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Home My WebLink AboutE2022-0200 - PermitsCity of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 1015 DOLPHIN TER Bldg: 1 Floor: Suite: Description of Work: ELEC -TEMP POWER POLE (X2021-2330) Inspector Area: 2 Legal Description: N TR 5130 LOT 4 Owner: POLOS PETER Contractor: Address: 2 HERMITAGE LN Address: NEWPORT BEACH CA 92660 Phone: Phone: Con State Lic: Issued Date:03/3012022 Lic Expire: U Bus Lic: Processed By: Lic Exp Date: New Construction Residential Multi -Family: 1-2 Family: Service 0-600V up to 20OA: 0 0-600V over20OA: 0 Over600V or1000A: 0 O/H to U/G 0 Il iii iiiii iiiii iiiii iiii iiiii iiiii iiiii 0 II LEGACY CUSTOM HOMES INC 1000 QUAIL ST, STE 220 NEWPORT BEACH CA 92660 949-887.4750 986194 08/31/2023 BT30045036 10/31/2022 Electrical Permit: E2022-0200 Project No : 1994-2021 Inspection Requests Phone (949)644-3255 Code Edit: 2019 Worker's Compensation Insurance Carrier: OAK RIVER INSURANCE CO Policy No: LEWC219928 Expire : 1210212022 FEES Receptacle/Switch/Outlets Motors/Transformers (HP/KVA) Receptacles/Outlets: 0 $0.00 0 to 1 HPIKW/KVA: 0 $0.00 Temp Underground: 0 $0.00 $0.00 Fixtures: 0,. $0.00 1 toll 0.Hp/IOW/KVA: 0 $0.00 Sub Panel: 0 $0.00 $0.00 Sep Circuits: 0' $0.00 -1.0 t0,,O� P/KWJKVA: 0 $0.00 0 $0.00 Low Voltage 0 $0.00-, ', ,50 to 100 HP/KW/KVA: 0 $0.00 0 $0.00 Signs � _`b Over 100 HP/KW/KVA: 0 $0.00 Record Mgmt Fee: $0.00 $0.00 Branch Circuit: 0 $0.00� Plan Check Fee: $0.00 $0.00 Each Add Circuit: 0 $0.00 Piggy BackJTemp Power: 0 $0.00 Investigation Fee: $0.00 $0.00 Time Clocks: 0 $0.00 Temp Power Pole: 1 $41.00 Issuance Fee: $38.00 $0.00 Additional Fee : $0.00 Supplemental Fee: $0.00 Fee : $79.00 Check Fee : 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. 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 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). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) 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 7000) of Division 3 of the Business and Professions de, an ice in full force and effect. License Class License No Date `� 2Z. Contractor Signatur NORKERS' COMPENSATION DECLARATION NARNING: 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 ($100,0001, IN ADDITION TO THE COST 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: 1 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 thI 'Normance 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: Policy Number of Agent Date 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 agre t, if I should become subject to the wo rs' compens n provisio Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant l% %y CLARATION REGARIiIF1G CTION LENDIN AGENCY Date / '/5 / 2 Z :reby affirm under penalty of perjury that there is a c struction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). ider's Name Lender's Address 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 state laws relating to building construction. I authorize representatives of this city or county to a the abo entifie tt party for inspection purposes. I W �^ nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name/ Y C6 �(,Y}/ LOQ Date2ilY7� Z ACTION DATE B DECLARATION OFCOMPLIANCE IMTHCODEOF EDEPAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 4401 [] I3UB"AITTF3F:SEESTOSNOP.FICATI0NTO: ❑ EPA ❑ AQMD El ASBESTOS M071ACA77ON IS NOT APPLICABLE TO P7O. OS -DDEMOLITION.. SIGLATUPE: FOR OFFICE USE ONLY PERMIT EXPIRED PERMIT CANCELLED PERM(TEXTENDED PERMIT FINAL '� I Z 1. DA-K-- F° CERTFFICATE OF OCCUPANCYISSUED