HomeMy WebLinkAboutE2016-0695 - PermitsLo City of Newport Beach - Building Division 11JI1111111111111111111111111111111p1111111111111111 JillElectrical Permit: E2016-0695
a. '� 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 6 0 6 9 5 Project No
°.,, Permit Counter Phone (949)644-3288
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'nx4rw�9.s - Inspection Requests Phone (949)644-3255
job Address: 1964 VISTA CAUDAL Bldg: 1 Floor: Suite:
Description of Work: ELEC/INSTALL A/C UNIT 46dB (RHEEM; RCQ3621-36) W/DUCT WORK
Inspector Area: 8 Code Edit: 2013)y'��yvvv����
Legal Description: TR 5435 (L.L. A
WaU�eo AAD Y
Owner: FABER MICHAEL/CYN HIA Contractor: OWNER/BLDR Worker's Compensation Insuranl e .
Address: 1964 VISTA CAUDAL Date•-AddFess. �FABERMICHA �f 3�f]{ICc f r
NEWPORT BEACH, C 92660 Policy No:
❑ 8010 &ET 100 !o refund
Phone: 714-396-0896 Pho o it o
ConCtateic: B
Issued Date:11/03/2016 LicBus NCELE to Whom:
Processed By: Lic Exp Date:
'd
Room
F
New Construction Receptacle/Switch/Outlets Motors/Transformers (HP/KVA)
Residential Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0 $0.00 Temp Underg und: 0 $0.00
Multi -Family: 0 $0 0 s: 0 $0.00 1 to 1 P/ W/KVA: 0 $0.00 Sub Panel: 0 $0.00
1-2 Family: 0 $0 0 e �1 $BQ 10 to 0 H K 0 0 $0.00
0 1 lI i�pb0 A 50 to /Ke ird plan $0.00
Service Sign v�rn Sr Over 100 HP/K /KVA: 0 $0.00 Record M mt as: $0.00
0-600V up to 20OA: 0 $0. 0 Bran�tt("rr�uR:3tiarl�Ci� $0,00 (no Work starter!) Plan Check Fluance:
: $0.00
0-600V over 20OA: 0 $0. 0 Each Add Circuit: 0 $0.00 Piggy Back/Temp Power: 0 $0.00 Investigatione: $0.00
Over 600V or 1000A: 0 $0. oNote: Time Clocks: 0 $0.00 Temp Power Pole: 0 $0.00 Issuance Fee $33.00
O/H to U/G TOTAL Fee : $39.0 ona ee : -PtamCheck-Fee-:--$0-00 Insiy, tf iV8401t� ®Rtls $39.00 $0.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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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 applicalrie item (a)
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 applicinit for
he 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
)rofessions 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
I ore than five hundred dollars ($500).
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,
3usiness 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
mprovements 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 itwas not built or
reproved for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not
Ipply 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 Licensa the foil wing reason:
iy my signature below I acknowl f m pp.-mgn i e in I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legalh
:ell a structure that I have built a an owner -builder if it has a tfi E¢by'lieer3sed�sontta®tmrsr.breRde'it^^ ' ^' ^D' ^` `H aDD1jgVp�� law Section 7044 of the Business and
'rofessions Code, is available u on re est whe t a i or a ollowing Web site:http://www.leginfo.ca.gov/calaw.html. ,f ? 6
signature of Property Owner or thori D !� 1
.ICENSED CONTRACTOR' DECLARAT O if applicable:
hereby affirm under penalty of rjury. that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professic s Code, and my license is in full force
Ind effect. ; 0 80% ((11T� (�j 1�0%
.icense Class nse to Cbht o a erb'fUrld
VORKERS'COMPENSATI N D LARA N
/ARNING: FAILURE TO SECURE WOR RS' C COVE UNWFUL, N HA U E T AL Q€bA'U��S('�IVIL FINES UP TO ONE HUNDRED THO AND DOLLARS (E100,000), IN ADDITION TO THE
:OST OF COMPENSATION, DAMAGES PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm undeJ of erju follow'n eclarations:
I have and will a ertifi to of co gent t e -insu Ar�w cer c p sa�' b 'rector of Industrial Relations as provided for by ection 3700 of the Labor Code, for th
erformance of the hi this ermit is ued. No
71 have and will mor ers' n ins , a eq y Sec n 00 tor the performance of the work for which this pe it is issued. My workers' compensatiol
isurance carrier anu er are:
:arrier Policy Number Expiration Date
lame of Agent Phone #
� YI certif that, in tha e k fQQr ��I h ,ry9ggt����yy,,`� Is s h�II�Iof em Io a er ni an se agBB��tt a 33 tF vorkers' mp nsation laws of California, and agre
ifI should becoc ' cbRl�ia so�Hsio f d6 X00 of the La p e, I h alt th hole 1�r rlianatureofADDlica(Work R4^rtiz(A1 i�_ .. _« i �v Dat
areby affirm under penalty o er)I hat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ Code).
ider's Name V\�07P' Lender's Address
my signature below, I certih to each of the o owing:
I am the property owner o authorized to act on the property o ner's behalf.
I have read this applicatio andiFe inrorma I nest lnsp. Initials:
agree to comply with all i - - ruction. 11/s
1 authorize representatives of this city or county to r e-iden " y for inspection purposes.
^�«u ru of Pr^no HV n... AiIHV ri,. I AOcnf Print Prooertv Owner's or Authorized Aqent's Name Dj)�
ACTION
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