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Home My WebLink AboutP2015-0395 - Permits1xao�� City of Newport Beach - Building Division 1111111111111111111111111111111111111111111111111111111 11111 a' 0 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 5 0 3 9 5 F 'p Permit Counter Phone (949)644-3288 u - - n'�4li1xR tI, -7 - Date: 2, _ 2 /// if applicable: Job Address: 23', C LAIlrtloor: uit ❑ �O��o Or ❑ Description of Wont: LU REP E E E ,: to whom: - nspectorArea: 6'•r t201 CEL Legal Description: 't Owner: MCD M TT nt r: O E Lif Address: 23 C I dr E E NEW R CO 57 ORA E A Phone: Issued Processed Bathroom Fixtura Toilet: if Bidet q, Urinal d Bath Tub: 0 Shower Stall: 0 Wash Basin: 0 Hydro -Mass Tub:0 Floor Sink: 0 Floor Drain: 0 Phone: 714-532-4857 Con State Lie: 511971 Lie Expire: 6/30/2017 1 te. 731 D P2616 (work started) PLUMBING Permit: P2015-0395 Project No : Worker's Compensatioi Carrier: SECURITI Policy No:SWC1011 Expire : 01/07/2016 Discard planstarted)(no work Requests Phone (949)644-3255 emmm m m ¢memco m m m m m memae nce - INS CO mmmom mm c c e e c m n m�mm m ¢. mm moxa co ° m °sem °emmm e TOTAL: $50.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $50.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION res Misc. Misc., 'IZrL� ino�fiM81S:$0.00 Other LNote,K chenSink: 0 $0.00 Water Pipin 0 water Softener: 0 0s" $0.00 r ea er: 1 $15.00 Grease Interceptor:0 $0.00 $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 $0.00 Ice Maker: 0 $0.00 Gas over outlets: 0 $0.00 Sewer Investigation: $0.00 $0.00 Dishwasher: 0 $0.00 Backflow up to 2": 0 $0.00 Sewer: 0 $0.00 Plan Check: $0.00 $0.00 Lndry/Trap: 0 $0.00 Backflow overt": 0 $0.00 Sewer Alter/Repair:0 $0.00 Issuance: $35.00 $0.00 Regulator: 0 $0.00 Hose Bibb: 0 $0.00 Sewer Abandon: 0 $0.00 Supplemental Fee: $0.00 $0.00 Lawn Sprinkler: 0 $0.00 Drinking Fountain: 0 $0.00 Additional Fee : $0.00 TOTAL: $50.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $50.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 iot more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U 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). • •• �• F, lal owne -of4he 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/o an owner or property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). 4 I am exemet O" licensure under the Contractors' State License Law for the following reason: 3ymy 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 legallt .,vAI a structurethat 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 ..VolessionCovft�is available upon request when this application is submitted or at the following Web site:http://wWW.Ieginfo.ca.gov/calaw.html. Signature of KIDS y Owner or Authorized Agent _ Date • .... LICENSED CONTRACTOR'S DECLARATION �I hereby affirliyL"pPpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions'o e, nd my license is in full force ARci.effect. [, kicelfse Class License No Date E - 3 ' S Contractor Signature VJ-AICERS' ejfiIfNSATION DECLARATION VARNIN& FAILURF�LO S$ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (l(MOD), IN ADDITION TO THE :OST OF COMPEy A POA.DAMAGES AS PROVIDED FOR IN SECTION 37DS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm 11hWpenalty of perjury one of the following declarations: - I 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 �rmance 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 Date ne of Agent Friona IF 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' , if I should become subject to the wprkers,' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provision. of Applicant ;reby affirm under penalty of perjury that there is I constructionending 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 count'vyr�� enter the ab ve-iden' ie �r!erty for inspection purposes. nature of Property Owner or Authorized Agent / �-- � L��U'' Print Property Owner's or Authorized Agent's N: ACTION DATE BY DECLARATION OF COMPUANCEWITH CODE OF FEDERAL REGULATIONS PART 67 OF TITLE40 AND AQMD RULE 1403. ❑ ISUBhgTTEDASBESTOSNOIIFICATIONTO: ❑ EPA ❑ AQMD ❑ ASBESTOS N07IRCATIGNIS NOTAPPLICABLE TO PROPOSED DEMOLITION. PERMITEXPIREDq -%'/& - A" FO1 PERMITCANCELLED PERMiTEXTENDED PERMIT FINAL OCCUPANCYISSUED SIGNATURE: /w/f laws of California, and %, 5.15-