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Home My WebLink AboutE2019-0285 - Permitstrr� City of Newport Beach - Building Division sJ 100 Civic Center Drive, Newport Beach, CA 92660 H 'g Permit Counter Phone (949)644-3288 iiiiiiiiii II Electrical Permit: E2019-0285 Project No : 2788-2017 Inspection Requests Phone (949)644-3255 New Construction Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) Job Address: 2715 WINDOVER DR Bldg: 1 Floor: Suite: Residential Description of Work: ELEC PIGGY BACK (X2017-3973) 0 $0.00 O to 1 HP/KW/KVA 0 $0.00 Temp Underground: 0" $0.00 Multi -Family: 0 Inspector Area: 4 Fixtures: 0 Code Edit: 2016 1 to 10 HP/KW/KVA Y $0.00 Sub Panel`. 0 € °°O•f 0 Legal Description: N TR 6113 LOT 39 Sep Circuits: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 0 $0.00 Owner: DUBCHANSKY SCOTT B Contractor: PATTERSON CONSTRUCTION Worker's Compensation Insurance ° 0 Address: 2715 WINDOVER DR Address: 15 CORPORATE PLAZA STEA50 Carrier: STATE COMP Service CORONA DEL MAR, CA 92625 Signs NEWPORT BEACH CA 92660 Policy No: 90654062018 Over 100 HP/KW/KVA: 0 Phone: Phone: 949-723-1800 Expire : 08/01/2019 0-600V up to 20OA: 0 $0.00 Con StateLic: 802367 $0.00 Issued Date:05/08/2019 LicExpire: 07/31/2020 $0.00 0-600V over 20OA: 0 $0.00 Bus Lic: BT02110534 $0.00 Piggy Back/Temp Power: 1 Processed By: LicExp Date: 10/31/2019 $0.00 Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 0 $0.00 Issuance Fee: $35.00 O/H to U/G 0 New Construction Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) Residential Receptacles/Outlets: 0 $0.00 O to 1 HP/KW/KVA 0 $0.00 Temp Underground: 0" $0.00 Multi -Family: 0 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA 0 $0.00 Sub Panel`. 0 $0.00 1-2 Family: 0 $0.00 Sep Circuits: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 0 $0.00 Low Voltage 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 0 $0.00 Service Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00 0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 $0.00 Plan Check Fee: $0.00 0-600V over 20OA: 0 $0.00 Each Add Circuit: 0 $0.00 Piggy Back/Temp Power: 1 $38.00 Investigation Fee: $0.00 Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 0 $0.00 Issuance Fee: $35.00 O/H to U/G 0 $0.00 Additional Fee : $0.00 Supplemental Fee: $0.00 PERMITS EXPIRE 980 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. 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 applicantfor 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 fora permit subjectsthe 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 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 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 im roved 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' 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). I am exr r'hpMrom licensure under the Contractors' State License Law for the following reason: By my signatdr9bblow I acknowledge that, except for my personal residence in which I must have resided for at least oneyear prior to completion of the improvements covered by this permit, I cannot legalh 1%164 structure llhat 1 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 Prof@ssions rots, -Is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date EaNSED QQ(J,TRACTOR'S DECLARATION I hereby affinn unVV?penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wit action 7 00) of Division 3 of the Business nd Pr ssions Code, and my license is in full force ah�l�Tfect. License Clasy'... License No Date g Contractor Signa re �QVKERS' 60MPENSATION DECLARATION NAR��NNf�r1G: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLO ER TO CRIMINAL PENALTIES AND CIVIL FINES UP O ONE HU D THOUSAND DOLLARS ($700,000), IN ADDITION TO THE Ct5SY0F COMPENBAT4%DAMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES hereby affirm under penalty of perjury one of the following declarations: I1;ve and =NIIl.m9lntaln acertificate 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 00 To ance of thY:'Work for which this permit is issued. Policy No. have and will maintain 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' compensatioi n ance carrier and policy number are: Policy Number Date is of Agent - Phone # certify that, in the pert mance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject t e workers' compensation laws of California, and agre if I should becomes ject to orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prove ons. / lature of Applicant :LARATION REGA DING CO RUCTION LENDING AGENCY /} NNN reby affirm under p natty of p ry that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).. ier's Name Lender's Address ny 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 provided is correct. I agree to comply with all applicable city and unty ordinances and state laws relating to building construction. I authorize representatives A this city or oen to en the above -identified property for' spa rint Pro purposese I�JPi'i 5r / > D lature of Prooertv Owner or Authorized Acen�J/ r�/y% ��---Print Prooertv Owner's or Authorized Agent's Name C G D e ACUON DATE I// BY t'tt-r_rrrwrrvn ur Lumrustrra.r rrrrrt wucvr 7 wn urncs wcurcryr 41 FEDERAL REGULATIONS PART 61 OF TITLE40AND I PERMITEXPIRED AQMDRULE1403. ❑ ISUSMITTEDASBESTOSNOTIFICATIONTO PERMITCANCELLEO ❑ EPA PERMITEXTENDED ❑ AQMD ❑ ASBESTOS NOURCA710NIS NOT APPLICABLE TO PERMITFINAL PROPOSED DEMOLITION. CERTIFICATEOF SIGNATURE: