HomeMy WebLinkAbout101 Main St - CofO (45)No.062432
�. CITY OF HUNTINGTON BEACH
2000 MAIN ST. DEPARTMENT OF
NT
HUNTINGTON BEACH CA 92648 P.O.
BOX 19 -CALIFORNIADEV92
r P.O. BOX 190 * ALIFORIA 92648
i ALL INSPECTION REQUESTS MUST BE RECEIVED BY 3:30 P'. M. (T1a)53s-5xa111
I FOR THE FOLLOWING DAYS INSPECTION.
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E L E C TR I CA1_ PERM I T s
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Permit Number: E-020089 BldgPermit: B-035607 PC # RD #461 l
Bldg. Address: 101 MAIN 36 Tract NA Lot. NA Block: NA ?
EXIST. BLDG. Building Use: COMM.OFF. T.I. LOW VLTG=PHONES
Owner: Contractor:
MIKE ABDELMUTI HORIZON BUILDERS
211 MAIN 22445 E LA PALMA
H.B. CA YORBA LINDA CA 92687
Ph. { )536-6567 Ph. (714 )692-800(7
St. No. B-567528 City Lic. A152100
Comments T.I. OFFICE LOW VLTG = PHONES iY?
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f Appl.. ate: 01105/94 'Approved:
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i Issf NB 01/05/94 E-020069 Released: Ni3 01/05/94
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INSPECTION FEES
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PERMIT FEES
I DESCRIPTION AMOUNT ACCOUNT DESCRIPTION AMOUNT ACCOUNT
4 ----------- _ — ---- — ---- ---- — -- -------
INSPECTION 0.0" RAACD23A30800 ISSUANCC 20.00 RAACD23430800
PLANCHECK 0.00 RAACD23430800 PENALTY 0.00 RAACD23430800
LW VLT-PHONE 20.00 Rw',ACD23430800
TO"i AL FEE 40.00
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Issued: NB 01/05/94 E-020089 Released: NB 01/05/94
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE OWNER -BUILDER. DECLARATION ) :�
i (This section need not be completed it the permit Is for one nundred dollars is100) or IessJ I hereby affirm that I am exempt from ins Contractors License Law for the .following reason. [(Sec. i
persoon_ 1 t: I certify i that.it artymannemanr so lobe;
performance of the work for which` this. Compensation Laws, permit Is issued, I shall not employ arty 7031.5) Business and Po(esslons Code: Any city or county which requfres'a permit to conslauct,
as
alter, Improve, demolish, a repair any :structure, prior. to Its issrance, also requires the applicant
t - for such permit to rile a signed statement that he is licensed pursuant to the provisions` of the
NOTICE LICANT: �' king this Certificate of Exemption, ecome subject to Contractor's License Law (Chapter 9 TICE
rs Co on provisions abor Code; you mu om :provision ( ap f (commencing With Section 7000) of Division 3:.0! the
is be a erred revoked, - w Business and Professions Code, or That he is exempt theelromand the basis for the alleged ,
LICENSED CONTRACTORS DECLARATION exemption. Any viceatfan of Section 7031.5 by any applicant for a permit 'subjects the. applicant
'1 herby affir : that 1 a licensed under provis of Chapter 9 (commencing with Section 700) of to a civil penalty of not more than five hundmd dollars (S500).j:
P Division 3 of a Business and Professors Code rW of license is in full force and effect t
1 ❑. I, as owner of the prolierty, or my employees with wages as their sole compensation, will do the
License Numb - Lie Class � work, and the structure is not intended or offered for safe. (Sec, 7044) ausincss and Professions. Code:
Contract a e ! ` 2 The Contractor's License Law does not apply to an owner of property who builds or Improves thereon,
` and whodoes such work himself a Ihrcugh his own employees, provided that such Improvements
' ]lam amthe licensing requirements as Lam a licensed architect or a registered professional are not Intended or offered for -sale.. ll, however, the buildin or Ira [�
' engineer achrg in my professional capacity (Section 7051. Business and Professions Code). 9 provemenf :Ls sold vnfhln one W '
year o! cam nq own the erlbuifder will. have the burden of proving that he did riot build or improve
Lic. or Reg. No. - - Date '
for ose of sale.
THIS BOX FOR REGISTER VALIDATION ONLY I, as. owner of the property, am exclusively contracting with licensed contractors to construct the +
projecL (Sec Buvoess 7044). and Professions Code The Contrectoes License Law does not apply : £;
C to an owner of property who builds or improves thereon, and who confrects for such projects with {(
a contractor(s) licensed pursuant to the ContractorsLicense Law.
❑ I am exempt under Sec. B. S P.C. for this reason q
)
Pate Owner
CONSTRUCTION LENDING AGENCY s
I hereby affirm that there is a constractioa tending agency for the performance of the work for which I
ibis ermit is is ued (Sec. 3091, Ctv. C.).:
3005/15 5Jan74 001/12 $40.00' E0c00B9 DUI L�19vap�
tender
I cert' Ihat 1 be a read This applica on and state that the above Infprmatirn is correct I agree to comply
with all -ify pr 'nances and S Ie laws relating to' building construction, and hereby aothoQ
fepre ergw ps of Is cit o of ppon the above mentioned property for inspect fa
`WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self insure, or a certiffcate of Workers Signature of Applicant or Agent _ Date
ompeneation Insurance, or a certified copy thereof (Sec. 3800, Lab. C). - \-
Policy No. CompanyCl
No.062432
Certified copy is hereby famished. - ,
Certified copy Is (letl(ytitfi thet cJjt bu'Iding inspection departmen6
DV —
Date ' J 4/j-- APpicant
t If work is not. commenced 180 days from dateA issue of this permit, orif work is '
abandoned for. m :re than 180 days, this permit shall be null and void
j s , WHITE COPY INSPECTOR BLUE COPY COI hITY, CANAf Y COPY OFFICE GREEN COPY - APPLICANT. PINK COPY TREASURER I'
FORM 140 flev. 121a0 INSPECTORS