HomeMy WebLinkAboutE2022-0390 - Permits•„ City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
5. + Permit Counter Phone (949)644-3288
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Job Address: 100 VIA FLORENCE Bldg: 1 Floor: Suite:
Description of Work: ELEC A/C DISCONNECT
Inspector Area: 2
Legal Description: N TR 907 LOT 972
Owner: RUSHMORE DAVID C
Contractor:
Address: 100 VIA FLORENCE
Address:
NEWPORT BEACH, CA 92663
Phone:
Phone:
Con State Lic:
Issued Date:06/30/2022
Lic Expire:
us Lic:
Processed By:
Lic Exp Date:
New Construction
Residential
Multi -Family:
1-2 Family:
Service
0-600V up to 20OA: 0
0-600V over 20OA: 0
Over600V or1000A: 0
O/H to U/G 0
(lull III I IIIII I III I IIIII II IIINI IIII I IINI II III IIIII
ALPS A/C & HEATING INC
1895 S SANTA CRUZ ST
ANAHEIM, CA 92805
714-633-8892
667953
04/30/2023
BT30047511
07/30/2022
Receptac I e/Switch/Outlets
Receptacles/Outlets:
1
$1.75
$0.00
Fixtures:
0
$0.00
$0.00
Sep Circuits:
0
$0.00
Low Voltage
0
$0.00
Signs
$0.00
Branch Circuit:
0
$0.00
$0.00
Each Add Circuit:
0
$0.00
$0.00
Time Clocks:
0
$0.00
$0.00
Additional Fee :
$0.00
39.75
Plan
Electrical Permit: E2022-0390
Project No :
Inspection Requests Phone (949)644-3255
Code Edit: 2019
•
°°•
Worker's Compensation Insurance
°
Carrier: INS OF THE WEST
Policy No:WSD506354500
Expire : 12/25/2022
oe
GO°O
FEES
Motors/Transformers (HP/KVA)
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
Piggy Back/Temp Power: 0 $0.00
Temp Power Pole: 0 $0.00
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:
$38.00
Supplemental Fee:
$0.00
Fee Due at Permit
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)
action 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 U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
mess 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
)ly 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:
my signary4e below 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)
a structurCfhVI 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
�fCFsions Cede! Is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm].
nature of Qroperty Owner or Authorized Agent Date
;EjJSED CONTRACTOR'S DECLARATION
neby of mn pnd%r penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 000 f Division 3 of the Business and P fe Ions ode, a is in full force
I affect. • -
gpse Class • • License No Da4l 2,,,) Contractor Signatur
JRKERS'COWIENSATION DECLARATION
44G: 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
iT OF COMPENSICfION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
:rebj affiiTnAdetpmalty of perjury one of the following declarations:
,I•43ve and will mantain 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 th
forrrPance of Ae work for which this permit is issued. Policy No.
Aa• ••
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' compensatiol
urm%e carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the performance of th Ork 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
lat, if I should become subject to the airs' compensatio s of Section 3700 of the Labor Code, I shall forthwith comply with those provigggio��-ns.
ignature of Applicant Date
ECLARATION REG TION LENDING AGENCY
hereby affirm under p n Iry that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ender's Name Lender's Address
y 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 correct.
agree to comply with all applicable city and count y ordina sand st s relating to building construction.
I authorize representatives of this city or courlty to ant > -Identified property for inspection purposes.
0
ACTION
DATE
BY
DECLARATION OF COMPUANCE VATH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART 61 OF TITLE40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO:.
❑ EPA
El AQMD..
PERMIT CANCELLED
PERMLTEXTENDED
❑ ASBESTOS NOTIRCATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSU€D