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Home My WebLink AboutP2019-0168 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIII II PLUMBING Permit: P2019-0168 04 100 Civic Center Drive Newport Beach, CA 92660 P 2 0 1 9 0 1 6 8 s Project No Permit Counter Phone (949)644-3288 �r"srwyv.`' Inspection Requests Phone (949)644-3255 Job Address: 2165 VISTA ENTRADA Bldg: 1 Floor: Suite: N Description of Work: PLUM -SEWER CLEAN OUT Inspector Area: 8 Code Edit 2016 Legal Description: TR 5878 (L.L.84-214031) PAR 47 1 Owner: THE BLUFFS HOA Contractor: ROTO ROOTER SERV Worker's Compensation Insurance - Address: 2141 VISTA DEL ORO Address: 23311 MADERO Carrier: FEDERAL INS NEWPORT BEACH, CA 92660 MISSION VIEJO CA 92691 Policy No:54309480 Phone: Phone: 949-380-4161 Expire : 08/0112019 °°••;® Con State Lie:101602t ° ° ° ;,•°; Issued bate:05/30/2019 Lie Expire: 07/31 /2020 om m Bus Lie: ST30057895 • •° •°° Processed By: Lie Exp Date: 01/31/2020 • • °° ° FEES Bathroom Fixtures Kitchen Fixtures Misc. Misc. Other mom000 ® ° ° Toilet: 0 $0.00 Kitchen Sink: 0 $0.00 Water Piping: 0 $0.00 Roof Drain: 0 $0.00 WOO ommmco Bidet 0 $0.00 GarbageDisp: 0 $0.00 Water Softener: 0 $0.00 Grease Trap: 0 $0.00 115060010 Urinal 0 $0.00 Bar Sink: 0 $0.00 Water Heater: 0 $0.00 Grease Interceptor:0 $0.00 m ... 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:O $0.00 Lndry/Trap: 0 $0.00 Backflow over 2": 0 $0.00 Sewer Alter/RepairA $35.00 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: $70.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $70.00 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 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 not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) 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). ❑ 1, as owner of the 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 to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By my 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 legall sell a structure that 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date •••• LICENSED CONTRACTOR'S DECLARATION I hereby affirm unelar penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force :.endselfect . �. Date Contractor Si nature License serlasClass License No 9 WORKURS' COP4PENSATION DECLARATION V ARNA S'FAILUREJO SE(;URE 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 ORCOMPENSATIGN, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: .... ❑"I'rtd{re and ft,ryVMain 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 the rice of the: ork for which this permit is issued. Policy No. eve: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' compensation irl'surand carrierAr"Micy number are: Agent certify that, in the performance of . if I should become su1b1ecJAO#f6 Policy Number ion Date work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and "kern' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions nature of Applicant INCON- Date/ .7 �3y/� 9 CLARATION REGARDING STRUCTION LENDING AGENCY Ireby affirm under penalty of perjury that there is a construction lending 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-o In nces and state laws relating to building construction. i L I authorize representatives of this city or county ant above -identified property for inspection purposes. /�5/ nature of Prooertv Owner or Authorized Aar — Print Property Owner's or Authorized Agent's Name Date ACT70N DATE BY UCCLAn FJV" VT ..VInrLr+ll..,_ 1-111 a.-... FEDERAL REGULATIONS PART 01 OF TIILE40AND AQMDRULE1403. ❑ ISUBMITTED ASBESTOS NOTtFICARONTO. C1 EPA 0 AQMD PERMITEXPIRED PERMITCANCELLED PERMIT EXTENDED 0 ASBESTOS N07IRCA170MIS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMITRNAL /i�./i �/ w, C'N/. CER77FWATEOF OCCUPANCYISSUED