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Home My WebLink AboutE2023-0006 - PermitsrEWPpRT City of Newport Beach Community Development Department- Building Division F 100 Civic Center Drive, Newport Beach, CA 92660 )� T Permit Counter Phone: (949) 644-3288 Inspection Requests Phone: (949) 644-3255 FUA newportbeachea.gov/inspectiDns 1111111111111111111111111111111111111111111111111111 jj Electrical Permit : E2023-0006 Plan Check No : PC2022-2689 Work Class : Other Issued Date : Inspection Area : 1 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS CPT:ice! C1 Job Address : 117 G ST Legal Desc : N TR 518 BLK A LOT 4 , v Description: ELEC-TEMP POWER POLE (XR2023-0017) Owner: MATTHEW CANADA Address: 546E MARIPOSA DR REDLANDS, CA 92373 Phone: Applicant: LEGACY C D M INC Address: 2618 SAN MIGUEL DR #204 NEWPORT BEACH, CA 92660 Phone : (949) 677-3650 Owner/Builder: Address Phone: Code Edition : 2022 Type of Construction : Building Setbacks : Front: 10, Side: 3, Side: 3, Rear: 10 Flood Zone : X Use Zone: R-1 - Single -Unit Residential PROCESSED BY: CA SPECIAL CONDITIONS: Contractor : LEGACY C D M INC Address : 2618 SAN MIGUEL DR #204 NEWPORT BEACH, CA 92660 Phone : (949) 677-3650 G Con State Lie : 962720Lie .,` v Expire ww`` \v®,� BusLiBT30043218 ��`Q\" Bus Lie Expire:05/31/2023 Workers' Compensation Insuranc Carrier : STATE FU b G G yr � Policy No: 9147240`� W. C. Expire: 11/24/2023 G Fire Hazard Zone : NO Occupancy Groups: OWNER -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 items) 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 io 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 7ofessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of $action 7031.5 by any applicant forepermit subjects the applicant to a civil penalty of of more than five hundred dollars ($500). 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) patens of the work, and the structure is not intended or offered for sale (Section 7044, tusiness 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 nprovements 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 nproved for the purpose of sale). I, as owner of the properly, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Slate License Law does not poly 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). 3 t am exempt frorn licensure under the Contractors' Slate License Law fur ilia following reesom _ iy my signature below I acknowledge that, exceptfor 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 all a structure that I have built as an owner -builder if it has not boon constructed in its entirety by licensed contractors.. I understand that a copy of the applicable law, Section 7044 of the Business and 7ofossions Code, is available upon request when this application is submitted or at the following Web site:http://w .loginfo.co.gov/calaw.html. signature of Property Owner or Authorized Agent Date ,ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of (vision 3 of the Business and Professions Code, and my license is In full force rid effect. License Class License No Dat 1 t Contractor Signaiur VORKERS' COMPENSATION DECLARATION 'ARNING: 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 LS100,000), IN ADDITION TO THE car OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37H OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: Tit 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 of the work for which this permit is issued. Policy No. _ 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' carrier and policy number are: Policy Number Date me of Agent Phone # I certify that, in the performance 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' compensatlon laws of Califomia, and agree t, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ,.nature of Applicant 1l . _ �._..-.y,_..........., .__m._.: CLARATION REGA I G C NSTRUCTION LENDING AGENCY sreby 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), Tders Name Lender's Address Iny 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 slate laws relating to building construction. I authorize representatives of this city or county to nter the above-idenlifie or inspection purposes. \' nature of Prooertv Owner or Authorized Anent � N%�f Print Pmnertv Owner'% nr Authorized Anent's Nam, 1. Dale r/-5 /t ACTION DAT F. 64 REGULATIONS OFCOMP OF WIT CODE AND FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE. 40 AND AQMD RULE PERMITEXPIRED j U I SUBMITTED ASBESTOS Nn-i IFICAI'UN TO PERMIT EXTENDED PERMIT FINAL ZE,2 . 1D U ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATEOF PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: