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HomeMy WebLinkAboutE2020-0182 - Permitsvut,� City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 E, Permit Counter Phone (949)644-3288 u p, �'�+taaati�s: Job Address: 218 COLLINS AVE Bldg: 1 Floor: Suite: Description of Work: ELEC/CHANGE OUT (E) OUTLETS Inspector Area: 2 Legal Description: BALBOA ISLAND SEC 3 BILK 11 LOT 19 Owner: JANSSEN TERRY Contractor: OWNER/BLDR Address: P.O. BOX 5380 Address: JANSSEN TERRY NEWPORT BEACH CA 92662 Receptacles/Outlets: AUTH W/X2020-0062 Phone: 949-933-0283 Phone: 0 $0.00 Con State Lic: O/B Issued Date:03/12/2020 Lic Expire: 0 /% ,�/�• `\��" Bus Lic: 0 Processed By: r 7 Lic Exp Date: New Construction 0 $0.00 Sub Panel: Receptacle/Switch/outlets Residential 0 to 1 HP/KW/KVA: 0 Receptacles/Outlets: 70 $70.00 Multi -Family: 0 $0.00 Fixtures: 36 $36.00 1-2 Family: 0 $0.00 Sep Circuits: 0 $0.00 Low Voltage 0 $0.00 Service Signs 0-600V up to 20OA: 0 $0.00 Branch Circuit: 0 $0.00 0-600V over20OA: 0 $0.00 Each Add Circuit: 0 $0.00 Over 600V or 1000A: 0 $0.00 Time Clocks: 0 $0.00 0/H to U/G 0 $0.00 Additional Fee : $0.00 E 20 2 0 0 1 8 2�� Electrical Permit: E2020-0182 Project No : 0075-2020 Inspection Requests Phone (949)644-3255 Code Edit: 2019 p Worker's Compensation Insurance l i Carrier: p� Policy No: ` J Expire Do FEES 0 $0.00 Sub Panel: 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 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: $0.00 Supplemental Fee: $10.00 Fee Due at Permit Issuance: $116.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:00 a.m. to 6:30ip.m. and Satl rdayffrom 8:00 a.m. to 6:00 p.m. GY Y Y• ♦ Y i0 ♦ Yi G L W ® O YO f Oyu Y • ♦iY 4 •• Y • {OD 9 Oifv C Y O U e• YiY Yi EY Y z 4Yi •YO )WNER-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 ie 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 'rofessions 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 got more than five hundred dollars ($500). 7 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, tusiness 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 nprovements 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 red for the purpose of sale). s 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 pply to an owner of property who builds or improves thereon, and who contracts f projects with a licensed Contractor pursuant to the Contractors' State License Law). I am exempt from licensure under the Contractors' State License L w for?<e folio ng reason: ly my signature below 1 acknowledge that, except for my personal r . Ide in wh' I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal ell a structure that I have built as an owner -builder if it has not be c truc n it entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and 'rofessions Code, is available upon request whe t s applica i'tt dn' ollowing Web site:http://www.leginfo.ca.gov/calaw.htmi. ;ignature of Property Owner or Authorized AgentDJ .ICENSED CONTRACTOR'S DECLA ON j` hereby affirm under penalty of perjury that I am licensed under pr Ions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force nd effect. icense Class License No Date Contractor Signature VORKERS' COMPENSATION DECLARATION IARNING: 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 OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under 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 th, erformance of the work for which this permit is issued. Policy No. 11 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' compensatior Isurance carrier and policy number are: 'wrier Po' y Number Expiration Date lame of Agent Phone # I certify that, in the performance rk f ich 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 Ia , if I should become skbject a on ovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisl ns. ignature of Appli DaaaO(J� DECLARATION R AR IN R ENDING AGENCY hereby affirm un r penalty o 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: am the property owner or authorized to act on the property o er shelf I have read this application and the information I have provi d' c rrec % Y 1 agree to comply with all applicable city and county ordi n d s r ing to building construction. I authorize representatives of this city or count t an roperty for inspection purposes. ignature of Property Owner or Authorized A an Print Property Owner's or Authorized Agent's Nam ACTION -DATE By DECLARATION OF COMPLIANCE IMTHCODEOF FOR OFFICE USEONLY • FEDE4ML•REGULARONS PART 61 OFTITLE40AND PERMiTEXPIR€D s•s • AQMQRULt 1403.: • i • •,—'4 • 0 :1 -%UBhV1T2D4SBE$TQS M071FICATION TO. PERMITCANCEILED • © BPA • PERMITEXTENDED ❑ AQMD ❑ ASBESTOS N071FICA170NIS NOTAPPLICABLE TO PERMITFINAL • frf;DPOJEQD�M.OLI CERTIFICATEOF OCCUPANCYISSUED 'VGVArUR% �•