HomeMy WebLinkAboutE2019-0046 - Permits,xti,R City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 9 0 0 4 6
* Permit Counter Phone (949)644-3288
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Jo¢ Address: 10 VINTAGE DR Bldg: 1 Floor:
Suite:
Description of Work: ELEC CAR CHARGER
*OWNER/BLDR FORM ATTACHED*
Inspector Area: B
Legal Description: N TR 15390 LOT 47
Owner: GRUBB GAYLE & BARABARA
Contractor: OWNER/BLDR
Address: 10 VINTAGE DR
Address: GRUBB BARABARA
NEWPORT BEACH, CA 92660
Phone:
Phone:
Con State Lic: O/B
Issued Date:01/28/2019
Lic Expire:
Bus Lic:
Processed By: u
Lic Exp Date:
New Construction
Receptacle/Switch/Outlets
Residential
Receptacles/Outlets:
1
$1.00
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
1-2 Family:
0
$0.00
Sep Circuits:
1
$7.00
Low Voltage
0
$0.00
Service
Signs
0-600V up to 20OA:
0
$0.00
Branch Circuit:
0
$0.00
0-600V over 20OA:
0
$0.00
Each Add Circuit:
0
$0.00
Over600V orIOOOA:
0
$0.00
Time Clocks:
0
$0.00
O/H to U/G
0
$0.00
Additional Fee:
$0.00
FEES
Electrical Permit
Project No :
E2019-0046
Inspection Requests Phone (949)644-3255
Code Edit: 2016
Worker's Compensation Insurance
Carrier :
'
Policy No:
T ,
Expire
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 Backrremp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Check Fee : $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:
$35.00
Supplemental Fee:
$0.00
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).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
,iness 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 :hat 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).
1, 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
#y_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).
J I am exeradt f,om licensure under the Contractors' State License Law for the following reason:
ly my signatrr^. h-ilow 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
ell L structure that' have built as an owner -builder i it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, S
'rofrssions Cole, i, available upon request when t is, application is submitted or at the Ilowing Web site:http://wW .leginfo.ca.gov/calaw.html.
lignature of Property Owner or Authorized Agent TIC /
.ICENSED CONTRACTOR'S DECLARATI N
hereby affirm urder penalty of perjury that I am 4censed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions
nd Effect.
icense Class License No Date Contractor Signature
CGMPENSATION DECLARATION
red
py tins permit, I cannot legal
t 044 of the Business and
and my license is in full force
WARNING: FAILURE r0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUW ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000(, IN ADDITION TO THE
33r.T LF COMPEN5ATIOV, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereLy affirm urloer penalty of perjury one of the following declarations:
C I hive and A'�II 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 thr
pe,io.mance of'hs v•ork 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'
ranee carrier and policy number are:
Policy Number
of Agent
Date
]I certify that, in the perifimance of the work for which this permit i sued, I shall not employ any person in any manner so as to become subject to th orkers' compensation laws of California, and agre(
tat, if 1 should become rG ject he workers' compensation pr ns of Section 3700 of the Labor Code, I shall forthwith comply with those provisio
lignature of Applicant jjt/ 1pI--{ Date
IECLARATION REGA DI CONSTRUCTION LENDING AGENCY
hereby affirm under penalty of perjurythat there is a construction lending agency for the performance of the work for which this permit is issued (r ction 3097, Civil Code).
Ender's Name Lender's Address
ly 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 Eve provided is correct.
I agree to comply with all applicable city and co my ordinances and state laws relating to building construction.
I authorize representatives of this city or count to an the abo�ve-identified �r ert,y nfor inspection purposes. �J
lignature of Property Owner or Authorized Agent T1 �ImL.✓✓Y,(ic�C .F f2cs /� Print Property Owner's or Authorized Agent's Name 17 A- b a:C± 6 n J b ri Date
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY 1
FEDERAL REGULATIONSPART 61 OFTITLE40AND
AQMD RULE 1403.
L
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIRCATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT CANCELLED
PERMITEXTENDED
PERMIT FINAL
CERTIFICATEOF
SIGNATURE:
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