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Home My WebLink AboutE2018-0737 - Permitsyr City of Newport Beach - Building Division 3 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 er o - Job Address: 111 VIA QUITO Bldg: 1 Floor: Suite: Description of Work: ELEC/DISCONNECT TO A/C Inspector Area: 1 Legal Description: N TR 907 LOT 134 Owner: RA JOHN EN Address: 1 VIA QUITO /NEWPORT BEACI , CA 92663 Phone: / Issued Date: 11/13/2018 New Construction / Residential Multi -Family: 0 $0.00 1-2 Family: 0 $0.00 Service 714-886-2021 Con State Lie: 0-600V up to 20OA: 0 $0.00 0-600V over20OA: 0 $0.00 Over 600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 Il rii iiiii iiiii iiiii iiii iiiii hili 7 II Contractor: SHALOM HEATING & AIR Address: 9191 VIA BALBOA CIR 1 BUENA PARK, CA 90620 Phone: 714-886-2021 Con State Lie: 967182 Lie Expire: 10/31/2019 Bus Lie: BT30065018 Lie Exp Date: 11/30/2019 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 Fixtures: 0 $0.00 Sep Circuits: 1 $7.00 Low Voltage 0 $0.00 Signs 0 to 1 HP/KW/KVA: 0 Branch Circuit: 0 $0.00 Each Add Circuit: 0 $0.00 Time Clocks: 0 $0.00 Additional Fee: $0.00 $0.00 Electrical Permit: E2018-0737 Project No : Inspection Requests Phone (949)644-3255 Code Edit: 2016 E ksor 'k i X • e ueooe Worker's Compensation Insurance • Carrier: NORGUARID • oeee°o Policy No: JOWC945078 < ° Expire: 04/11/2019 om o ELECTRICAL METALLV'FC°,"-_l1N(:'A• e ee ° (EMT) IS NOTALLOi,1lEDIOR e°0000 • EXTERIOR APPLICATIaNS e•°oeo eoo mo• o 0 ° FEES $0.00 Plan Check Fee: ee e 0 0 • e •oeo Motors/Transformers(HP/KVA) Issuance Fee: $35.00 Supplemental Fee: $0.00 0 to 1 HP/KW/KVA: 0 $0.00 Temp Underground: 0 $0.00 1 to 10 HP/KW/KVA 0 $0.00 Sub Panel 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 0 $0.00 Over 100 HP/KW/KVA: 0 $0.00 Piggy Back/Temp Power: 0 $0.00 Temp Power Pole: 0 $0.00 Record Mgmt Fee: $0.00 Plan Check Fee: $0.00 Investigation Fee: $0.00 Issuance Fee: $35.00 Supplemental Fee: $0.00 Due at Permit Issuance : 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. 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). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) 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 improved 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 whobuildsor improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt 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 atleastone 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.gov/calaw.html. Signature of Properly owner or Authorized Agent Date UCEMSED CONTRACTOR'S DECLARATION I hereby affirm Vad'*nalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of. Division 3 of the Business and Professions Code, and my license is in full force and effect. Liceaae Class License No Date "1 -19 Contractor Signature IYORI(ERS' SbMP NSATION DECLARATION NARNING: 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 P94T.gF COMPE*Aj101 ,DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. , agrp�f affirm 411d& penalty of perjury one of the following declarations: .I• a 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 je or ce oft8awork for which this permit is issued. Policy No. M and wiu nyyntain 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' compensation nsrre a carriarand fJolicy number are: ler Policy Number Expiration Date me of Agent Phone # I certify that, in the performance of the 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 It, if I should become subject to a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant �-+ �� Dai CLARATION REG DING CO T T G AGENCY ereby 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). ider's Name Lender's Address 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 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 co my to � ed h abov - ' ' d roperty for inspection purposes. k�� /' nature of Prooertv Owner or AuthorizAcent Print Prooertv Owner's or Authorized AGent's Nam ate AC17ON DATE BY utLLrita+fv� ur uvmruAnrL mra uvvc ur tvR vttrct Ust ONLY FEDERAL REGULATIONS PART 61 OF Tf17 E40AND PERMIT EXPIRED AQMD RULE?463. f SUBMITTED ASBESTOS NOTIFICATION TO: PERMITCANCELLED ❑ EPA PERMIT EXTENDED ❑ AQMD PERA41TFINAL [ OPOS STOS MOJT CA770NIS NOT APPLICABLE TO CER77FICATEOF OCCUPANCYISSUED SIGNATURE: