HomeMy WebLinkAboutE2019-0195 - Permits,1 City of Newport Beach - Building Division
-' 100 Civic Center Drive, Newport Beach, CA 92660
Y Permit Counter Phone (949)644-3288
11p111111111111111111111111111111111111 11 Electrical Permit: E2019-0195111111111Project
Job Address: 188 HARTFORD DR Bldg: 1 Floor: Suite:
Description of Work: ELEC A/C DISCONNECT (H2O19-0168)
Inspector Area: 8
Legal Description: TR 11604 LOT 5 UNIT 113 OF PROJECT LOCATED ON AP 442-291-40
TOGETHER
Owner: BURKE SHEILA MARIE
Contractor:
Address: 188 HARTFORD DR
Address:
NEWPORT BEACH, CA 92660
$0.00
Phone: 949-244-5556
Phone:
BURKE SHEILA MARIE
Con State Lic:
Issued Date:04/03/2019
Lic Expire:
�/�
Bus Lic:
5`k✓
Processed By: 5i)4\ \
Lic Exp Date:
New Construction
Residential
Multi -Family:
0
$0.00
1-2 Family:
0
$0.00
Service
o
BURKE SHEILA MARIE
0-600V up to 20OA:
0
$0.00
0-600V over20OA:
0
$0.00
Over 600V or 1000A:
0
$0.00
O/H to U/G
0
$0.00
Inspection Requests Phone (949)644-3255
Code Edit: 2016 ell
e•e•
OWNER/BLDR
Worker's Compensation Insurance
$0.00
'.. °
0
$0.00
e
o
BURKE SHEILA MARIE
Carrier.
•
•°°• m
$0.00
Branch Circuit:
0
$0.00
„°°°
0
Policy No:
Time Clocks:
0
$0.00
Additional Fee :
$0.00
Supplemental Fee:
Expire:
$0.00
...°°o
Cis
...®.•
° °
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
Fixtures:
0
$0.00
Sep Circuits:
0
$0.00
Low Voltage
0
$0,00
Signs
0
$0.00
Branch Circuit:
0
$0.00
Each Add Circuit:
0
$0.00
Time Clocks:
0
$0.00
Additional Fee :
$0.00
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 Back/Temp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Plan Check Fee:
Temp Underground:
0
$0.00
Sub Panel:
1
$26.00
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
Fee Due at Permit Issuance:
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.
VNER-BUILDER DECLARATION ti
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)
action 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
ifessi ns 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
m e 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 (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
ass 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
)ro ements 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 owns. 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
fly to an ou0ve9r of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
, Lim exerept from licensure under the Contractors' Stale License Law for the following reason:
mysignaturebebw 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 tflat I have built as an owner -builder if has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 044 o the usiness and
QP,s'sIons Coda,� available upon request when t s icati is sub dor ffie following Web site:http://www.leginfo.ca.gov/calaw.html.
nijture of PfEpertyAwner or Authorized Agent Da
TENSED COAiI•RACTOR'S DECLARATI N
Aeby affirrM•urt{fef penalty of perjury that I am icensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions HE. and my license is in full force
1•elfect.
Etta Class • License No Date Contractor Signature
)WERS' COP
lFI�NSATION DECLARATION
ININd'. 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 ($100,000), IN ADDITION TO THE
IAOflCOMPENSQT�ON, DAMAGES AS PROVIDED FOR IN SECTION 9708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
baby affirm erldp: penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the
formance of the work for which this permit is issued. Policy No.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
rance carrier and policy number are:
Policy Number
Date
ne of Agent )'none a
certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to/he workers' compensation laws of California, and agree
t, if I should becomPICONSTRUCTION
workers' mpe sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi ons. �J
nature of ApplicanDat
CLARATION REGLEND) G AGENCYrreby affirm underury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ider's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct. If
I agree to comply with all applicable city and county ordinances and state laws relating to building construction. (((��� ///
I authorize representatives of this city or county loi$pter t��a above:i ntifie property for inspection purposes. ,//� '// `�
nature of Prooertv Owner or Authorized ADent ��/i� l�P-N i fs \ . Print Property Owners or Authorized Agent's Na/e �' "" � V D to i Jl
ACTION DATE BY I' DECLARATIONOFCOMPLIANCEWITHCODEOF R r I FOR OFFICE USE ONIf
PERMITEXPIRED I I I
PERR9fTCA14CEII-ED
PERMIT EXTENDED
PERMITFINAI I `&J I.1 It -,W% I
❑ I SUBMITTED ASBESTOS NOTIFICATION TO.
❑ EPA
AQMD
❑ ASBESTOS NOTFIRCATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
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