HomeMy WebLinkAboutE2019-0230 - PermitsCity of Newport Beach - Building Division
1 C0 Civic Center Cri-e. Nerop3rt Beach, CA 02660
ti g 1 Permit Counte, P7ore (94La)644-3288
U i
}ems
Job Addresfi:721' MAFGU."EFITEAVE Bldg:1 Floor: Suite:
Description of WorK ELE-1'ESLA CHAkGING STATION
Inspector Area: 5
Legal Description: CORONA DEL MAR BLK 738 LOT 21
Owner: CORTRIGHT CHARLES
Contractor:
OWNER/BLDR
Address: 721 MARGUERITE AVE
Address:
CORONA DEL MAR, CA 92625
Phone:
Phone:
Con State Lic:
O/B
Issued Date:04/18/2019
Lic Expire:
Bus Lic:
Processed By:
Lic Exp Date:
New Construction
Receptacle/Switch/Outlets
Residential
Receptacles/Outlets:
1 $1.00
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
0-6110V up to 20OA: 0 $1,00
Branch Circuit:
0 $0.00
0-600V over 20OA: 0 $0.00
Each Add Circuit:
0 $0.00
Over 600V or 1000A: 0 $0.00
Time Clocks:
0 $0.00
O/H to U/G 0 $0.00
Additional Fee:
$0.00
TOTAL Fee:
II�IE II� 0I�IIIII�IIIII�III�IIIII0 II
Electrical Permit: E2019-0230
Project No:
Inspection Requests Phone (949)644-3255
Code Edit: 2016
Worker's Compensation Insurance
Carder:
Policy Np:
Expire
I
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
Plan Check Fee:
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:
$35.00
Supplemental Fee:
$0.00
Due at Permit Issuance:
$36.00
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.
)WNER-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 checkmark(s; I have yacnd ;ext 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, pn& to its issuance, also requires b]e applicant for
is 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 3vct;J. i 700C) of C;visior. 3 of talc 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).
11, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is no' in'end�C or of`errd fo- -,ale (Sec'ior 7c44,
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, bl Bids or ;mpruves the plopefty, provioed that the
nprovements 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 Gurden Jf provigg, that i; was , got -built or
In 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
pp 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 m exempt from licensure under the Contractors' State License Law for the following reason:
ly in 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 legall)
ell a tructure that I have built as an owner -builder if it has not been constructed in its ant'rety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Busines and
f sons Code, is available upon request wh this application is subm�'t d t t �owino_.Web Site:http::/ ..leginfo.ca.gov/calaw.html.
signature of Property Owner or Authored Ager� r, A_ � 4 4 D
.ICENSED CONTRACTOR'S DECLARATION yl/!
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
nd effect.
icense Class License No _ Date Contractor Signature
VORKERS' COMPENSATION DECLARATION
IARNING: 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
DST 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:
I 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 IN
erformance of the work for which this permit is issued. Policy No.
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'
rance carrier and policy number are:
Policy Number
Agent
Date
I rtify that, in the performance of the work for w 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
that, I should become subject to wo ' c pe ation pr Lions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions./ t )�
lure of Applicant 4 Dater. /
DECLARATION REGARD G CONSTRUCTION LENDING AGENCY
I 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).
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 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 ordinances d state laws relating to building construction.
I authorize representatives of this city or county o�P.Jer e p rty for inspection purposes.
Signature of Property Owner or Authodzed Agen L., Print Property Owner's or Authorized Agent's Name G��'✓ ��r v� r� Date yL Z12
ACDON
DATE
BY
DECLARATION OF COMPLIANCE WITH CODEOF
FOR OFFICE USE ONLY
FEDERAL REGUL.ATIONSPART61 OFTITLE40AND
AQMD RULE 1403.
PERMIT EXPIRED
I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICARONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMITCANCELLED
PERMITEXTENDED
PERMITFINAL
-26/.17
DO -I` 4:O4- ?
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