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Home My WebLink AboutE2017-0569 - Permits0 trap City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIII II Electrical Permit: E2017-0569 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 7 0 5 6 9 Project No : 1686-2016 'y Permit Counter Phone(949)644-3288 "tuvx¢& Inspection Requests Phone (949)644-3255 Job Address: 216 AGATE AVE Bldg: 1 Floor: Suite: Description of Work: ELEC DISCONNECT FOR A/C UNIT Inspector Area: 2 Legal Description: BALBOA ISLAND RESUB SEC 1 BLK 10 LOT 33 Owner: HILLMAN KAREN Contractor: JOSH LINDSAY BUILDERS Address: 20 BRENA Address: 9092 ENLOE WAY IRVINE CA 92620 0 GARDEN GROVE CA 92844 Phone: Phone: 714-271-4565 0-600V over 20OA: Con State Lic: 1002027 Issued Date:11/06/2017 Lic Expire: 03/31/2019 O/H to U/G Bus Lic: BT30057219 Processed By:-� Lic Exp Date: 11/30/2017 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 over 20OA: 0 $0.00 Over 600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 Fee : 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 m e Branch Circuit: 0 $0.00 Each Add Circuit: 0 $0.00 Time Clocks: 0 $0.00 Additional Fee : ee•e $0.00 FEES m $0.00 Motors/Transformers (HP/KVA) m.e.em 0 to 1 HP/KW/KVA: 0 < 1 to 10 HP/KW/KVA: Code Edit: 2016 $0.00 m e 0 e ••mono 0 meeeme • m e 0 ° e o e ee•e o 0 O° ° Worker's Compensation Insurance •eOeB• $0.00 Carrier: EVEREST Issuance Fee: .° o00 ee o Policy No: 7600017282, omoo •oo• _ ..moo Expire : 02/05/2018 0 °e.oco Fee Due at Permit Issuance: m e oom000 m o 0 . moemeem o 0 oo• 000moo o n • e mmmo 00 FEES 0 $0.00 Motors/Transformers (HP/KVA) Sub Panel: 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/remp Power: 0 $0.00 Temp Power Pole: 0 $0.00 Plan Check Fee: Temp Underground: 0 $0.00 Sub Panel: 1 $25.00 0 $0.00 0 $0.00 Record Mgmt Fee:- $0.00 Plan Check Fee: $0.00 Investigation Fee: $0.00 Issuance Fee: $33.00 Supplemental Fee: $0.00 Fee Due at Permit Issuance: $58.00 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 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, 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 ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or Im roved for the purpose of sale). I, as owner •; ftmg Property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not aa�plply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). adl.lam exemet from Vicensure under the Contractors' State License Law for the following reason: 8y my Signature`be%v;l acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and ;1rofeeslons Codg,iis javailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date 1.ICl;QISED CCNfRACTOR'S DECLARATION L 7erg12y affirm yIS$er penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wit Secn 7000) of Division 3 of the Business and rofess' n ode, and my license is in full force and effect. • •. MMA Class License No Dat /G / Contractor Sign 1A/aRKERS' F IQQVVSATION DECLARATION WARNING: FAILURE TO SECERE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T E HUNDRED THOUSAND DOLLARS ($760,6061, IN ADDITION TO THE OOaYOf C°OMPENSATIOl1•gAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. affirm $dLr 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 ormance of the work for which this permit is issued. Policy No. 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' carrier and policy number are: Policy Number of Agent Date 3I certify that, in the performance f 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 rat, if I should become b'ec kerss ensa ' ' ns of Section 3700 of the Labor Code, I shall forthwith comply with those rovislo 1 i PY P ignature of Applicant -- Date iECLARATION RE R G CONSTRUCTIO ING AGENCY hereby affirm under nalty of perjury th ere is a construction lending agency for the performance of the work for which this permit is issued Sectio r 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 di ces and state laws relating to building construction. I authorize representatives of this city or countH en r e above -identified property for inspection purposes. ACTION DATE ,f/ BY uLLLAMAricm UrwrvfruanLrVVIIn4Uu Ur nun Utrrrt UsE UrIEr ] FEDERAL REGULATIONS PART 61 OFTITLE40.AND PERMITEXPIRED AQMD.RULE1403. I SUBMITTED ASBESTOS N071FICATION TO: PERMIT CANCELLED ❑ EPA PERMITEYTENDED ❑ AQMD ❑ ASBESTOS NOTIRCADONIS MOTAPPLICABLE TO PERMITFINAL PROPOSED DEMOLITION. CERTIFICATE OF OCCUPANCYISSUED SIGNATURE: