HomeMy WebLinkAboutE2020-0518 - Permitser„4 City of Newport Beach - Building Division
4
100 Civic Center Drive, Newport Beach, CA 92660
r: n Permit Counter Phone (949)644-3288
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Job Address: 706 OCEAN FRONT W Bldg: 1 Floor:
Description of Work: ELEC - TEMP POWER POLE
Inspector Area:
Legal Description: EAST NEWPORT LOT 25 BILK 8 AND LOT 26 BILK 8
Owner: TNS DEVELOPMENT, LLC Contractor:
Address: 2618 SAN MIGUEL DR 335 Address:
NEWPORT BEACH CA 92660
Phone: Phone:
Con State Lic:
Issued Date:09/29/2020 Lic Expire:
Bus Lic:
Processed By: Lic Exp Date:
II�IIIIIIIIIIII�IZIIIIIIIIII�Illlllllullll'llll II Proisject ! 046-2020
Permit:
E2020-0518
Inspection Requests Phone (949)644-3255
Code Edit: 2019
S C HOMES INC �+ Workers Compensation Insurance
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COSTA MESA q6pC,6 ONSTRUCTI®r i�o icy o 63760ND
949-723-4243 Expire:0,,110712021
828216
12/31/2021
BT30002421
oz128/2026/zozl ON S/�Tl1Ft®AYS
FEES
New Construction
Receptacle/Switch/Outlets
Motors/Transformers (HP/KVA)
Residential
Receptacles/Outlets:
0
$0.00
0 to 1 HP/KW/KVA:
0
$0.00
Temp Underground:
0
$0.00
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
0
$0.00
1-2 Family:
0
$0.00
Sep Circuits:
0
$0.00
10 to 50 HP/KW/KVA:
0
$0.00
0
$0.00
Low Voltage
0
$0.00
50 to 100 HP/KW/KVA:
0
$0.00
0
$0.00
Service
Signs
Over 100 HP/KW/KVA:
0
$0.00
Record Mgmt Fee:
$0.00
0-600V up to 20OA:
0
$0.00
Branch Circuit:
0
$0.00
Plan Check Fee:
$0.00
0-600V over 20OA:
0
$0.00
Each Add Circuit:
0
$0.00
Piggy Back/Temp Power:
0
$0.00
Investigation Fee:
$0.00
Over 600V or 1000A:
0
$0.00
Time Clocks:
0
$0.00
Temp Power Pole:
1
$41.00
Issuance Fee:
$37.00
O/H to U/G
0
$0.00
Additional Fee:
$0.00
Supplemental Fee:
$0.00
TOTAL Fee: $78.00
Plan Check Fee: $0.00
Fee Due at Permit Issuance:
$78.00
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.
DocuSign Envelope ID: 1460CC23-5942-4B4A-BOOF-DBEB7AC6FB2E
s
of Agent
OWNER -BUILDER DECLARATION
I herEDy 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 ned to the applicable nem(s)
(Section 7031.5, Business and Professions Code: Any cay or countythat requires a permit to construct, alter, improve, demolish, or repafrany structure, prior to its issuancealso requires the applicant for
the permit fo 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) )I 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 viotatian of Section 7031.5 by any applicant for a permit subjects 'ire appiirantto a civil penally of
not more than five hundred dollars ($500).
131, as owner of the properly, or my employees with wages as their sole compensation, will do U all of or L•) portions of the work, and the structure is not intended or offeTad for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does net apply to an owner of properly who, through employees' or personal effort, builds or improves he property, provided that the
improven rams 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 fiat it was not built or
rovec for the purpose of sale).
ff 1, as )caner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions. Cale_ The Contractor:' State License Law does not
apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuant to the Contractors' State License Law).
❑ lam axempt from ficensure under the Contractors' State license Law for the following reason:
By my sill nature 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 legally
sell a stn>cture that I have built as an owner -builder it it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Seciio'17044 of the Business and
Prefessic ns Code, is available upon request when this application is submitted or at the following Web sfte:Mlplfwww.leginfo.ca.govicalaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penally of perjurythat I am licensed under provisions of Chapter9 (commencing with Section 7 �$3 n � °2 t7� �u��s�arja Prates ris code, and my license is in tali force
and effect. License Class' License No Dat Contractor ignatur
WORKERS' COMPENSATION DECLARATION
wARMNG:�AILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DI;LLAR4 ($IOQSM),. M ADDrON TO THE
COST OF C JMPENSAT GESAS PROVIDED FOR IN SECTION WWDFTHE LABOR CODE, INTEREST, ANDATTORNErS FEES
I Hereby �:fflRn _ Ity of perjury one of the following declarations:
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
much 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' compensation
carder and policy number are: -
ATE COMPENSATION INSURANCE FUNPjloy Number 1763760 Expiration Date 01/07/2021
877-405-4545
certih,that, in the performance of tale work for which this perrut is issued, I shall not employ any person in any manner so as to become subject to the workers' compenE ation laws of California, and agret
,ff I s:'+outd become sub t to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. � Q9�28/'0 1 2 : 03 PM PDT
Iature of Appllcah Datt
t.fflrm under penally of perjury thatthere is a
of the work for which this permit Is issued (Section 3097, Civil Code).
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.
1 havu read this application and the information I have provided is correct
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I autt onze representatives of this city or cou. to e r the above-ideru fled property for inspection purposes.
nature of Property Owner or Authorized Agem� Print P(ODerty Owner's or
•ore a eee ee
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e o
• ore ® ° cc o
eore a o 0 0 0
¢cc co 00 o c¢o oo¢
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
IS NOTAPPUCABLE TO
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