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Home My WebLink AboutE2011-0018 - PermitsCity of Newport Beach Building Department PO Box 1768 Newport Beach, California 92658-8915 ELECTRICAL Permit No: E2011-0018 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 4. t1; Job Address: 1 (38) HOAG DR Bldg: 1 Floor:""' ` Suite: Description of Work: ELEC/SOUTH PARKING STRUCTURE #38 LIGHTING RETROFIT & PHOTO CELL FOR SHUT-OFF 0039-2011 Inspector Area: 7 Legal Description: OF LOT Owner: Address: Phone: IRVINE SUB BLK 2 LOTS 169 & 170 POR OF LOTS & BLK 1 172 POR HOAG MEMORIAL HOSPITAL 1 HOAG DR NEWPORT BEACH CA 92663 949-764-4624 Issued Date:01/13/2011 Processed By: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: LIGHTING TECHNOLOGY SER. INC. 2801 CATHERINE WAY SANTA ANA CA 92705 949-428-5040 675901 08/31/2011 Code Edit: 2010 Worker's Compensation Insurance Carrier : COMPANINO PROPERTY Policy No: CPCA11985 Expire : 11/02/2011 0 p New Construction Residential Multi -Family: 0 $0.00 1-2 Family: 0 $0.00 Service 0-600V up to 200A: 0-600V over 200A: Over 600V or 1000A: 0/H to U/G 0 0 0 0 $0.00 $0.00 $0.00 $0.00 TOTAL Fee : $528.45 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 Fixtures: 317 $298.30 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 10 to 50 HP/KW/KVA: 0 50 to 100 HP/KW/KVA: 0 Over 100 HP/KW/KVA: 0 $0.00 $0.00 $o.00 $0.00 Piggy Back/Temp Power: 0 $0.00 Temp Power Pole: 0 $0.00 Plan Check Fee : $0.00 Temp Underground: Sub Panel: Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: Fee Due at Permit Issuance : 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $22.05 $0.00 $0.00 $33.10 $0.00 $528.45 • ••• ••• • ••• ... • • • •• . • • • •• •• • •• • PE`2Ml T9 EXPIRJ 180 b4Y! gfiTElil`SSUANCE OR LAST VALID INSPECTION • • • • • • • • • •••• •••••• • ••• • • •• •••• • .• •• • • • • • •• • • \2--2N32 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 pemiit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (, all of or (J portions of the work, and the structure is, itot intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does hot apply to an owner of property who through employees' or personal effort, builds or improves the property, providedthat the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of -completion, the Owner -Builder will have the burden of proving that it was not built or improved for the urpose ofs e)3 I, as Ovr of the property, am exclusively contracting with licensed. Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property whobuilds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors State License Law). ❑ I amexempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year pnor to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner - builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:httpl/www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I amlicensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the l3i. ness and Professions Code, and my license is i full forat and cif Lice a .lag$ C':. License No. 7S 7C1 / / //�� D l( Contractor Signat u � 1 WORKERS' OMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,, 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 trial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is S e Policy o. ❑ I ave an pert ance o rier uired by Se ion 3700 of the Labor Code, for the ensation ins : nce r ri_ d policy number are: Name of Agent ' �` ...a..._...• iL��. P e •�i'e ❑ I certify that, in the performance of the work for which this permit is issued, I shall not em; • so as to become subject to.t e workers' c ppensation,l�ws ofCaliforniaand agree that if workers' compensatio. pro��. sof Secti 37t,9 of abor Code, I shaiI forthwith comply with t Signature of Applican DECLARATION ' E I hereby affirm u which this permit is Iss Lender's Name Lender's Address maintain workers' compensation insurance, as ork for which thi it'sissu_. y • rs' .m• Da NG CONSTRUCTION LENDING AGENCY enalty of perjury that there is a construction lending agency for the performance of the work for. Section 3097, Civil Code). y any person in any manner ould become . ubjec to the ose.0 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 ordin nces and ate laws relating to building construction. I authorize representatives of this city or county to Ater 9e above j ntjfj'6�,Croperty for inspection purposes. Signature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Na • • • • • • • ••• ACTION PERMIT EXPIRED DATE: BY: PERMIT CANCELLED PERMIT EXTENDED PE RMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED • • • • • • Da • te • • • • •••• • .. •.I •• •• ••' r• • • • • • • • • • • • • • • • FOR OFFICE USE ONLY TYP_01/01/2009