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Home My WebLink AboutE2019-0686 - Permitstv City of Newport Beach - Building Division 6 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 ��I� ��I II Project Electrical Permit: E2019-0686 Inspection Requests Phone (949)644-3255 Issued Date:10/10/2019 Lic Expire: 06/31/2021 Bus Lic BT97027460 Processed By: Lic Exp Date: 11/30/2019 New Construction Residential Multi -Family: 0 1-2 Family: 0 Service 0-600V up to 20OA: 0 0-600V over20OA: 0 Over 600V or1000A: 0 O/H to U/G 0 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 $0.00 Fixtures: 0 $0.00 $0.00 Sep Circuits: 2 $14.00 Low Voltage 0 $0.00 Signs $0.00 Branch Circuit: $0.00 Job Address: 4521 DORCHESTER RD Bldg: 1 Floor: Suite: Time Clocks: $0.00 Additional Fee: Description of Work: ELEC (2) DISCONNECTS (H2O19-0622) 10 to 50 HP/KW/KVA: 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 Over 100 HP/KW/KVA: 0 Inspector Area: 5 $0.00 Issuance Fee: Code Edit: 2016 $35.00 Supplemental Fee: $0.00 Qm.m®® Legal Description: N TR 3519 LOT 91 omom ° Owner: SHUSTERJUDY Contractor: OASIS AIR CONDITIONING Worker's Compensation lnsuranc Address: 3435 COLONY PLAZA Address: P 0 BOX 937 Carrier: NATIONAL LIBILITY ° NEWPORT BEACH CA 92660 SAN JUAN CAP CA 92693 Policy No: V9WC854146 am.mmm ®mm° Phone: Phone: 949-420-1321 Expire : 12/31/2019 ® ° Con State Lic: 767272 mmmm mmo�o Issued Date:10/10/2019 Lic Expire: 06/31/2021 Bus Lic BT97027460 Processed By: Lic Exp Date: 11/30/2019 New Construction Residential Multi -Family: 0 1-2 Family: 0 Service 0-600V up to 20OA: 0 0-600V over20OA: 0 Over 600V or1000A: 0 O/H to U/G 0 Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 $0.00 Fixtures: 0 $0.00 $0.00 Sep Circuits: 2 $14.00 Low Voltage 0 $0.00 FEES Signs $0.00 Branch Circuit: $0.00 Each Add Circuit: $0.00 Time Clocks: $0.00 Additional Fee: FEES 0 $0.00 Motors/Transformers (HP/KVA) 0 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: 0 $0.00 $0.00 $0.00 Piggy Back/Temp Power: 0 $0.00 $0.00 Temp Power Pole: 0 $0.00 $0.00 Plan Check Fee : mmmoo� mmmmm . o ° °mmcre opo° Temp Underground: 0 $0.00 Sub Panel 0 $0.00 0 $0.00 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 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. INER-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). ction 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 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 fessions 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 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 (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Iiness 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 rovements 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 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 ply 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 exempd4roR'ulicensure under the Contractors' State License Law for the following reason: i signature belowl 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 '§Qucture JIM t A ve 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 fessions Code, -is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. nature of Property Owner or Authorized Agent Date I&SED CCINT"CTOR'S DECLARATION 'reby affirm tnW*nalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sect 7000) of Division 3 of the Business ?DRED s Code, an license is in full force :nee Class • • License No Date Contractor Signature YRARS' CO.MIDENSATION DECLARATION :AM§: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE THOUSAND DOLLARS ($100,000), IN ADDITION TO THE T 06 COMPEW*QTpa,•bAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. orbit affirm under penalty of perjury one of the following declarations: t tlave ancli 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 thI 'ormance of fhe'v3ork for which this permit is issued. Policy No. e 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' ^e carrier and oil cry�Fn�'u�m��bar are: f� S OV, 1 1 `4E: C,�.D C S i Policy Number Expiration Date Tie of Agent rnone a certify that, in the per' ante of the work for which this permit is issued, I shall not employ any person in any manner so as to become subj/(Se to/E workers' compensation laws of California, and t, if I should beco ` u ' rt a worke p ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pature ofApplicant DCLARATION REGAR CONSTRU TION LENDING AGENCYareby affirmunder pe altyofperjurythat there isaconstructon lending agencyforthe performane oftheworkforwhich this permitisissued ction 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. 1 agree to comply with all applicable city and county oIlLinances and state laws relating to building construction. I authorize representatives of this city or county r t e abov = eRtiiie9-p operty for inspection purposes. ,��/� � �9 / f nature of Property Owner or Authorized Agent 5 Print Property Owner's or Authorized Agent's Name `-�lZt �� t./�Tt-</ �lfd%�� _ ! `iU ACTION DATE &Y DECLARATION OF COMPLIANCE KITH CODEOF FOR IIFFIC€OSEO Y FEDERAL REGULATIONS PART 6S OF TITLE40AND AQMD RULE 1403. P€RMITEXPIR€D ISUBMITTEDASBESTOS NOTIFICATIONTO; ❑ EPA ❑ AQMD PERMIT CANCELLED P€RMIT€XT€NDED ❑ ASBESTOS NORRCATIONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMITFINAL CERTIFICATEOF SIGNATURE: OCCUPANCYISSUED