HomeMy WebLinkAboutP2019-0137 - PermitsH
City°eneop°Beach Division
100 Civic Center CA 92660
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°q Permit Counter Phone (949)644-3288
Job Address: 220 VIA ITHACA Bldg: I Floor: Suite:
Description of Work: PLUM GASLINE TO BBQ
Inspector Area: 1 Code Edit 2016
Legal Description: N TR 907 LOT 731
Owner: LIGHTNER CINDY Contractor:
Address: 220 VIA ITHACA Address:
NEWPORT BEACH, CA 92663
Phone' 949
GREYSON CONSTRUCTION
22858 HUNWUT DR
3WILDOMAR CA
00 4443
Phone:
Issued Date:05/02/2019 Con State Lic:329260
Lic Expire: 09/30/2020
Processed By:Bus Lic: BT30067164
Lic Exp Date: 05/31/2020
Bathroom Fixtures
$0.00
Kitchen Fixtures
$0.00
Misc.
FE
Toilet:
Bidet
0
0
$0.00
$0.00
Kitchen Sink:
Sink:
p
$0.00
Water Piping:
0
Urinal
0
$0.00
Garbage p
a :
Bar Sink:
0
$0.00
Water Softener:
0
Bath Tub:
0
$0.00
Vegetable Sink:
0
0
$0.00
$0.00
Water Heater:
0
Shower Stall:
0
$0.00
Ice Maker:
0
$0.00
Gas up to 4 outlets:
1
Wash Basin:
0
$0.00
Dishwasher:
0
$0.00
Gas over 4 outlets:
0
Hydro -Mass Tub:0
$0.00
Lndry/Trap:
0
$0.00
Backflow up to 2".
0
Floor Sink:
0
$0.00
Regulator:
0
$0.00
Backflow over 2":
0
Floor Drain:
0
$0.00
Lawn Sprinkler:
0
$0.00
Hose Bibb:
Drinking Fountain:
0
0
TOTAL:
$42.00
Plan Check Fee:
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Misc.
PLUMBING Permit: P2019-0137
Project No 1583-2018
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier: NORGUARD
Policy No:GRWCO21682
Expire :02/23/2020
Roof Drain: 0
$0.00
Grease Trap: 0
$0.00
Grease Interceptor:0
$0.00
P -Trap: 0
$0.00
Sewer
Sewer: 0
$0.00
Sewer Alter/Repair:0
$0.00
Sewer Abandon: 0
$0.00
Additional Fee :
$0.00
Other
oeee
$0.00
e e
$0.00
oome
$35.00
coc
e
eoecc`
mm p 4
Oe O
m m`
000u
oo �
o m
o 0
oeoe
o 0 0
00 0
O° o
e e
m0000
o mm
o
om000
0
oc0000
m
e
000coo
0 om
000en°
'so"GGm
$0.00
Record Mgmt Fee: $0.00
Investigation:
$0.00
Plan Check:
$0.00
Issuance:
$35.00
Supplemental Fee:
$0.00
Fee Due at Permit Issuance: $42.00
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 applicantits for
or count that requires a permit to construct, alter, improve, demolish,(Chapter 9r(commencing with Section 7000) of Division 3rof the Business and
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for ale r, improv indicated below by tany he chec structure,
prior I have placed next to the applicable item(s)
(Section 7031.5, Business and Professions Code: Any city Y hcant for a permit subjects the applicant to a civil penalty of
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License La ( P
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 app'
on 7044,
not more than five hundred dollars ($500). ortions of the work, and the structure is not intended or offered for sale (Sect that the
❑I, as owner of the property, or my employees with wages as their sale compensation, will do (_) all of or (_) p
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
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).
❑ap ly to an er f the property am operty who builds oel c otvastthe eon!Iand who cont actsrforr the projectsto construct hwi hroali ten ed Contractor pu suant to he Contactors Business and Professions tlSt to L cense Law).ae- The Contractors' State License Law does no
ll
I am exempion Of t- 11
t from licensure under the Contractors' State License Law for the following reason:
tu
By ell a structure that I have built as that, ext builfor der if ithasonot been constructed Iint itsust havent'vety by licensed contractors. I understand that aeoopy of the applicable law, Section 7044 of thad by this t Businessfanda
an Date
Professions j7b92!iy available upon request when this application is submitted or at the following Web site:http:l/www.leginfo.ca.govlcalaw.html.
Signature of Property -Owner or Authorized Agent
• • • • • LICENSED CONTRACTOR'S DECLARATION
°I hereby affirm:undc4enalty of perjury that I am licensed under provisions of"Chapter 9 (commencing with action of DivislCoM Contractor Signature
a Profs Sir od and my lice a is in u force
•andeffecl. License No Date
licetTse Class �yy
VyOJ�RERS' CQ RIISATION DECLARATION WFUL AND
O NMMCOMIPENSATi�IOYCOAMAGEe AS PROVIJRE IDED FOR INN COVERAGE
9T IS UNLA' THE LABOR CODE, IANTERESTEAND ATTORNEY'S FEES.
0.1MINAL PENALTIES AND CIVIL FINES UP TO ONE HUN EDTHOUS O DOLLARS (E�Oe,OUe), IN ADDITION TO THE
LURE
I lberaby affirm unser penalty of perjury one of the following declarations:
I. Mel and wyl maiptain 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
rformaace of lire morlefor which this permit is issued. Policy No.
T Mle:and will"aintain 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, compensatle
in •e carrier•%rgf�cRicy number are: Expiration Date
Policy Number Phone #
Carrier
Name of Agent
I certify that, in the pert mance of the rk fcompensation provlis'ons of Section 113700 of not the LaboPCode. Il shall forthwith comply bwith those provit ons.oe k2_`/. pensation laws of California, an agr�
that, if I should becomes bject t th o pa( 7
Signature of Applicant "DING AGENCY d/
DECLARATION REGA DIN
I hereby affirm under P naIt f p jury hat there is a construction lending agency forthe pert Address
of the work for which this permit is issue (Section 3097, Civil Code).
Len
lender's Name
By my signature below, I c�j ify to as h of the following:
I am the property own6'r or authe zed to act on the property owner's beh If.
I have read this application and the information I have provided is co .-
lagree to comply with all applicable city and coun ordinanc a t laws re dFig to building construction. osea C_r� �2K� SON/ Dated _2
I authorize epresentatives of this city or county t enter the a o -i a ifie operty for i PPni PropertP Owner's or Authorized A ant's Name l
Drnnurw owner or Authorized A ant
DATE �` BYI
FEDERAL PEGULAT(ONSPARTSTOFiItfccausuYV
ACRaN
AOMOROLE14Q3.
❑ I SUBMITTEDASBESTOS NOTIFICATION TO.
EXPIRED
❑ EPA
CANCELLED
❑ AQMD
NOTIRCATIONIS NOT APPLICABLE TO
EXTENDED
❑ ASBESTOS
PROPOSED DEMOLITION,
FINAL
SIGNATURE.-
OCCUPANCYISSUED