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Home My WebLink Aboute2021-0415 - PermitsCity of Newport Beach - Building Division d 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 ii, 9Y c" a Job Address: 1305 PARK AVE Bldg: 1 Floor: IC Description of Work: ELEC PIGGYBACK (X2020-2192) Inspector Area: 2 Legal Description: BALBOA ISLAND SEC 4 LOT 17 BLK 1 ELY 39 FT Owner: BELL LANTZ Contractor: OWNER/BLDR Address: 1305 PARK AVE Address: O/B AUTH ATT NEWPORT BEACH CA 92660 GALLAGHER SHAUN Phone: Phone: Con State Lic: O/B Issued Date:07/14/2021 Lic Expire: Bus Lic: Processed By: i _ Lic Exp Date: 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 over20OA: 0 $0.00 Over600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 TOTAL Fee: Receptacle/Switch/Outlets Receptacles/Outlets: 0 $0.00 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 *E2021-0415* Electrical Permit: E2021-0415 Project No : 1763-2020 Inspection Requests Phone (949)644-3255 Code Edit: 2019 Worker's Compensation Insurance Carrier : Policy No: Expire : 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: 1 $41.00 Temp Power Pole: 0 $0.00 eaa• ��aaa • aaa aaawc• • 0 as osea.a • . a �aa : • • cca�e a aV as 9 eaeae ® aaaE am co a v a xn m a ma aec+ae 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: $38.00 Supplemental Fee: $0.00 Fee Due at Permit Issuance : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday- Friday7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. LDER 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 U 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 imrI ed for the purpose of sale). ],5Cj,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 N/F 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: By my signatures �elop, 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 legal sell a structuredh at. have built as an owner -builder if it has not been constru d i 'ts entirety by licensed contractors. I understand that a copy of the applicable law, Section 7944 of the Business and Profesyons Core, Is available upon request wheNt�`y�S ap n sub led o a he following Web site:http://www.leginfo.ca.gov/calaw.html. 9lgrfa41y4e of Plppg"Owner or Authorized Agent Y �— Date 2 LICENSED CONTRACTOR'S DECLARATI� I hereby affirm under penalty of perjury that I am lice ed under provisions of apter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod and my license is in full force License No Date Contractor Signature VOPKERS' GOMRENSATION DECLARATION 'E.RI 1&jS FAILURfdO srCURE 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 11i COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES. Hweh,y,affirm ur der Penalty of perjury one of the following declarations: I have and'afi{{ 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 0rfoltDr a of toe work for which this permit is issued. Policy No. Y have and will mairkain 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: of Agent Policy Number Expiration Date Phone # I 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 the workers' compensation laws of California, and agree lat, if I should becme/subject t ieworl nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provt\sl/ops. ignature of Applicant( , 3 Date X iECLARATION REG R NG CONSTRUCTI LENDING AGENCY hereby affirm under enal y of perjury that the Is a construction lending agency for the performance of the work for which this permit is issued (4cho 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 an county ordinances and tate laws relating to building construction. I authorize representatives of this city or cou ty pb er tljle v ntified property for inspection purposes. of Property Owner or Authorized ACTION DATE V BY DECLARATION OF COMPLIANCE 1NITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONSPART 61 OF TITLE40 AND AQMO RULE 1403. PERMIT EXPIRED ❑ I SUBMITTEDASBESTOS NOTIFICATION' TO.,. ❑ EPA El AQMD PERMIT CANCELLED T E PERMITIXTENDED ❑ ASBESTOS NOTIRCARONIS NOT APPLICABLE TO PROPOSED DEMOLITION PERMIT CERTIFICATEOF B l OCCUPANCYISSUED SIGNATURE.,