HomeMy WebLinkAboutE2021-0456 - PermitsCity of Newport Beach - Building Division 'E2021-0456` Electrical Permit: E2021-0456
100 Civic Center Drive, New ort Beach, CA 92660 p Project No : 0265-2021
(9)
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 2301 15TH ST Bldg: 1 Floor: Suite: INSPECTOR
Description of Work: ELEC TEMP POWER POLE
Inspector Area: 3
Legal Description: FIRST ADD TO NEWPORT HEIGHTS BILK 38 LOT 13
Owner: HATZIRIS VASILI
Contractor:
Address: 2301 15TH ST
Address:
NEWPORT BEACH, CA
Phone: 310-456-4493
Phone:
Con State Lic:
Issued Date:08103/2021
Expire:
�u
Bus Lic:
Processed By:
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 over 20OA:
0
$0.00
Over600V or1000A:
0
$0.00
O/H to U/G
0
$0.00
TOTAL
Fee:
$79.00
Code Edit: 2019
OWNER/BLDR Worker's Compensation Insurance
SEE X2021-0246 Carrier:
Policy No:
Expire
O/B
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
FEES
Motors/Transformers (HP/KVA)
0 to 1 HP/KW/KVA:
0
$0.00
Temp Underground:
0
$0.00
1 to 10 HP/KW/KVA:
0
$0.00
Sub Panel:
0
$0.00
10 to 50 HP/KW/KVA:
0
$0.00
0
$0.00
50 to 100 HP/KW/KVA:
0
$0.00
a
0
$0.00
Over 100 HP/KW/KVA:
0
$0.00
Record Mgmt Fee:
$0.00
Plan Check Fee:
$0.00
Piggy Back/Temp Power:
0
$0.00
Investigation Fee:
$0.00
Temp Power Pole:
1
$41.00
Issuance Fee:
$38.00
Supplemental Fee:
$0.00
Plan Check Fee :
Fee
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.
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 Cade: 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
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
'r fessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption ny violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
ore than five hundred dollars ($500).
I, wrier 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,
usiness and Professions Code: The Contractors' State License Law does not apply to an owne o operty who, through employees' or personal effort, builds or 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 Owner -Builder will have the burden of proving that it was not built or
nproved 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
poly 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 y 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[,
ell a structure that i nave built as an owner -build if t has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Sectio 7044 of the Business and
'rofessions Coda, ;a available upon request when s lic do is T itted o t th following Web site:http://www. leginfo.ca.gov/calaw. html. Il
5gr.a'Lre of Property Owner or Authorized Agent D P�
.ICENSED CONTRACTOR'S DECLARATI N
h�reb" 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 od , and my license is in full force
nd e,f;ct.
:cen.:e Class License No Date Contractor Signature
iKERS' COMPENSATION DECLARATION
ING: FAILLIKE TJ SE.:URE 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
OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hq�eb,, affirm under penalty of perjury one of the fallowing declarations:
I h.,ve and will m.lintain 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
,IFeio-r..ance of the work for which this permit is issued. Policy No.
1lI have and &I, i nanntain 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' compensa
insurance carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the pert rmance 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 agre
that, if I should becom s lect to thew�orkers' camp @(�nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi ii/ops.
Signature of Applicant -X i'' DateA17,1
DECLARATION REGA DING CONSTR�LENDI 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 (Secti n 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. '/SI I LL tzir/,1
I agree t0 comply with all applicable city and cou 51yordinances and state laws relating to building construction.
I authorize representatives of this city or county t en er th��)above-ide Ified property, for inspection purposes. A-72
Signature of Property Owner or Authorized Agent V �T I1.A��� Print Property Owner's or Authorized Agent's Name M /1�.--�CP 4 Da Z
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE40AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERA41TEXTEAIDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
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