HomeMy WebLinkAboutP2016-0322 - PermitsCity of Newport Beach - Building Division
o� 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
N>i'18ViA �;
Job Address: 2139 VISTA ENTRADA Bldg: 1 Floor: Suite:
Description of Work: PLUMB- SEWER CLEAN -OUT
Inspector Area: 3
IIII IIIIII IIIII1 J IIliill0II3IIIIIIIIIIIII II
Legal Description: TR 5878 T 31 (=LLA 84-214031 Py [ /(
Date:___
Owner: THE BLUFFS H Contractor ROTO ROOTER
Address: 2141 VISTA DE RO Add 11 D O y
own
NEWPORT BEA H, C L0 SI I A 926EL
Phone: Ph e: 7 3
Cc .290
Issued Date:06/07/2016 Lic Expire: 08/31/2017
Bus Li c: B 8
IREDProcessed B Lic at 31
PLUMBING Permit: P2016-0322
Project No :
Inspection Requests Phone (949)644-3255
it applicable: INSPECT(J"'N'
'-j 8o%Nr arrierM: ZZURICCHH AMERII fuMdur1N INS
Policy No:WC017954500
to whom: F,...nira m/w=16
Bathroom Fixtures Kitchen Fixtures 141sc. �w is
Toilet: 0 $0.00 K n: 0 ing: 0 ! T`n:'°f 9 0 Other
Bidet 0 $0.00 G rbag Di 0 1.01 rYSAftener: .0 Q tease Trap: ��tt $0.00
Urinal 0 $0.00 B 0 $0.00 Water Heater: $0:00po*@WAISfip $0.00
Bath Tub: 0 $0.00 Vegetable Sin(cWml*k$6.Wrted&s up to 4 outlets: 0 $0.00 P-Trap: 0 $0.00 Record Mgmt Fee:
Shower Stall: 0 $0.00 Ice Maker: 0 $0.00 Gas over 4 outlets: 0 $0.00 Sewer Investigation:
Wash Basin: 0 $0.00 1 sh asher: 0 $0.00 BackOow up tro 2": 0 0.0 Phan Check:
Hydro -Mass Tub:O $0.00 Lll�ra ---�_ c ow over 0 $0.00 Sewer Alter/Reppa1'�r.1 $32. i suance:
Floor Sink: 0 $0.00 Regulator: 0 $0.00 Hose Bibb 0 $0.00 SeweiiAWdAp.lf�ts pplemental Fee:
Floor Drain: 0 $0.00 Lawn nrink�n e0;0�� rnq rou nam. v $0.00 Add tlmat izaa °'c1, is m•
Plan Check Fee: $0.00 Fee Due at Permit Issuance: $64.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
mm.m
°
Comm
mmoo ommoc�•
c e m m
0
mm o
oeea
o m m o
oomo m e c
o
00o m
o ¢ omoco
oe o
°moon
mmm oo
0 0 0 0
00000 0
$0.00 mm moo
mm m
$0.00
$0.00
$0.00
$32.00
$0.00
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„)_.
J I, as owner of the property, or
Business and ProfessionsiCod,
improvements are not intalndec
improved for the purpose of,sale;
I, as owner of the property, ar
apply to an owner of properly wl
❑ 1 am exempt from Iicer;,Ure
3y my signature below I ack(j-pwll
sell a structure that I have•pui
Professions Code, is aveiilabk
Signature of PtdpMR? Qwbd['or
=LIC
T Mdrt�y affirm amdareenlaI,(y of
and effect..
Llaense Class
woo
' employees with wages as heir so a compensa Ion, wl
rd6 offered for sale (Section 7044,
he ntractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or roves the property, provided that the
offe le. If, however, the building or improvement is sold within one year o 0 1 n th wner-Builder will have the b Tdan of proving that it was not built or
ff � Picas e:
ontracting with licensed Contractors to construct the project (Section 7 Business a.
Ir s thCteLice
AD
r fo he AI'i�a ed Cont a 619%a n
r ors'r w reasonrr r a, t h ided foLCI
t one y.e1a'rrr..,ptr�io�r two�er ift to its y Ift�9e�fsh. IWmglrlq,pr�l
when this application is submitted or at the following Web site: http://www.leginfo.ca.go
7000) of Division 3 of
Contractor
Code: The Contactors' State License Law does not
Law).
covered by this permit, I cannot leg;
i, Section 7044 of the Business and
Date
Code, and my license is in full force
2KERS' COMRENSA;TIO DECILARATION t /
IN(# FAILUREde BadURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU AND DOLLARS ($100,000), IN ADDITION TO THE
dx COMPE NSATIONj DAMAGES A ROVI a IN S ION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. n
?by affirm rider penaltyof p jury ne of he w disc a��pns gpa=q� is � 8 " om9 i G �r rpj
have and wiY maintaitj ifica rise to re for ensation, iss th tl do I e for by action 3700 of the Labor Code, for the
fiance of tj a work forjwhic this permit is issues, pp VVul 'A At0. /I �f1 1A/(f t� c}a�}[a l
d will*maiiltain (vork1 s' compensation Insurance, as required di y Section 3700 of the Labor Code}'fb9tht✓ RfiKrma4 WF*work for which this per it is issued. My workers' compensation
ance c rriecandpolicy lum r kkr�I: -
',.' I�l0�t�. Policy Number Expiration Dat
of Agent -
ertify that, in the pe Orman oHheweFWGPxhicb_thi° permit . A Jed I shall not employ any person in any manner s�p�@�o�b�'q�I 4y�act the workers' c pensation laws of California, and agre(
if I should becom sub2 ion rovisions of Section 3700 of the Labor Code, s�alrTo�fi wl comlily with those ro
ECLARAT ON EPARDI�ONSTRUCTION LENDING AGENCY
hereby affi nder penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued
ender's Name Lender's Address
y 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 c ty nd county ordinances and state laws relating to building construction.
I authorize representatives of this city o county a teal a above -identified property for inspection purposes.
ignature of Property Owner or AuthonzeAn
ent wT_ Print Property Owner's or Authorized Agent's Na
3097, Civil Code).
Lr-- —\'Ife F' _ 1 .(C
ACT/ON
hATE
BY
DECLARATIONOFCOMPLIANCEMTNCODEOF 71
FEDERAL REGULATIONS PART6I OFTITLE40AND
AQMO RULE 1401
[3 ISUBMTTEDASBESTOS N07lFICATIONTO:
❑ EPA
❑ AQMD
❑ ASBESTOSN077HCA770NISNOTAPPLICABLETO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
PERMITEXPIRED
A/
,�Y .S
PERMITCANCELLED
PERMIT EXTENDED
PERMIT FINAL
CERTIFICATEOF
OCCUPANCYISSUED