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Home My WebLink AboutE2021-0349 - Permitsh. City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 `- Permit Counter Phone (949)644-3288 u '�xlassa� Job Address: 121 45TH ST Bldg: 1 Floor: Suite: Description of Work: ELEC/OVERHEAD TO UNDERGROUND Inspector Area: 1 Legal Description: RIVER SECTION BLK 45 LOT 23 IIIIII'lll�llllll'IIIIIIIIIIIIIII II Electrical Permit: E2021-0349 E 2 0 2 1 0 3 4 9 Project No: Inspection Requests Phone (949)644-3255 Code Edit: 2019 Owner;VENT LC Contractor: OWNER/BLDR Worker's Compensation Insurance AddresHTCIR Address: Carrier: ACH CA 92660 Policy No: Phone Phone: Expire Con State Lie: O/B Issued Lie Expire: .... Bus Lie:roces Lic Exp Date: . . . FEES '• '• •B° NewConstructi Receptacle/Switch/Outlets Motors/TransformerS(HP/KVA) o° Residential Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0 $0.00 Temp Underground: °..°.Q KIM ° Multi -Family: 0 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 Sub Panel: ° 0 $O..W* 1-2 Family: 0 $0.00 Sep Circuits: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 _. .0 $DVIX Low Voltage 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 0 *..d $D.00 Service Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: . $$1OW 0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 $0.00 Plan Check Fee: : ° ° ° ° ° $V0V ° 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: $37.00 O/H to U/G 1 $46.00 Additional Fee: $0.00 Supplemental Fee: $0.00 TOTAL Fee: S83.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $83.00 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). J I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U portiol ;usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, thr' nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of nproved for the purpose of sale). 1 I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Cont I am exempt from licensure under the Contractors' State License Law for the following reason: Iy my signature below I acknowledge that, except for my personal residence in which I must have resided for at least ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractor. 'rofessions Code, is available upon request w I ap lic non subrgI e� or at the following Web site:http://wwa ',ignature of Property Owner or Authorized Agent ,A &4p ,f"')'1/ t .ICENSED CONTRACTOR'S DECLARATIO0 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7C nd effect. icense Class License No Date VORKERS' COMPENSATION DECLARATION 'ARNING: FAILUV*rt3tr.URE WORKERS' COMPENSATION COVERAGE Is UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL DST OF COMPENSA610N, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ba e4affirm wwderpenalty of perjury one of the following declarations: I t;Ve and'will Vaintain a certificate of consent to self -insure for workers' compensation, issued by the Dire1 e*rmence of the work for which this permit is issued. Policy No. JI have and A naaiotain workers' compensation insurance, as required by Section 3700 of the Labor Code, for sdr6npCe carrier'aod policy number are: TUL Policy Number that, irLthepprformance of the work forwhich this permit is issued, I shall not employ any person in any could he-m oe:subj^ect to�HewDrJfers' coLm�pen/slation provisions of Section 3700 of the Labor Code, I shall ` of Applicant . � a �.✓I AA�f- 0 �/ �' Ireby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for 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 county to er a abov�!-ideIfied property for inspection purposes. nature of Property Owner or Authorized Agellt� /. 1,411L Kam// � Print Property Owners of the work, and the structure is not intended or offered for sale (Section 7044, gh employees' or personal effort, builds or improves the property, provided that the )mpletion, the Owner -Builder will have the burden of proving that it was not built or Business and Professions Code: The Contractors' State License Law does not pursuant to the Contractors' State License Law). ne year prior to completion of the improvements covered by this permit, I cannot I understand that a copy of the applicable law, Section 7044 of the Business and Date of Division 3 of the Business and Professions Code, and my license is in full force Contractor Signature AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE of Industrial Relations as provided for by Section 3700 of the Labor Code, for performance of the work for which this permit is issued. My workers' Date so as to become subject to the workers' compensation laws of California, and agre I comply with those provlsl ns. D e S�zT� I this permit is issued (Section 3097, Civil Code). Name Date ACTION DATE BY DECLARATION OF COMPLIANCE tMTH CODE OF FOR OFFICE USEONLY FEDERAL REGULATIONSPART61 OFT17LE40AND AQMD RULE 1403. PERMIT EXPIRED ❑ 1 SUBMffTTEDASBESTOS NORFICATION TO:. ❑ EPA ❑ AQMD PERMIT CANCELLED PERMITExTENDED ❑ ASBESTOS NORRCATION IS NOT APPLICABLE TO PROPOSEDDEMOLfTION. PERMIT FINAL p 1Z CERTIFICATEOF SIGNATURE: OCCUPANCYISSU€D