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Home My WebLink AboutE2016-0411 - PermitsCity of Newport Beach - Building Division IIIIIIIIII�IIIIIIIIIIIIIIIIIII II 100 Civic Center Drive, Newport Beach, CA 92660 E 2 0 1 6 0 4 1 1 Permit Counter Phone (949)644-3288 Job Address: 428 MORNING CANYON RD Bldg: 1 Floor: Description of Work: ELECTRICAL TO BBQ & FIREPIT Inspector Area: 5 Legal Description: N TR 1237 LOT 26 Owner: GOSSEN BRAD Contractor: Address: 428 MORNING CANYON RD Address: CORONA DEL MAR, CA 92625 Phone: Phone: Con State Lic: Issued Date:06/28/2016 Lic Expire: Bus Lic: Processed 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 TOTAL Fee: Suite: DIG 2732 E COAST HWY #A CORONA DEL MAR CA 92625 949-673-5450 932954 05/31/2017 BT30026912 01/31/2017 Receptacle/Switch/Outlets Receptacles/Outlets: 3 $3.00 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 Electrical Permit: E2016-0411 Project No : Inspection Requests Phone (949)644-3255 Code Edit: 2013 Worker's Compensation Insurance Carrier: STATE FUND Policy No: 9055938 Expire : 06/01/2017 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 BackfTemp Power: 0 $0.00 Temp Power Pole: 0 $0.00 Fee : PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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: $32.00 Supplemental Fee: $0.00 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, 3i.iness 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 Ie permit to file r ^i3ned 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 rofes,ions Code) o• 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 Dt mo:e than ;ivE hundred dollars ($500). iI,'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, usi,xss 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 nprce,ements.are rot,:ntended 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 nuroved for the purpose of sale). I as owner of'.he property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not DOW to an owner or property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). I I Pm exempt from licensure under the Contractors' State License Law for the following reason: y my signature. oelow 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 legalh all a structure that I h6ve built as an owner -builder if it has not ��eeen constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and rofess,'ons Codn, i-, 3vailable upon request wh n t is applicati� sA ubmitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. \� Iggaetore of Pn,perty Owner or Authorized Agent ) \i= Date'` U-ZH- ICENSED CONTRACTOR'S DECLARATION 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 (S100,000), 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 the gdo.nmance of the work for which this permit is issued. Policy No. Fhave 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' compensation urance carrier and policy number are: carrier Policy Number Expiration Date lame of Agent Phone # DI certify that, in the perfoNnce 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 agree iat, if I should become suL11eo1 t4 the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 'signature of Applica ` I/1t\ DatoK. � 4-ZB- � u IECLARATION REGARDIN CONSTRUCTION LENDING AGENCY 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). ender's Name Lender's Address ly 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 or nances and state laws relating to building construction. I authorize representatives of this city or coutD4 to en r th/�above�identified property for inspection purposes. \ ` signature of Property Owner or Authorized Age rW� / '� Print Property Owner's or Authorized Agent's Nam-Zv3 - �P. ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMO RULE 1403. P€RMIT EXPIRED ❑ I SUBMITTEDASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMITEXTENDED ❑ ASBESTOS NOIIRCAHONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL C€RTIFICATEOF SIGNATURE: OCCUPANCYISSUED