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HomeMy WebLinkAboutE2021-0387 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Electrical Permit: E2021-0387 Project No : 1459-2021 Inspection Requests Phone (949)644-3255 Job Address: 1221 SURFLINE WAY Bldg: 1 Floor: Suite: Description of Work: ELEC TO BBQ (S2021-0150) P,N Inspector Area: 6 Code Edit: 2019 Legal Description: N TR 6113 LOT 9 Owner: WILD FOREST Contractor: INSTANT POOLSCAPES Worker's Compensation Insurance •••• Address: 1221 SURFLINE WAY Address: 833 DOVER DR#24 Carrier: WC EXEMPT °....° CORONA DEL MAR, CA 92625 NEWPORT BEACH CA 92663 Policy No: (NO EMPLOYEES) •°•• e•••° %'> Phone: Phone: 949-795-0648 Expire: Con State Lic: 1009644 • °° •° Issued Date:06/28/2021 Lic Expire: 12/31/2021 °. Bus Lic: BT30053469 0 •..° .° .° Processed By: Lic Exp Date: 12/31/2021 °° • °° ° ..°°° New Construction Residential Multi -Family: 0 $0.00 1-2 Family: 0 $0.00 Service 0-600V up to 20OA: 0 $0.00 0-600V over 20OA: 0 $0.00 Over600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 TOTAL Fee : $38.75 Receptacle/Switch/Outlets Receptacles/Outlets: 1 $1.75 Fixtures: 0 $0.00 Sep Circuits: 0 $0.00 Low Voltage 0 $0.00 Signs Branch Circuit: 0 $0.00 Each Add Circuit: 0 $0.00 Time Clocks: 0 $0.00 Additional Fee : $0.00 Plan FEES 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 Sub Panel: Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: Fee Due 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. •° ° 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 $37.00 $0.00 INER-BUILDER DECLARATION s 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) .ction 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 �fessions 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 more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, ;iness 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 uovements 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). 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 )ly 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). I am exempt from licensure under the Contractors' State License Law for the following reason: 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 IegallN 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 Ifessions Code, is available upon request when this application is submitted or at the following Web site:http://www. leginfo.ca.gov/calaw.html. nature of Propeoty Owner or Authorized Agent TENSED Cbag'RdCTOR'S DECLARATION g%*affirm un{1¢69enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profs sio ce i effect. anse Class �� License No Date �z��Z Contractor Signature )RKERS' CQMPANSATION DECLARATION R;JIN& FAILURLI'[0 SECBRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL ION TO THE STAG �OMPENSA rON, dAMAGES AS PROVIDED FOR IN SECTION 3766 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.. r1%4 affirm gp8eri5gralty of perjury one of the following declarations: T ASmaintain 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, or t fcomance of the work for which this permit is issued. Policy No. have and 4I:pi9i nIain 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' compensatiol hOrkp carrier pd pslicy number are: (ration Date PAr Expiration Policy Number Agent Phone #. cep ify that, in the pert mance of the ork for which this ermit is issued, I shall not employ any person in any manner so as to become subject to the workers: compensation laws of California, and agre If I should become bje t'to compen provisions ction 3700 of the Labor Code, I shall forthwith comply with those provisions. / nature of Applicant Dai'• hereby affirm under penalty perjury t at 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 ly 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 h rovide Tec I agree to comply with all applicable city and ou y ordinance s to laws r ullding construction. I authorize representatives of this city or y'/unety t enter above -Ids ifi property for i pection purposes. s... nfi—..r Dr—%F r—.. r nr Ai dhnrl7cH o' aof Print Prooertv Owner's or Authorized Agent's Name ACTION DATE BY FEDERALREGUtAT10NSPARTri10FTiTLE4©AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO:. ❑ EPA ❑ AQMD' PERMIT EXPIRED PERMITCANCELLED PERMITEXTENDED ❑ ASBESTOS NO77F1CATIONISNOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE., PERMITFINAL CERTIFICATEOF OCCUPANCYISSUED FOR OFFICE USE -Z 1