HomeMy WebLinkAboutE2017-0091 - PermitsrN City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIII II
o -- 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 7 0 0 9 1
Permit Counter Phone (949)644-3288
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Job Address: 1215 BALBOA BLVD E Bldg: 1 Floor: Suite:
Description of Work: ELEC/TEMP POWER POLE
X2017-0656
Inspector Area: 1
Legal Description: BALBOA TR EAST SIDE ADD LOT 7 BILK 20(AND WLY1/2 LOT 8 BLK 20
Owner: TYSON FAMILY TRUST
Address: 21731 TURA BLVD #300
WMDLANEk HILLS. CA 91364
Phone:
Issued
Processed
New Construction
Residential
Multi -Family:
0
$0.00
1-2 Family:
0
$0.00
Service
0
$0.00
0-600V up to 20OA:
0
$0.00
0-600V over20OA:
0
$0.00
Over 600V or 1 OOOA:
0
$0.00
O/H to U/G
0
$0.00
TOTAL
Fee:
$46.00
Contractor:
Address:
Phone:
Con State Lic:
Lic Expire:
Bus LIC:
Lic Exp Date:
TONY VALENTINE CONST INC
700 CARNATION AVE
CORONA DEL MAR CA 92625
949-723-6449
467553
04/30/2018
BT00021099
02/28/2018
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
Fixtures:
0
$0.00
Sep Circuits:
0
$0.00
Low Voltage
0
$0.00
Signs
$0.00
10 to 50 HP/KW/KVA:
Branch Circuit:
0
$0.00
Each Add Circuit:
0
$0.00
Time Clocks:
0
$0.00
Additional Fee:
$0.00
Electrical Permit: E2017-0091
Project No: 0536-2016
Inspection Requests Phone (949)644-3255
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OR
Code Edit: 2017
C
Worker's Compensation Insurance ••••
Carrier: STATE COMP INS FUND •••e
Policy No: 1794693 ••
e e
Expire : 07/01/2017 ••
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0
FEES
Motors/Transformers (HP/KVA)
0 to 1 H P/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
Plan Check
Piggy BackfTemp Power: 0 $0.00
Temp Power Pole: 1 $36.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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e m
Temp Underground: .10
Sub Panel: 0
0
0
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
Fee Due at Permit Issuance:
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$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$10.00
VNER-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)
fiction 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
ifessions 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,
siness 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 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
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
ifessions Code• ig.yailable upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.html.
nature of Property Owner or Authorized Agent Date
-W.S.ED CONTRACTOR'S DECLARATION
)reby affirm uederpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
I effect. .0
a%q.tlass • License No Date <�'/Contractor Signeture�z9��
JRKERS' COAAI?EEISATION DECLARATION
khelFAILURE TS•SECITRE 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 COMPENSAVIO111,0AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
:reby offirm underpenalty of perjury one of the following declarations:
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 of the Labor Code, for
a o workfor which this permit is issued. Policy No.
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'
number are:
Policy Number
Date
lame of Agent rnone s
71 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 laws of California, and agree
eat, if I should become subject to the woork/ers' com sation rovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
signature of Applicant/ J ;;g= p D �
IECLARATION RECyARDING CONSTRUCTION LENDING AGENCY 11
hereby affirm undegpenalty 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)
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 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 ter the ab v-ide9tifi d property for inspection purposes.
��/� Print Prooertv Owner's or Authorized AGent's NaRn D ✓ /
ACTION DATE BY
FEDERAL REGULATIONS PART 61 OFTITLE40AND
AQMDRULE 1407
P€RML7EYPtR€D.
❑ I SUBMITTEDASRESTOS AIDRFiCATION T0:
❑ EPA
❑ AQMD
PERMLTCANCELLED
PERMITEXTENDED
❑ ASBESTOS N077FICAJIONIS NOTAPPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERMITFINAL .\`j-
C€RRFICATEOF
OCCUPANCYISSUED
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