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Home My WebLink AboutE2020-0522 - Permitsawwr„4� City of Newport Beach - Building Division 1111111111111111111111111111111111111111111111111 ill Jill 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 2 0 0 5 2 2 r: + Permit Counter Phone (949)644-3288 U � $ t�, y �tuuxr� Job Address: 4515 ORRINGTON RD Bldg: 1 Floor: Suite: Description of Work: ELEC -TEMP POWER POLE Inspector Area: Legal Description: N TR 3357 LOT 76 Owner: ZIEMBA FAMILY TRUST Contractor: S C HOMES INC Address: 520 FIINTDALE RD Address: 3050 PULLMAN ST HOUSTON, TX 77024 COSTA MESA CA 92626 Phone: Phone: 949-723-4243 Con State Lic: 828216 Issued Date:09/29/2020 Lic Expire: 12/31/2021 Bus Lic: BT30002421 Processed By: Lic Exp Date: 02/28/2021 New Construction Receptacle/Switch/Outlets Residential Receptacles/Outlets: 0 $0.00 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 20DA: 0 $0.00 Branch Circuit: 0 $0.00 0-600V over 20DA: 0 $0.00 Each Add Circuit: 0 $0.00 Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 O/H to U/G 0 $0.00 Additional Fee: $0.00 TOTAL Fee: Electrical Permit: E2020-0522 Project No : 2795-2019 Inspection Requests Phone (9, 9)644-3255 Code Edit: 2019 Worker's Compensation Insurance Carrier: STATE FUND Policy No: 1763760 Expire : 01107/2021 JNSFE T®g 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 : 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: $37.00 Supplemental Fee: $0.00 Fee Due at Permit Issuanr e : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. DocuSign Envelope ID: 1460Cc:23-5942-4B4A-BDOF-D8EB7AC6FB2E S OWf iER-BUILDER DECLARATION I hare.)y affirm underpenalty 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 Hems) (Section ; 031.5, Business and Professions Code: Any cityor countythat requires a permit to construct, alter, improve, demolish, or repairany structure, priorlo its issuance. also requires the applicant for the permi futile 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) )f Division 3 of the Business and Professro is Code) or that he or she is exempt from licensure and the oasts for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects 'he appliGantto a civil penalty of not more han rive hundred dollars ($500). ❑ 1, as rwner 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. 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 'he property, provided that the improver ants 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 ;)roving that it was not built or diroved or the purpose of sale). LJ I, as c wrier of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractor,-' State License Law does not apply to a i owner of property who beliefs or improves thereon, and who contracts forthe projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for line following reason: By my Sigtamre below 1 acknowledge that, except for my personal residence in which I must have resided for at least one year pdorto Completion of the improvements cove red by this permit, I cannot legally sell a SITU -lure 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, Sectio'i 7044 of the Business and Professioi is Code, Is available upon request when this application is submitted or at the following Web site:httpYNrww.leginfo.cagovicalaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 ) n c3 u j Protes ns Coop, and my license is in full force and effect License Class License No Dat '� ' I Connttractor 8ignatur WORKERS' COMPENSATION DECLARATION EARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINES UP TO ONE HUNDRED THOUSAND YlLARS (E70(1,000), IN ADDITION TO THE AST OF CC MPENSAm0 MAGES AS PROVIDED FOR IN SECTION3706 OFTHE LABOR CODE, INTEREST,ANDATTORNEY'S FEES. hereby affirm : Ity of perjury one of the following declarations: maintain a certificate of consent to self -insure for workers' compensation, issue(] by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for workiorwhlch this permit is issued. Policy No. and Wilt maintain workers' compensation insurance, as required by Section 37CO of the Labor Code, for the performance of the work for which this permit is Issued. My workers' artier and policy number are: ATE COMPENSATION INSURANCE FUTAIicy Number 1763760 Expiration Date 01/07/2021 of F gent q 877-405-4545 certify that, in the performance of the work for which this permit is Issued, € shalt not employ arty person in any manner so as to become subject to the workers' compam allon laws of California, and , if I sr.ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those DrOVlsions. A Da ,P9/28/.'_0 1 2:03 PM PDT areby a dim 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). sler's N ame Lender's Address my sign atum below, I certify 10 each of the following: I am ine 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 relating to building construction. I authorize representatives of this city or County to outbr the above-identmed property for inspection purposes, ,S Cott Cross nature -if Property Owner or Authorized Agent Print Prooanv Owner's or Authorized ADent's Narfie PERMIT CERTIFIC4 EOF OCCUPANc YISSUED DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AOMD ROLE SUBMITTED ASBESTOS PROPOSED NOT,FICATIO;J S NOTAPI`UCABLF TO 8/20