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Home My WebLink AboutE2019-0320 - Permits(9) City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 1119 DOLPHIN TER Bldg: 1 Floor: Suite: Description of Work: ELEC -TEMP POWER POLE (X2019-1575) Inspector Area: 2 Legal Description: N TR 1700 LOT 1 Owner: DOLPHIN LLC Contractor: Address: PO BOX 7067 Address: NEWPORT BEACH, CA 92658 Phone: 949-698-2256 Phone: Con State Lic: Issued Date:05/1712019 Lic Expire: Bus Lic: Processed By: _ Lic Exp Date: New Construction Residential Niul!i-Family: 1-9 Family: Service U-600V up :C ^_OOA: 0 0-600V over 2CCA: 0 Over 600V er 1000A: 0 O/H to U/G 0 TOTAL IIIIIIIIIIIIIIIIIIIIIIIIII II Electrical Permit: E2019-0320 E 2 0 1 9 0 3 2 0 Project No : 1880-2018 JACK W MITCHELL 2902 CALLE HERALDO SAN CLEMENTE, CA 92673 949-498-3127 988218 11130/2019 BT30055847 07/31/2019 Inspection Requests Phone (949)644-3255 Code Edit: 2016 Worker's Compensation Insurance Carrier : WC EXEMPT Policy No: (NO EMPLOYEES) Expire FEES Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA: 0 $0.00 Temp Underground: 0 $0.00 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 Sub Panel: 0 $0.00 $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 Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00 $0.00 Branch Circuit: 0 $0.00 Plan Check Fee: $0.00 $0.00 Each Add Circuit: 0 $0.00 Piggy Back/Temp Power: 0 $0.00 Investigation Fee: $0.00 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 1 $38.00 Issuance Fee: $35.00 $0.00 Additional Fee : $0.00 Supplemental Fee: $0.00 99 nn Plan rhnr4 F.. - an nn Fee Due at Permit Issuance $73.00 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. )WNER-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) Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, pdorto its issuance, also requires the applicant for is 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 [Censure 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 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, lusiness 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 property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not pply 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: y my signature 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 legally ell a structure that I 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 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. lignature 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 70 ) of Division 3 of the Business and Pr fa SIG Code nd my lice a is in full force nd effect. icense Class License No Da Contractor Signature VORKERS' COMPENSATION DECLARATION IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN R THOUSAND DOLLARS ($100,000), IN ADDITION TO THE OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37D6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I have and 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 o` the Labor Co4R,.fay thl erformance of the work for which this permit is issued. Policy No. 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' compsalustiar rance carrier and policy number are: 'ier Policy Number Expiration Date _ 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' compensation lawe of•Cclifornia, and agree t, if I hould become subj o t workers' c mpenaation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /y tu4A Applica Date 7 _ CLARATION RE R ING ON TRUCTIO L NDING AGENCY ereby affirm under penalty o perjury that there is a construction lending agency for the performance of the work for which this pemnt is issued (Sect) n 3097. Civil Code). ' Ider'a 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 tcyetlterle ov = ified property for inspection purposes. /; (y nature of Property Owner or Authorized AgenY� �� Print Property Owner's or Authorized Agent's Name,y� 19( \\ rn ��C `1� (l Date/� %�� 7 ACTION DATE BY DECLARATION OFCOMPLIANCE MTHCODEOF FOR OFACE U5E ONLY FEDERAL REGULATIONS PART 61 OF TITLE40AND AQMD RULE 1403. PERMITEXPIRED ❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED ❑ ASBESTOS M077RCANONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL CERTIFICATEOF OCCUPANCY)SSUED SIGNATURE: