HomeMy WebLinkAboutE2010-0427 - PermitsCity of Newport Beach Building Department ELECTRICAL Permit No: E2010-0427
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
Job Address: 1 HOAG DR 8ldg: 1 Floor: Suite:
Description of Work: ELEC/UNINTERRUPTED POWER SOURCE (BATTERIES) (BLDG 44 - DATA ROOM)
1466-2010
Inspector Area: 7
Legal Description: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR
OF LOT
Owner. HOAG HOSPITAL FD&C
Address: 500 SUPERIOR AVE #300
NEWPORT BEACH CA 92663
Phone: 949-764-4486
Issued Date:08/18/2010
Processed By:
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus Lic:
Lic Exp Date:
MISSION CRITICAL SPECIALISTS
836-B SOUTHAMPTON RD.#344
BENICIA CA 94510
530-621-4785
919248
07/31/2012
BT30032698
08/31/2011
Code Edit: 2007
Worker's Compensation Insurance
Cartier : SOUTHERN INS CO
Policy No: W51000242602
Expire : 09/15/2010
,NSPECTOR
New Construction
Residential
Multi -Family:
1-2 Family:
0 $0.00
0 $0.00
Service
0-600V up to 200A: 0 $0.00
0-600V over 200A: 0 $0.00
Over 600V or 1000A: 0 $0.00
0/H to U/G 0 $0.00
TOTAL Fee : $482.60
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
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: 1 $92.00
Piggy BacklTemp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Plan Check Fee : $280.00
Temp Underground: 0 $0.00
Sub Panel: 2 $46.00
P/C FEES: 2 $280.00
. 0 $0.00
Record Mgmt Fee: $31.50
Plan Check Fee: $0.00
Investigation Fee: $0.00
Issuance Fee: $33.10
Supplemental Fee: $0.00
Fee Due at Permit Issuance $202.60
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PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Name of Agent
❑ I certify that, in the pertonn
so as to become subject toj'
rkers' compensation pit
Signature of Applicant
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 ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or t 1 portions of the
work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors'
StateLicenseLawdoes not apply to an owner of property who through employees' or personal effort, builds or improves the
within one eareoftcothe
letion, improvements
er-Builder willdhdaver thee offered
nsoepfhowever,
g thatritiwas building
built improvementIIfors the
purpose of sale). completion,
proving p
❑ 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or
improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors State License
Law),
0 I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below acknowledge that, except for my personal residence in which I must have resided for at least one year
prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -
builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law,
Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the
following Web site:http://www.leginfo.ca.govicalaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provi ions Chapter 9 (commencing with Section 7000).
of Division 3 of the Business and Professions Code, and my license is in for and effect.
A f ense Class License No.
(Dpte$-fg u'�Comractor 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 affirm under penalty of perjury one of the following declarations:
❑ I have 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 the performance of the work for which this permit is
ed.
No.
ave and will maintain workers' compensation insurance, as requiredby •Section 3700 of the Labor Code, for the
ante of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Canter Policy Number Expiration Date
Phone #
the work for which this permit is issued, I shall not employ any person in any manner
rs' com ensation laws of California, and agree that if 1 should become subject to the
s eat DO of the Labor Code, I shall forthwith co ply ytith thv provisions.
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm underpenalty 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:
$ am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information t have provid is correct.
1 agree to comply with all applicable city and county o ma and state laws relating to building construction.
I authorize representatives of this city or county t er t abov�entified property for inspection purposes.
�ignature of Property Owner or Authorized Agent
ate 7-10
print Property Owner's or Authorized Agent's Name:.
01/01/2009
ate ce 77-7%)
ACTION
PERMIT EXPIRED
DATE:
BY:
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATE OF
OCCUPANCY ISSUED
Nerttits
FOR OFFICE USE ONLY
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