HomeMy WebLinkAboutE2018-0565 - PermitsCity of Newport Beach - Building Division
o ? 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Job Address: 14 TWILIGHT BLUFF Bldg: 1 Floor: Suite:
Description of Work: ELECNEHICLE CHARGING STATION
Inspector Area: 6
Legal Description: N TR 16408 LOT 12
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Owner: KHOSRAVI AHMAD
Contractor: OWNER/BLDR
Address: 14 TWILIGHT BLUFF
Address: KHOSRAVI FARIBA
NEWPORT COAST, CA 92657
Phone:
Phone:
Con State Lic: O/B
Issued Date:08/21/2018
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
TOTAL Fee: $42.00
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
Electrical Permit: E2018-0565
Project No :
Inspection Requests Phone (949)644-3255
Code Edit: 2016
Worker's Compensation Insurance
Carrier :
Policy No:
Expire :
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:
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.
A
0
0
0
0
IWNER-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
is 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
'rofessions 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
of 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,
siness 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
n ents 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
n rove) for the purpose of sale).
I s 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
VI
y 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).
am exempt from licensure under the Contractors' State License Law for the following reason:
ly my signature below I acknowledge that, except for my personal residence in which 1 must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
ell 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
'rofessions Code, is available upon request whe t applicat miffed or at the following Web site:http://www.leginfo,ca.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARAT N
hereby affirm ry rm under penalty of perjuthat I a licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co e, and my license is in full force
nd effect.
icense Class License No Date Contractor Signature
VORKERS'.COMPENSATION DECLARATION
'ARNING: FAILURETO SECURE 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
OST OF COMP,ENSATION, 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 tha
ertormance of the work forwhich 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'
rance carrier and policy number are:
Policy Number
of Agent
Date
certify that, in the performance of the work forr wI hich 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
1 if I should become subject to the w�co pensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Date sigtls.
signature of Applicant �7Cp� CO /,�
IECLARATION REG G �O EN G AG Y
hereby affirm under enalty of perjury t at 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 ordinance a state laws relating to building construction.
I authorize representatives of this city or cou ty .enter ntifled property for inspection purposes. ff % / signature of Property Owner or Authorized Agent i I Print Property Owner's or Authorized Agent's Namy� /'d a D SVn.a�at
ACT70N
DATE
BY
DECLARATION OF COMPLIANCE 10W HCODE OF
FOR OFFICE USE ONLY
FFTIFRAI REGULATIONS PART fifOFTITLE40ANDC3
AQ.MD RULE 14.
PERMITEXPIREO
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- ❑ I SJBMITTED ASI-ES TOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMITEXTENDED
❑ ASBESTOS M077HCA170MIS NOT APPLICABLE TO
PROPOSED0EMOUDON.
PERMITF1NAL
CERTIFICATE OF
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SIG;iATURE:
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