HomeMy WebLinkAboute2022-0046 - Permits8 stJ City of Newport Beach - Building Division *E2022-0046*
c' tip 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Job Address: 1950 PORT CARDIFF PL Bldg: 1 Floor: Suite:
Description of Work: ELEC A/C DISCONNECT �g p 1 Y
Inspector Area: 4
Legal Description: N TR 6623 LOT 9
Owner: WEST JUSTIN
Contractor:
DEPENDABLE GRAHAM AC
Address: 1950 PORT CARDIFF
Address:
2952 CENTURY PLACE
NEWPORT BEACH, CA
COSTA MESA CA 92626
Phone:
Phone:
714-546-1653
Con State Lie:
472690
Issued Date:0112512022
Lie Expire:
04/30/2022
Bus Lie:
BT01013104
Processed By: _
Lie Exp Date:
1213112022
Electrical Permit: E2022-0046
Project No :
Inspection Requests Phone (949)644-3255
Code Edit: 2019
Worker's Compensation Insurance
Carrier: SERVICE AMERICAN
Policy No: SAMTWC0072800
Expire : 07/01/2022
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FEES
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 Underground:
0
$0.00
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
1
$29.00
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:
0
$0.00
Investigation Fee:
$0.00
Over 600V or 1000A:
0
$0.00
Time Clocks:
0
$0.00
Temp Power Pole:
0
$0.00
Issuance Fee:
$38.00
O/H to U/G
0
$0.00
Additional Fee :
$0.00
Supplemental Fee:
$0.00
TOTAL Fee:
$67.00
Plan Check Fee: $0.00
Fee Due at Permit Issuance :
$67.00
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.
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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 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).
I, as owner of the property, or my employees with wages as their sole compensation, will do U 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
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 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.Wow I 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 legall)
sell a structure't ill.IJPave 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
rofes ions Code, is %vailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Igriat of Property Owner or Authorized Agent
LJCENSED CONTRACTOR'S DECLARATION Date
hE�p9 affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with coon 7000) of Division 3 of the Business and rofe ns Code, a my lice se is in full force
and effect. •• // �tl
1censs,Class •••• License No Datei, !'-�j -ZZ Contractor Signature iJ�jy� K,
ORKERS' JgAPF•NSATION DECLARATION �`
WARNINOI FAILURE TO SPCURE 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
C891•QF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
t Illeby affirm under penalty, of perjury one of the following declarations:
I have and VAN 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 IN
pert finance of the work for which this permit is issued. Policy No.
..
Vihave and wiR fnairftain 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
r carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the perfo once 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 agre
It, if I should become su jec the workers' pensatipn provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi ion .
(nature of Applicant .CTe
CLARATION REGA N STRUC ION LENDING AGENCY
3reby 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 cou y ordinances and state laws relating to building construction.
I authorize representatives of this city or cou ty t er th aby�2-idenf d property for inspection purposes. / %� - /,/
nature of Property Owner or Authorized Agent �n i 1\ Print Property Owner's or Authorized Agent's NI \ //4k.TliLM /'I�ri4�,iLlyl Datd1[�1� S'—
AC77ON
DATE It
BY
DECLARATION OF COMPLIANCE 4NTH CODE OF
FEDERAL REGULATIONSPART 51 OF TIRE40 AMD
AQMD RULE 4403
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
El ASBESTOS NOTIFICATIONIS NOT APPLICABLE TO
PROPOSED. DEMOLITION.
SIGNATURE.
FOROFFICEUSEONLY
PERMIT EXPIRED
PERMIT CANCELLED
PERM€TEXTEIVOED
PERNFICATELOF
—
CERTIFICATE
OCCUPANCYISSUED