HomeMy WebLinkAboutE2018-0502 - Permits' City of NoIIIw oart Beach®- Sul4tiing Division 11111111111111p11111p1Jill11111p11111111p111111111 Electrical Permit: E2018-0502
' 100 Civic Cents: Drive, Vewppn.9eicl� ICA 12%0 E 2 0 1 8 0 5 0 2 Project No: 1826-2018
s Permit Counte! rboft(940)g44-62a8 �.
p"tMrrr"r Inspection Requests Phone (949)544-3255
• e e • •
Job Address: 1963 POR7 DUNLEIGM OIR•;Bldg: 4 Noc r: ° Suite
Description of Work: ELEC/BBQ
Inspector Area: 4
Legal Description: N TR 7027 LOT 48
Owner: CONCHACASA LLC
Contractor:
Address: 5316 SEA SHORE DR
Address:
NEWPORT BEACH, CA 92663
Phone:
Phone:
Con State Lic:
Issued Date:08/21/2018
Lic Expire:
'
Bus Lic:
Processed By:
Lic Exp Date:
PREMIER POOLS ORANGE CTY
22 SAN RAPHAEL
DANA POINT CA 92629
626-422-5426
798298
12/31/2019
BT30056113
08/31/2018
New Construction
Receptacle/Switch/Outlets
Residential
Receptacles/Outlets:
2
$2.00
Multi -Family:
0
$0.00
Fixtures:
0
$0.00
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 over 20OA:
0
$0.00
Each Add Circuit:
0
$0.00
Over 600V or 1o0oA:
0
$0.00
Time Clocks:
0
$0.00
O/H to U/G
0
$0.00
Additional Fee :
$0.00
Code Edit: 2016
Worker's Compensation Insurance
Carrier: STATE COMP
Policy No: 9158204
Expire : 05/03/2019
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:
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:
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.
IWNER-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 che®kr;ark(st I have placeQ 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 repai"44 SuOtuPe, priorto 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
of more than five hundred dollars ($500). • • , • , ,', '
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and TN struelura is not inter ded or *ri�d lyr sale (Section 7044,
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' odp4son$I effort, builds- 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 Owrfer-BORdbr wili'Ma6e tH'e burden of proving that it was not built or
n 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
pply 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:
ly 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 legally
ell 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
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sect*700) sion 3 of the Business4androfo`hs de, d icens s in full force
nd effect.
icense Class License No DateContractor Signatur
VORKERS' COMPENSATION DECLARATION
DARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO C IMINAL PENALTIES AND CIVIL FINES UP TO ONUSAND 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:
31 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 the
ICI nance of the work for which 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'
carrier and policy number are:
PnlirvLld�hei Expiration Date
IS of Agent
certify that, in the perfo ana
if I should become sub ct to
of
/ Phone #
is issued, I shall not employ any person in any manner so as to become subject to the workers' c mpe ation laws of California, and agre,
ipos of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ,r fl
Datet /'f1TY/
DECLARATION REGAMN(i�� ST NDING AGENCY
I hereby affirm under penalty o equry that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the arty owner's b
I have read this application and the information I ve pro 'ded is rect.
I agree to comply with all applicable city and coun ordin s nd stat aw relati o building construction.
I authorize representatives of this city or county to t e ove-id ified rop y for inspection purposes.
,Signature of Property Owner or Authorized A ant rint Property Owner's or Authorized A ent's Nam
this
ACTION
DATE
BY
DECLARATION OF COMPLIANCEMTHCODEOF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE40AND
AQMD RULE 1403.
PERMITEXPIRED
0 1 SUBMITTED ASBESTOS NOTIFICATION TO:
0 EPA
0 AQMD
0 ASBESTOS M077RCAR0NIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT CANCELLED
PERMITEXTENDED
PERMITFINAL
CERTPRCAT€OF
SIGNATURE:
OCCUPANCYrsSUED