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Home My WebLink AboutE2021-0328 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 i 111411 11111 V Electrical Permit : E2021-0328 Project No : 0388-2021 Inspection Requests Phone (949)644-3255 Job Address: 3711 BALBOA BLVD W Bldg: 1 Floor: Suite: Description of Work: ELEC/LIGHT FIXTURES @ ROOFTOP DECK & EXTERIOR STAIRS Inspector Area: 1 Legal Description: Owner: Address: Phone: Issued Date Processed By: SCHROEDER CHRIS 3711 = =OA BLVD N PORT B • ACH CA 92663 Contractor: OWNER/BLDR Address: Phone: Con State Lic: O/B Lic Expire: Bus Lic: Lic Exp Date: 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: O/H to U/G 0 0 0 0 $0.00 $0.00 $0.00 $0.00 TOTAL Fee : $20.75 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 Fixtures: 5 $8.75 Sep Circuits: 0 $0.00 Low Voltage 0 $0.00 Signs Branch Circuit: Each Add Circuit: Time Clocks: Additional Fee : 0 0 0 $0.0 $0.0 $0.0 $0.0 Pla 0 0 0 0 Code Edit: 2019 Worker's Compensation Insurance Carrier : Policy No: Expire : 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 50 to 100 HP/KW/KVA: 0 Over 100 HP/KW/KVA: 0 $0.00 $0.00 $0.00 Piggy Back/Temp Power: 0 $0.00 Temp Power Pole: 0 $0.00 n r:hark Fee : $0.00 Temp Underground: Sub Panel: Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 $12.00 Fee Due at Permit Issuance : $20.75 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. s P is )WNER-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 nexl (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, a 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 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 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 L) portions of the work, and the structure is not intended or offered 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 m iprovements 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 pro m iproved 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' S 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). ❑ I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my pers. 'a residence in which I must have resided for at least one year prior to completion of the improvements coverec ell a structure tt.c.: ; have built as an owner -builder if it has �.t ben ear�structed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7 rofessions Cori' , i^ available upon request when thissite:http://wwvv.leginfo.ca.govicalaw.html. capon is su or at e following Web site:http://ww.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent .ICEFJSED CCNTRACTOR'S DECLARATION 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 Professions Code, a rid effect. icense Class License No Date Contractor Signature WORKERS' COMPENSATION DECLARATION to the applicable item(s) so requires the applicant for Division 3 of the Business and applicant to a civil penalty of for sale (Section 7044, property, provided that the ving that it was not built or tate License Law does not by this permit, I cannot legal! 044 of the Business and ? Date nd my license is in full force WARNING: FAILUPE T') SE"URE 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 COMPEN£.>TIJI., DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. riereoy affirm unc:er penalty of perjury one of the following declarations: I have and will ma'ntain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 37 performance of tine worK for which this permit is issued. Policy No. UI have and v•i!! .r.a:r,:ain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issuE insurance carrier and policy number are: er pe\of Agent c rtify that, in the performance a 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 agree that f I should become subject t t woe ers compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / D DaTe� 5- c / 8- a/ I I L B Policy Number Expiration Date 00 of the Labor Code, for the d. My workers' compensatior gnature of Applicant Phone # ECLARATION REGAR NG STRUCTION LENDING AGENCY iereby 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). :nder's Name Lender's Address y my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provide Is correct. I agree to comply with all applicable city and county ordina a nd state laws relating to building construction. I authorize representatives of this city or county to�R•#er a ove e tified property for inspection purposes. ❑nature of Prnnerty r)wner nr A ithnriyarl A ent /� 9 ACTION PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTI F!CATE OF OCCUPANCY ISSUED DATE BY rint Property Owner's or Autnorizea Hr gens Name k VI ✓) .0 L� rT ('(A-0 e DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: FOR OFFICE USE ONLY