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Home My WebLink AboutE2019-0219 - Permitsw City of Newport Beach - Building Division *E2019-0219* Electrical Permit: E2019-0219 a 100 Civic Center Drive, Newport Beach, CA 92660 Project No e: Permit Counter Phone (949)644-3288 0i� FEES '��r4vok .Inspection Requests Phone (949)644-3255 New Construction Job Address: 1240 BALBOA BLVD W Bldg: 1 Floor: Suite: Motors/Transformers (HP/KVA) Description of Work: £LEC/DISCONNECT TO AIC -0 M2019-0211 Residential S� 1 Inspector Area: 1 Receptacles/Outlets: F € , 2 Code Edit: 2016 h ' `ko iia Y Legal Description: 234 BILK 112 LOT 11 0 to 1 HP/KW/KVA 0 BEL DENNIS Contractor: OwnCatee:04 POLAR BEAR HTG & AIR Worker's Compensation Insurance AddW BALBOA BL D #B Address: 23422 PERALTA DR#G Carrier: MlD-CENTURY INS ORT BEACH, CA 92661 LAGUNA HILLS CA, 92653 Policy No: A09468247 Pho78-1950 Phone: 949-388-9484 Expire' 11/30/2019 Con State Lie: 968411 e e e e omee Issu2019 Lie Expire: 12/31/2019 11 oetlo e° 30 WIDE X 361, N eil l ° o Bus Lica BT30060265 2 - Processed By: Lie Exp Date: 04/30/2020 tlm° REQUIRED $0.00 FO:Ro.oto $0.100°' e tl e A/C DISC nntntc.�, , F 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. FEES New Construction Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) -0 Residential Receptacles/Outlets: 0 $0.00 0 to 1 HP/KW/KVA 0 $0.00 Temp Underground: a ° $6.00 Multi -Family: 0 $0.00 Fixtures: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 Sub Panel: q 0 $8.100` ° 1-2 Family: 0 $0.00 Sep Circuits: 2 - $14.00 10 to 50 HP/KW/KVA: 0 $0.00 ° mtl @ $0.100°' Low Voltage 0 $0.00 50 to 100 HP/KW/KVA 0 $0.00 ° 0 $0.00 - Service Signs Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00 0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 $0.00 Plan Check Fee: $0.00 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 10o0A: 0 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 0 $0.00 Issuance Fee: $35.00 O/H to U/G 0 $0.00 Additional Fee: $0.00 Supplemental Fee: $0.00' TOTAL Fee: $49.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $49.00 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. OWNER -BUILDER DECLARATION I hereby affirm under penally 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 apermit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the 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 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 not 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, Business 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 improvements 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 im 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 apply 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). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By 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 legall,. sell 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty 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 and effect. .... '/(, 21 /S, _ License Class `.... ` License No Date Contractor Signature— (,VORKERW OOMPENSATION DECLARATION l c NARNING'FAILURE TOSECURE 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 ;ft OP pOMPENSAT10N, DAMAGES A6 PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. 'herdtfy affirm under penalty of perjury one of the following declarations: e and wllf 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 th i rfor ce of toe wgrt for which this permit is. issued. Policy No. Iff♦� and wilt mairkain 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' compensation nsura Me carrier Sod policy number are: Policy Number Date Warttify thst,rl4 Otte *rformance of the work for which this permit is issued, I shall not employ any person in any manner se as to become subject to the workers' compensation laws of California, and agre t, if I should b9edn9ee ssuu¢)'act to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. mature of Applicant /" ri Date, CLARATION REG DING CONSTRUCTION LENDING AGENCY ;reby affirm under p nalty 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). lder'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 ar4r the above -identified property for inspection purposes. neh,m of Ornn.rfu n...nor nr A,Ahnroarl Annnf Y ��% Print Pmnedv flwncre nr Aufhnrncd AncnYe N�r vmu BVI �/ / AC77ON DATE BY DECLARATION OFCOMPLIANCE MTN CODEOF FOR OFRCE USE ONLY FEDERAL REGULATIONSPART 61 OFTITLE40AND AQMDRULE1403. PERMITEXPIRED ❑ I SUBMITTEDASBESTOS NODFICATION TO: 0 EPA 0 AQMD PERMITCANCELLEO PERMIT EXTENDED El ASBESTOS P OPOSEDDEMOU ON RONIS NOT APPUCABL.E TO PERMIT FINAL - CERTt€LCAT€OF OCCUPANCYISSUED SIGNATURE: