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Home My WebLink AboutE2018-0165 - PermitsCity of Newport Beach - Building Division t 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 n"�ilRlY14C14. Job Address: 4615 BRIGHTON RD Bldg: 1 Floor: Suite: Description of Work: ELEC-ELECTRICAL FOR BBQ Inspector Area: 5 Legal Description: N TR 3357 LOT 147 iiiiii1i5ii II Owner: SHILOH LLC Contractor: DYER J C COMPANY INC Address: 4615 BRIGHTON RD Address: 1540 S COAST HWY #205 CORONA DEL MAR, CA 92625 LAGUNA BEACH CA 92651 Phone: 949-419-5266 Phone: 714-809-3258 Con State Lic: 586784 Issued Date:03/12/201� Lic Expire: 0313112018 Bus Lic: BT98042174 dyj'7 Processed By: Lic Exp Date: 02/28/2019 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 over 20OA: 0 $0.00 Over600V or1000A: 0 $0.00 O/H to U/G 0 $0.00 Receptacle/Switch/Outlets Receptacles/Outlets: 10 $10.00 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 Plan Electrical Permit: E2018-0165 Project No : 2823-2015 Inspection Requests Phone (949)644-3255 Code Edit: 2016 Worker's Compensation Insuranc Carrier: EVERST NATIONAL Policy No: 7600012640 Expire : 01/0112019 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 Temp Underground: 0 $O.6o 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: $0.00 Supplemental Fee: $10.00 Fee Due at Permit 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. DWNER-BUILDER DECLARATION ", �, � - I hereby affirm under penalty of perjury that I am exempt from the Ct,ntiactcs' S'atc License Law fo-thereason(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 o ronstr,lct, PIter, 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 pruvisiol is of ti le Co,,trac,or,' 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 sr,le . Orrlp ,nsaticn, Nill Lc U al' of or IL) 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 doer not apply to in owner of property wno, 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 ,mprovemfnt is sold wi,hil, o,B year of completion, the Owner-Builderwill 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 7000) of Division 3 of the Business and Profs ode, and y ense Is in full force and effect. ? a (0 './<� License Class License No Date J Q Contractor Signatun� __ _'� 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 ($100,000), 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: 111 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, performance of the work for which this permit is issued. Policy No. ❑I 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' compensatior insurance carrier and policy number are: Policy Number Date ie of Agent rnone s certify that, in the performance 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 , if I should become subject to theyvorRxrc compensatiorAVovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. of Applicant Date/ `3 — i 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 ry 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 ordinances and statp laws relating to building construction. I authorize representatives of this city or con ty o ter th bove- roperty for inspection purposes. T mac,../' ra ., o.I,.t or.,,.om, n,.,�orC r.r A„fn,.rl�orl Ancn1'c Namdl/r .f—%llI / J�� i., i-�Nl iAte AC77ON DATE By DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OFTITLE40AND AQMD ROLE 1403. PERMfT FXPLRED ❑ 1 SUBMITTED ASBESTOS N071FICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMIT EXTENDED ❑ ASBESTOS N071FICATIONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMITFLNAL L-(Ul/� CERTWI CATE OF SIGNATURE: OCCUPANCYISSUED