HomeMy WebLinkAboutE2022-0394 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 1950 GALAXY DR Bldg: 1 Floor: Suite:
Description of Work: ELEC SEPARATE CIRCUIT
Inspector Area: 3
Legal Description: N TR 4224 LOT 17
Owner: ZMIJEWSKI JEANETTE
Contractor:
Address: 1950 GALAXY DR
Address:
NEWPORT BEACH, CA 92660
Phone:
Phone:
Con State Lic:
Issued Date:07/0512022
Lic Expire:
Bus Lic:
Processed By: Q0.
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
Over600V or1000A:
0
$0.00
O/H to U/G
0
$0.00
TOTAL Fee:
IIIIIIIIIIIIIIIIillllllllllll II Electrical Permit: E2022-0394
Project No : 2889-2021
WATERWORX POOLS INC
202 FASHION LN STE 219
TUSTIN, CA 92780
714-714-0424
1059336
10/31/2023
BT30074831
03/31/2023
Receptacle/Switch/Outlets
Receptacles/Outlets: 0 $0.00
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
Inspection Requests Phone (949)644-3255
Code Edit: 2019
Worker's Compensation Insurance
Carrier: CAROLINA CASUALTY
Policy No: BNUWC0154761
Expire : 0810212022
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:
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 appli::ant 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 sale 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).
❑ 1 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 legally
sell a structure 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 Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 71100 of Division 3 of the Business and ProfessjA le, did my lice Is in f II o e
and effect.
License Class License No Date 72 Z ZContractor Signet
WORKERS' COMPENSATION DECLARATION
WARNING: 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 I$100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
ieJfl 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 th
p ormance 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:
ie of Agent
certify that, in the performance
if I should become subject 15
lature of Aoolicant
Policy Number
Date
I not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
3700 of the Labor Code, I shall forthwith comply with those Date
` b Z
z
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, ivil ode).
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 ordinan s nd ate relatin building construction.
I authorize representatives of this city or county to enter € ov Id ifi prope r inspection purposes.
Date EJ& LZ'Z
ACTION
DATE
BY
DECLARATION OFCOMPLANCE MTHCODEOF
FOR OFFICE USE ONLY
FEDE4AL REGULATIONS PART 61 OF TITLE 40 AND
AQr,,O.ZULE 1403.
❑ I SUBA'ITTFDAS,3Ev TCS NO119CATION TO:
❑ FPA -
❑ AQMD
PERMIT ENPIREO
PERMIT CANCELLER
PERMITENTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPCS-D DFMOLITION.
PERMIT FINAL
1. Z
CERTIRCATEOF
SIGNATUPE:
OCCUPANCYISSUED