HomeMy WebLinkAboutE2021-0852 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 3 MADISON Bldg: 1 Floor: Suite:
Description of Work: ELEC A/C DISCONNECT
Inspector Area: 4
Legal Description: N TR 15409 LOT 111
Owner: ROBBINS JOSHUA
Contractor:
Address: 3 MADISON
Address:
NEWPORT BEACH, CA 92660
Phone:
Phone:
Con State Lic:
Issued Date:12/14/2021
Lic Expire:
0
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
: $67.00
"E2021-0852' Electrical Permit: E2021-0852
Project No :
c'L:.
ALPS AIC & HEATING INC
1895 S SANTA CRUZ ST
ANAHEIM, CA 92805
714-633-8892
667953
0413012023
BT30047511
07/30/2022
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
Inspection Requests Phone (949)644-3255
Code Edit: 2019
Worker's Compensation Insurance
Carrier: AMERICN ZURICH INS
Policy No: WC110287600
Expire : 04101/2022
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
Plan Check
Piggy Back/Temp Power: 0 $0.00
Temp Power Pole: 0 $0.00
Temp Underground
Sub Panel:
Record Mgmt Fee:
Plan Check Fee:
Investigation Fee:
Issuance Fee:
Supplemental Fee:
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.
0
1
0
0
.00
$0.00
$29.00
$0.00
$0.00
$0.00
$0.00
$0.00
$38.00
$0.00
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 items)
(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 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
not more than five hundred dollars ($500).
I, 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 not intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
improvements 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
improved 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
apply 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:
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 thst I hate 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Siyca'um of Prop=rty Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
4. hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 700.) of Division 3 of the Business an Professio
and a 1ect. ,and my license is in full force
_ioense Class License No Date I Contractor Signature
YVOKKERS' COMPENSATION DECLARATION
VARN,NG: FAILURE TO CECURE 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
'AST 0- COMPENSAT,ON, LAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORN ER FEES.
hemhy affirm under penalty of perjury one of the following declarations:
I ha✓e and will ma'ntain 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
Icr`.'frmance of the worK for which this permit is issued. Policy No. -
h2ve and Val n &hdain 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'
:once carrier and policy number are:
Policy Number
of Agent
Date
I certify that, in the performance of the work for which this permit is not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
t, if I should become subjed to the wor pen visions of Section 3700 of the Labor Code, I shall forthwith comply with those provisi ns. `,rr nature of Applicant__ Date I �7
CLARATION REGA I U N LENDING AGENCY ✓fit\
=reby 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'. do 3097Civil Code).
Ider's Name Lender'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 with all applicable city and county ordinancestate Ing3E to building construction. J
I authorize representatives of this city or county enter the ntified property for inspection purposes. nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Aoent's Name��, 1 � JA II I rTI 6. n�ro
ACTION
PERMIT EXPMED
PERMIT CANCELLED
�PERMITEXTEAIDED ,
DATE BY
PERMIT FINAL
CERTrFICATE OF
OCCUPANCYISSUED
FEDERAL REGULATIONS PART 51 OF TITL.E40AND
AQMD RULE 1407.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOIIFICA17ON IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR