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Home My WebLink AboutE2021-0448 - PermitsCity of Newport Beach - Building Division p 100 Civic Center Drive, Newport Beach, CA 92660 :, d`§E (• Permit Counter Phone (949)644-3288 n:. c"'tarv;Ka''� Job Address: 4615 DORCHESTER RD Bldg: 1 Floor: Suite: Description of Work: ELEC EV CHARGER IN GARAGE Inspector Area: 5 Legal Description: N TR 3519 LOT 88 Owner: PROKOCKI BETH Contractor: Address: 4615 DORCHESTER RD Address: CORONA DEL MAR, CA 92625 Phone: Phone: Con State Lic: Issued Date:07/28/2021 Lic Expire: 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 over20OA: 0 $0.00 Over 600V or 1000A: 0 $0.00 O/H to U/G 0 $0.00 *E2021-0448* THE ELECTRIC CONNECTION 9937 COMMERCE AVENUE TUJUNGA CA 91042 818-446-0888 406002 09/30/2021 BT30073295 10/31/2021 Receptacle/Switch/Outlets Receptacles/Outlets: 1 $1.75 Fixtures: 0 $0.00 Sep Circuits: 1 $7.00 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 Electrical Permit: E2021-0448 Project No : Inspection Requests Phone (949)644-3255 Code Edit: 2019 ' Workers Compensation Insurance Carrier: INS. CO. OF THE WEST Policy No: WVE505631101 Expire : 07/0112022 ' 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: $38.00 Supplemental Fee: $0.00 Fee Due at Permit Issuance : $46.75 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. OWNER -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 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 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 (_) 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 legE'7y cll a structu,e 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 Professions C,de, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Prcperty Owner or Authorized Agent Date LIicNSED CONTRACTOR'S DECLARATION hetaby affirm anderpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 000) f Division 3 of the Business and rofession ode, and m lic se is in full force and affect. Ucense Class License No Date ` Contractor Signature `PORKERS' COMPENSATION DECLARATION INP PY'N3: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU HOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST Or COMPENSAT'ON DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under penalty of perjury one of the following declarations: i have and .+ill 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 I@rfortinance of the work for which this permit is issued. Policy No. l 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' and policy number are: Policy Number me of Agent _ Date I certify that, in the perfo once of the work fo c this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' ompensI ion laws of California, and agree It, if I should become ub a or compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi io ^ S �r. ;nature of Applicant Date `l/ �3 :CLARATION REGAR I ONS UCTION LENDING AGENCY ereby affirm under pea jury that there is a construction lending agency for the performance of the work for which this permit is issued ( ttl n 3097, Civil Code). nder'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 ordina es ands I authorize representatives of this city or county tb gnter a Identifiec of Property Owner or Authorized ,s relating to building construction. property for inspection purposes. Print Property Owner's or Authorized Agent's Name ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONL FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PE.RMITCANCELLED PERMfTEXTENDED ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL CERPFICATEOF SIGNATURE: OCCUPANCYISSUED