HomeMy WebLinkAboutP2019-0143 - PermitsCity of Newport Beach - Building Division I IIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIII II
a 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 9 0 1 4 3
Permit Counter Phone(949)644-3268
PLUMBING Permit: P2019-0143
Project No : '
Inspection Requests Phone (949)644-3255
Job Address: 7121/2 ORCHID AVE Bldg: 1 Floor: Suite:
Description of Work: PLUM WATER HEATER C/O
Inspector Area: 5 Code Edit 2016
Legal Description:
Owner: BUTTON SALLY Contractor: OWNER/BLDR Worker's Compensation Insurance
Address: 7121/2 ORCHID AVE Address: BUTTON SALLY Carrier :
NEWPORT BEACH, CA 92625 O/B FORM ATTACHED Policy No:
Phone: 602-510-7486 Phone: Expire
Con State Lic:O/B
Issued Date:05/08/2019 Lic Expire:
Bus Lic:
Processed By: Lic Exp Date:
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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.
FEES
Bathroom Fixtures
Kitchen Fixtures
Misc.
Misc.
Other
Toilet:
0
$0.00
Kitchen Sink:
0
$0.00
Water Piping:
0
$0.00
Roof Drain: 0
$0.00
$0.00
Bidet
0
$0.00
Garbage Disp:
0
$0.00
Water Softener:
0
$0.00
Grease Trap: 0
$0.00
$0.00
Urinal
0
$0.00
Bar Sink:
0
$0.00
Water Heater:
1
$16.00
Grease Interceptor:0
$0.00
Bath Tub:
0
$0.00
Vegetable Sink:
0
$0.00
Gas up to 4 outlets:
0
$0.00
P -Trap: 0
$0.00
Record Mgmt Fee:
$0.00
Shower Stall:
0
$0.00
Ice Maker:
0
$0.00
Gas over 4 outlets:
0
$0.00
Sewer
Investigation:
$0.00
Wash Basin:
0
$0.00
Dishwasher:
0
$0.00
Backflow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
$0.00
Hydro -Mass Tub:0
$0.00
Lndryfrrap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
$35.00
Floor Sink:
0
$0.00
Regulator:
0
$0.00
Hose Bibb:
0
$0.00
Sewer Abandon: 0
$0.00
Supplemental Fee:
$0.00
Floor Drain:
0
$0.00
Lawn Sprinkler:
0
$0.00
Drinking Fountain:
0
$0.00
Additional Fee :
$0.00
TOTAL:
$51.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance: $51.00
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
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 Division3 f the E� Slness 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 applic It 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 (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business an j rgiessions 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 %r; 'hot 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
proved for the purpose of sale).
•I, aS owner of tha •property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law doeE c..
ply to an ow .er of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
®.I•am exe mpt from licensure under the Contractors' State License Law for the following reason:
Jay rqy 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 legalt
• nit a struct6rBttiat I have built as an owner -builder' it has not San constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Secti 7044 of the Business and
Professions Caft is available upon request whe his p1' ion is 'tt or at the following Web site:http://www.leginfo.ca.gov/calaw. html. �� D 9 ` / fl
'S§Rafure of awperty Owner or Authorized Agent D CJ / T
•••• LICENSED CONT ECLARATION
•IIT 4by affirm undei penalty of perjury that I am 1 ensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professiom ode, and my license is in full force
andeffect.-
4icaraeClass License No Date Contractor Signature
WORKERS' 6Q,feENSATION 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I 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 th
performance of the work for which 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
Date
is of Agent —rnone n
certify that, in the peormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to
, if I should become 11ubjeX tq*e workegrs%compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisiS
nature of Applicant i U
CLARATION REG ING CONSTRUCTION LENDING AGENCY
3reby affirm under enalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued
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 count rdina as and state laws relating to building construction.
I authorize representatives of this city or county ter e abo-i enti d property for inspection purposes.
nature of Prooertv Owner or Authorized Aoent ,/ Print Property Owner's or Authorized Agent's Nam
workers' compensation laws of California, and
3097, Civil Code).
AC17ON DATE / BY UtLLAMA rrrm Ur LUMVUAIVLC VVI r n UVUr / Putt UrrJUt wt LVW.r
FEDERAL REGULATIONSPART 67 OF TITLE40AMD
PEFMITE]CP/RED AQMO.RULE?403.
t SUBMIITEDASBESTOS NOTtFiCATfON TO:
PERMfTCANCELLED ❑ EPA
PERMI'TEXT€NDED ❑ AQMD
❑ ASBESTOS NOTIHCATIONIS NOT APPLICABLE TO
PERMITFINAL I—PROPOSED DEMOLITION.
CERTIFICATEOF
OCCUPANCYISSUED SIGNATURE:
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