/19/2016Lic Expire: Bus Lic: Processed By: Exp Date: HEALTH-E-AIR INC 2310 N LAIRD STREET SANTA ANA CA 92706 714-866-9614 888966 01/31/2017 BT30055752 07/31/2017 New Construction Receptacle/Switch/Outlets Residential Receptacles/Outlets: 1 $1.00 Multi -Family: 0 $0.00 Fixtures: 0 $0.00 1-2 Family: 0 $0.00 Sep Circuits: 0 $0.00 - Low Voltage 0 $0.00 Service Signs 0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 $0.00 0-600V over 20OA: 0 $0.00 Each Add Circuit: 0 $0.00 Over 600V or 1o00A: 0 $0.00 Time Clocks: 0 $0.00 O/H to U/G 0 $0.00 Additional Fee: $0.00 TOTAL Fee: Electrical Permit: E2016-0591 Project No : Inspection Requests Phone (949)644-3255 Code Edit: 2013 Worker's Compensation Insurance Carrier: REPUBLIC INS Policy No: ATWO09442-00 Expire: 03/07/2017 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 Plan Check Fee: PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Temp Underground: 0 $L.P0 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: $32.00 Supplemental Fee: $0.00 Due at Permit Issuance: $33.00 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 Iicensure 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 ($500). ❑ I, as owner of thp�roperty, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and PRptessloAs Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are -not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the"furpose of sale). ❑ "I, asAner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not a i t$ 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). it am exempt from Iicensure 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 legally ®� 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,html. Signature o' Property Owner or Authorized Agent Date LICENSED :_NTRACTOR'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 Prof ssions Code, and my license is in full force ano effect. License Class License No Date '- - U Contractor Signature NnRKERS' COMPENSATION DECLARATION APNING: FAI'LLRE rU 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. I hereby affirm urde.. penalty of perjury one of the following declarations: ID I nave 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 th, Wpape ormance of the work for which this permit is issued. Policy No. ve and whl mantain 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' compensatior rarce carrier anr+ policy number are: (:Prrirr - Policy Number Expiration Date Name of Agent Phone # 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 of California, and agre, that, if I should become suulojecct too the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant Date /i•-/� 20G DECLARATION REGARDING 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 owners 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 relating to building construction. I authorize representatives of this city or county t°/ent�e�r the above -identified property for inspection purposes. �n/ /� Jc �7 /q Sianature of Prooertv Owner or Authorized Agent ,�`- Print Property Owner's or Authorized Agent's Name J` /r i21 D e l / ACTION DATE By DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE FEDERAL REGULATIONS PART 61 OF TITLE40 AND PERMITEXPIRED AQMD RULE 1403. ❑ I SUBMITTEDASBESTOS NONFICATIONTO: PERMITCANCELLED ❑ EPA PERMIT EXTENDED ❑ AQMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PERMIT FINAL 'J;DC vt<'a^ PROPOSED DEMOLITION. CERTIFICATEOF uL7- SIGNATURE: OCCUPANCYISSUED