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Home My WebLink AboutE2023-0138 - Permitsa£WPORT City of Newport Beach o�`m Community Development Department- Building Division r � 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone: (949) 644-3288 N r Inspection Requests Phone: (949) 644-3255 oe - newportbeachca.gov/inspections Electrical Permit : E2023-0138 Plan Check No : PC2023-0111 Work Class : Other Issued Date : 02/24/2023 Inspection Area : 8 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 : 2512 MARGARET DR Legal Desc : N TR 1880 BLK LOT 3 Description: ELEC INSTALL 200A TEMPORARY POWER POLE Owner: JOHN ROACH Address : 2512 MARGARET DR NEWPORT BEACH, CA 92663 Phone: (949)462-4106 Applicant: BEN MEDINA Address: 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362 Phone: (818)735-7876 Owner/Builder : Address Phone: Code Edition : 2022 Type of Construction : Building Setbacks Flood Zone Use Zone : PROCESSED BY SPECIAL CONDITIONS: Front: 20, Side: 4, Side: 4, Rear: 10 X R-1 - Single -Unit Residential 05 Contractor : UNITED SITE SERVICES OF CA INC Address : 50 WASHINGTON STREET # 1000 WESTBOROUGH MA 01581 Phone: (800)864-3387 Con State Lic : 873553 Lic Expire : 02/29/2024 Bus Lic : BT30012720 Bus Lic Expire:12/31/2023 Workers' Compensation Insurance Carrier: SAFETY NATIONAL CASUALTY CORP Policy No : LDS4047370 W. C. Expire: 12/31/2023 Fire Hazard Zone : NO Occupancy Groups: U CA OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate 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 Cade: 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). ❑ [, as owner of the property,or my employees with wages as their sole compensation, will do C-) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Cade: 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! t was not buitt or rovedforfor the purpose of Sale). L1 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 legally sell a structure [hat 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 7C44 of the Business and Professions Code, is available upon request when this application is submitted or at the fallowing Web site:http:i/%,,k '.leginfo.ce.gov/cataw,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 70 o� 3 of the Busll a 9Sr _A at o e, and my license is in full force and effect. License Class License No Date G Contractor Signature WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVfL FINES UP TO ONE HUNDRED THOUSAND DOLLARS J$114.000), IN ADDmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, ANO ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: EJ 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 Ih performance of the work for which this permit is issued. Policy No.. have 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' ranee carrier and policy number are: re of Agent certify that, in the performance of if I should become subject to tt>6 Of Policy Number Date for which thi " " e 1 shall not employ any person in any manner so as to become subject to the workers' compensation I s of Califo., and ogre nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.may/' mfa �� DECLARATION kF(-1AJfN STRUCTION LENDING AGENCY he,ehyaIflrrruyoury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Fnder's ; aame Lenders Address y .ny s'gnalura below, I certify to each of the following: I e_;-, the property owner or authorized to act on the property owner's behalf. I hr)e read this anpircation and the information I have provided is tract. I : g'ee to comply will all applicable city and county ordin sand state laws relating to building construction, ' ,wthorize representatives of this city or county to enter ve-identified property for ins e r Civil Code), S'ii of Proper. Owner or Authorized Agent Z mi hunt rroperty uwner s or Aumonzea Agent s Name I --— :.LT:CP' DATE BY DEC COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY I ATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PFPMIT aPIRED' I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CAACELCEJ -�MEPA PERMITEXTENOED—_�gL1AQM.D PERMri FfNAt 2J (L✓/s i A58EsroS NOIIFICA7VON IS NOT APPLICABLE TO CERTiFiCA7_EGF PROPOSED DEMOLITION OCCUPANCY ISSUED �' I'•� I SIGNATURE: