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HomeMy WebLinkAboutE2022-0883 - Permits"EWPogr City of Newport Beach D 6�Community Development Department - Building Division 100 Civic Center Drive, Newport Beach, CA 02660 u yn S Permit Counter Phone: (949) 644-3288 cq �" Nor Inspection Requests Phone: (949) 644-3255 00. newportbeachca.gov/inspections 111111111111111111111111111111111111111111111111111Electrical Permit : E2022-0883 Plan Check No : PC2022-2951 Work Class : Other Issued Date : Inspection Area : 1 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS Job Address : 20 BAY ISLAND Description : ELEC -TEMP POWER POLE (XR2022-3082) Owner: JOHNODOM Address : 11400 SE 8TH ST #300 BELLEVUE, WA 98004 Phone: Legal Desc : S TWP 6 RGE 10 SEC 34 Applicant: LEGACY CUSTOM HOMES INC Address: 1000 QUAIL ST, 220 NEWPORT BEACH, CA 92660 Phone : (949) 887-4750 Owner/Builder Address Phone: Code Edition : 2019 Type of Construction : Building Setbacks Flood Zone Use Zone : PROCESSED BY AE, 8 FT RM - Multiple :11 SPECIAL CONDITIONS: Contractor : LEGACY CUSTOM HOMES INC Address : 1000 QUAIL ST, 220 NEWPORT BEACH, CA 92660 Phone : (949) 887-4750 Con State Lic : 986194 Lic Expire : 08/31/2023 Bus Lic: BT30045036 Bus Lic Expire:10/31/2023 Q� Workers' Compensation Insurance Carrier : OAK RIVER INSURANCE COMPANY Policy No: 219928 W. C. Expire: 12/2/2022 Fire Hazard Zone : NO Occupancy Groups : R3 - Multiple Residential, RM - Multiple Residential, OS - Open Space, OS - Open Space, RM - Multiple OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicatedbelow 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 Iicensure and the basis for the alleged exemption. Anyviolation 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 (_) 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 doesnot apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are net 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 improved for the purpose of sale). ❑ I, as owner of the properly, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property w1ho builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). © 1 am exempt from licensors under the Contractors' State License Law for the following reason: By 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 legall, sell a structure that. I have built asan owner -builder if it has not beenconstructed in its entirety by licensed contractors. I understand that a copy of the applicable law. Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http:fly w .leginfo.ca.govlcalaw.html,. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perury that I am licensed under provisions of Chapter 9 (commencing with Section 7 00) D' sion of the Business and Profs ' Code, a icense i I farce and effect. License Class License No Date Contractor Signal. WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO Cell AL LTI£S AND CIVIL FRIES UP TO ONE HUNDRED T OUSAND DOL ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION b70S OF THE LAaOR COOP, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: -11 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 libformance 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: to of Agent certify that, in the performance of If I should become\ul�ect to ttifi Policy Number Expiration Date for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation lays of California, and agre col pen anon pro s of Section 3700 of the Labor Code,: I shall forthwith comply Withthose provisions. nature of Applicant _ _ CLARATION REGARD, UCTION L NG AGENCY real, affirm under penalty of patio that there i a construction lending agency for the performance of the work for which this permit Is issued (Section 3097. fvil Code). Iders Name Lendar's Address 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 withall applicable city and county ordinal, and state aws relati building construction. I authorize representatives of this city or couunty, ant above-.',7 led pr for inspection purposes. �% nature of Property Owner or Authorized AgentX Print Prooertv Owner's or Authnri7ad Anant'z Nam IqAfljl 1 : / r6:114I n�xd Ar /s?J27_ PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFIC47nEOF OCCUPANCytSSUEQ OAT BW "-DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I REGULATIONS PART 61 OF TITLE. 40 AND AOMD RULE 1403 LJ t SUBMITTED ASBESTOS NOTIFICATION TO ISNOTAPPLICOL'E TO FOR OFFICE USE ONLY