HomeMy WebLinkAboutP2001-0036 - PermitsCity/of Neweach
Building Department
PLUMBING Permit No: P2001-0036
PO Box 1�768/3300 Newport Blvd., Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288/3289 Inspection RequestsTelephone (949)644-3255
Inspector Area: 7 Code Edit: 97
Owner:
Address:
Phone:
Issued :
Processed By:
HOAG MEMORIAL HOSPITAL
301 NEWPORT BLVD
NEWPORT BEACH CA92658
Floor: Suite:
Legal Desc.:
Contractor:
Address:
Phone:
Con. State Lic. :
Lic Expire:
Bus. Lic.:
Lic. Exp Date:
Description of Work: PLUMBING/SUMP PUMP
1877-2000
PAN -PACIFIC PLUMBING CO
1821 MC GAW AVE
IRVINE CA
949/474-9170
093910
10/31/2001
BT00003287
02/28/2001
Bathroom Fixtures
Toilet 0
Bidet 0
Urinal 0
Bath Tub 0
Shower Stall 0
Wash Basin 0
Hydro -Mass Tub 0
Floor Sink 0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
D.CONTRACTORS DECLARATION
Floor Drain
Kitchen Fixtures
Kitchen Sink:
Garbage Disp
Bar Sink
Vegetable Sink
Ice Maker
Dishwasher
Lndry/Trap
0 $0.00
O $0.00
0 $0.00
O $0.00
O $0.00
O $0.00
O $0.00
O $0.00
TOTAL: $28.72
FEES
INSPECTOR NOTES: '
ea
fit 7 -4 /
12401 (I& Lift?... +o 4 k - -fees Kok-c_
Regulator 0 $0.00
Lawn Sprinkler 0 $0.00
MSC
Water Piping 0 $0.00
Water Softener 0 $0.00
Water Heater 0 $0.00
Gas up to 4 outlets 0 $0.00
Gas over 4 outlets 0 $0.00
Backflow up to 2" 0 $0.00
PAYMENT: $0.00
Backflow over 2"
Hose Bibb
Drinking Fountain
Roof Drain
Grease Trap
0
0
0
0
0
Grease Interceptor 0
P-Trap 0
Other
SUMP PUMP
BALANCE: $28.72
eby 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 code.
. nd my license is in full force and effect. License No: 093910 Class: Date: X Canhacbr: PAN -PACIFIC PLUMBING CO
WORKFRS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided fa by Section 3700 of the labor code. for the performance of the work
for whick this permit Is Issued.
I hove 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 h issued.
My workers' compensation insurance carver and policy number is:
Carrier. ULICO INS Polley number. WCS11002301 Expire: 07/01/2001
(This section need not be comp_ieted !f thp-: L1it is for one hundred dollars ($100) or less.
I certify that in the performance of the work for wnich his permit is issued. I shall not employ any person in any man
of Californ nd a e t t It I should become snhjeca to the corkers compensation provisions of - •n 3
Date: �_ Applicant Slgnalure: s 7
e subject to the workers' compensotPNDs
sh•II fotthwlth comply with those provisions. Gas Pipe (rough)
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Sewer
Sewer 0 $0.00
Sewer Alter/Repair 0 $0.00
Sewer Abandon 0 $0.00
Record Management Fee: $0.27
Investigation $0.00
Plan Check 11.75
$7.00 Issuance $19.70
Supplemental Fee $0.00
Approvals
Soil Pipe (ground)
Sewer
Water Pipe (ground)
Gas Pipe (ground)
Plumbing (rough)
JAN092001
S/�(�TWater Heater
Warning:workers' Failure to secure workecompensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred CITY OF NEWPORT vEACI
thousand dollars 1$100,00). if. cciition t, the cog of compensaticn,dnmcges r s provided for In Section 3706 of the labor code, interest. and attorneys fees. Gas PSI Test
I hereby acknowledge that ',hove read the ar plic otior., that tt.e is.Tori raton given is correct: and that I am the owner. or duly authorized agent of the owner.) agree to
comply witn city and stc'e laws regulating construction: and in aoing the work authorized thereby. no person will be employed in violatbn of the labor code of the state of
California relating to workmen's colnr nsafji insurance. �t
Permittee Name (Print) _
/ Data 11-c-dw! Address : /79/1 H,7t geLL SOU111 /rUQ CA
Signature of permitteei' Yy 2L Date: //9/ 0�
Gas Co Notified
Final
WORK MUST BE STARTED WITHIN A PERIOD OF 180
DAYS FROM THE DATE OF VALIDATION OR THIS
Inspector/Date
9zo/
PERMITS OMES NULL AND VOID.
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