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HomeMy WebLinkAboutE2016-0734 - Permitsrby City of Newport Beach - Building Division c� 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 527 SANTA ANA AVE Bldg: 1 Floor: Suite: Description of Work: ELECTRICAL- PANEL UPGRADE Inspector Area: 2 iii►►►►�2��►►0�►►►���6��►������0��►►7 3►►►��4►� Legal Description: FIRST ADD TO NEWPORT HEIGHTS BLK 31 LOT 18 Owner: PAVLOVICH MATTHEW Contractor: OWNER/BLDR Address: 527 SANTA ANA AVE Address: PAVLOVICH MATTHEW NEWPORT BEACH, CA 92663 O/B ATTACHED Phone: Phone: Con State Lia O/B Issued Date:11/17/2016 Lic Expire: Bus Lic Processed By: Lic Exp Date: New Construction 0 $0.00 Receptacle/Switch/Outle Residential $0.00 Receptacles/Outlets: 0 Multi -Family: 0 $0.00 Fixtures: 0 1-2 Family: 0 $0.00 Sep Circuits: 0 $0.00 Issuance Fee: Low Voltage 0 Service $0.00 Signs 0-600V up to 20OA: 1 $41.00 Branch Circuit: 0 0-600V over 20OA: 0 $0.00 Each Add Circuit: 0 Over 600V or 1000A: 0 $0.00 Time Clocks: 0 O/H to U/G 0 $0.00 Additional Fee : TOTAL Fee: Electrical Permit: E2016-0734 Project No • 00 OC e me•mm• m Inspection Requests Phone (949)44-3255 • m s m• n m m •seem• m e c m m ea' o e e es•eo 9�p�� 5mvi A-�If..o. • m Code Edit: 2013 `•m.m mmmm o m. m ®.emm Worker's Compensation Insurance Carrier: Policy No: Expire : is Motors/Transformers (HP/KVA) $0.00 0 to 1 HP/KW/KVA: 0 $0.00 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 Over 100 HP/KW/KVA: 0 $0.00 $0.00 $0.00 Piggy Back/Temp Power: 0 $0.00 $0.00 Temp Power Pole: 0 $0.00 $0.00 Fee : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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: $33.00 Supplemental Fee: $0.00 Fee : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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: $33.00 Supplemental Fee: $0.00 Fee Due at Permit Issuance: DWNER-BUILMAIIIECLARATION :..6l;K;eby affiran under penalty of perjury that I am exempt from the Contractors' State License Law for the reason (a) indicated below by the checkmark(s) I have placed next to the applic;ietiten %) 5ection'7031.5; WiRgss 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 :PEpe%it 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 arofeseions 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 penally of int more than five Ywac6d dollars ($500). 1!a's 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, g"r"s and Piofesslons 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 ptpgovpMents &I 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 ed for the purpose of sale). s.owner pttpg pjoperty, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not g to 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). • � J PVexempj frQlnNipensure under the Contractors' State License Law for the following reason: 3y my signature below f 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 cell 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 th Business and Drofessions Code, is available upon request whethis ap on Is submitted or at the fo owing Web site:http:/lwww.leginfo.ca.gov/calaw.html. 7r Signature of Property Owner or Authorized Agent Date lf✓ LICENSED CONTRACTOR'S DECLARATIO 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. -icense Class License No Date Contractor Signature NORKERS' COMPENSATION DECLARATION YARNING: 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 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 1 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 thr Jerformance of the work for which this permit is issued. Policy No. :1I 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' compensation nsurance carrier and policy number are: Policy Number Agent Date irtify 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 I should becomes SI/abject to the r/,er1s' -compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. signature of Applicant 1l �` �� DatP- IECLARATIONREGA CONSTRUCTION LENDING AGENCY hereby affirm under penalty 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 Iy 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 ordinance and state laws relating to building construction. I authorize representatives of this city or couety to enter ove-identified property for inspection purposes. 1'' �ionature of PrODertv Owner or Authorized Aaent \ /� ���Print Property Owner's or Authorized Agent's Name K M Kc Q e V tlV, V Dag -_— 1 AC77ON DATE BY ur t..vmr"AUVUU Volo a-Vve yv rare. vrre�e we wr�� FEDERAL REGULATIONS PART 61 OFTI-ILE40AND AQMDRULE 1403. 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