HomeMy WebLinkAboutP2016-0380 - Permits�w City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II p 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 6 0 3 a 0
- Permit Counter Phone (949)644-3288
`nHtararu�a .
Job Address: 2157 VISTA ENTRADA Bldg: 1 Floor:
Description of Work: PLUM -SEWER CLEAN OUT
Inspector Area: 3 ey
Legal Description: TR 587 (L.L.84-2140:
Owner: PFLAUM PET R Date:
Address: 2157 VISTA E TRADA
NEWPORT B AC
Phone:
Issued Date:07/13/2016
Processed By:
Bathroom Fixtures
Toilet:
0
Bidet
0
Urinal
0
Bath Tub:
0
Shower Stall:
0
Wash Basin:
0
Hydro -Mass Tub:O
Floor Sink:
0
Floor Drain:
0
PAR
Suite:
5/Il'
Address: 23311 MADERO STR—E ---
At
0 IEJ A 9 91
Con
- 0
€&S /2
Bus Lic: BT00000858
__I.=.EsaDate: 12/31/2016 -
PLUMBING Permit: P2016-0380
Project No:
Inspection Requests Phone (949)644-3255
I N S P Ll:mmm
fo
If appliCca.
ftker's Compensation Insurance -
Carrier: ZURICH AMERICAN INS
Pgglic N9WCO17954500
80% Or ❑E4 ?`il1,761Z/2016
°o<`
to whole:
°
m
mmmm
mmmmoo
Kitchen Fixtures Misc. Misc.
he ink: 0 $0.00 Water Piping: 0 00 Roof Drain: 0 $0.00
G rb bcal$0((AAQQ ,� yaL�ter Softens 00 Grease Tr $0.00
9S $0 s �V�te PHeater: eXCE �rce�5tt9r 00
Ve eta l``e,� yya�m 0 $. ®p0 Gas u to 4 ou d t� 0 0
IceMak�Y or � eta ) Gas over 4outlets U( 9Uorlf'gt rted)
Dishwasher: 0 $0.00 Backflow up to 2": 0 0.00 $ewer: 0 $0.00
Dtendry/Trap: 0 $0.00 Backflow over 2": 0 $0.00 Sewer Alter/Repair1 $32.00
Regu a or: °v Bi" o SO 00 1--_ Abandon: 0 $0.00
Lawn Sprinkler: 0 $0.00 Drinking Fountain: 0 $0.00 Additional Fee : -
s-- - - - - Insp. ia3itiolS -. _/ �
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Other
$0.00
$0.00
Record Mgmt Fee: $0.00
4nvestigation:
$0.00
Plan Check:
$0.00
Nssuance:
$32.00
!Supplemental Fee:
$0.00
$64.00
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 Iicensure 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).
1, as owner of the property, or my employees with wages as their sole compensation, will do U 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).
I, as owmT Dftbe 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).
I am eRempfftom Iicensure under the Contractors' State License Law for the following reason: -
3y My signature below I ImAdaagai2which I murLhaue.LesidadJQ6aaWaas zprovements covered by this permit, I cannot Iega11,
.sell a structure that Ithave built as an owner -builder if it has not been constructed in its entirely by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
', Orofessions Code, sitlpttp=info�?-gov/calaw.html.
available upon request when this application is submitted or at the following Web sit ttpinfo.ca.gov/calaw.html.
Signature of FPopetty wnerE)&Wr1zed Agent Date
• • LICENSED NTRACTOR'S DECLARATION
I hereby af*m.untler natty of perjury that I am licensed under provisions of Ch ter 9 encing with nt!rr�®�0)81{ i 015 Busme �2nd,Professions Code, and my license in full force
••anceffectt• '• V 0 /�VVUU O fCIU ll
MAlnse Class • Icense N teg� % B'ontrar Dnatu
NINE: FAILURE TO SOCd E WO NSATIOR`MVERME IS URMWFUL, ARb SHACL SUBJ
F Vtt COMPENSA.TMD, MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTERESI
rby affirm;pnd®npe arty a of t iXderhave and will mai ain certifica of co oMquiredefio
Dce of the work orw ch this p it is hav and will maint in wensa s
ce carrier and policy number are:
'ier Policy Number
is of Agent 66^�ae�� .�4�1+��
certify that, in the perform nce o the o inalpefmB 715"bP Al shall not
if should become ubje wo �,fiS Ilion l3700
notlature of ADDlicfifl'F� ��^� i�CAi -it5
hereby affirm under penalty of perjury that there is a construction lending agency for the
Ender' name •�}�' i Lenr
ly my signature below, I cert to eac o e o owing:
I am the property owner or authorized to act on the property owners behalf.
I have read this applitatiorrand'th'e'hTfDRttatfOrfTFi rove a Is come
I agree to comply with all applfeable-o"
I authorize representatives of this city or coun� to enter the above-ide Ified roperty
signature of Property Owner or Authorized Agent�l/ �,
r
ACTION DATE BY DEC
I PERMITEXPIRED Ili /1 L/ I% I /L///T G I
PERMITCANCEELED ' t
P£R/v�ITEXTENDED
'R7x:IuDY�IP7_L�-
FEES.
the Director of Industrial Relations as
Code, for the performance of the work for which
Date
the
DOLLARS (S100,0001, IN ADDITION TO THE
bySection3700 of the Labor Code, for
permit is issued. My workers'
compensation laws of California, and
3- (,G
performance of the work for which this permit is issued (Section 30 7, Civil Code).
er's Address
—Insp. initials:
for inspection purposes. ,/ `
Print Property Owner's or Authorized Agent's NarA� ate-,-.3 x"-'t�f�'� - D� 7�
r T
ARATION OF COMPUANCEIMTH CODE OF I FOR OFFICE USE ONLY
=RAL REGULATIONS PART 61 OFTIRE40 AND
❑ 1 SUBWTTEDASBESTOS NOTIFICATfON TO:
❑ EPA
❑ AOMD
❑ ASBESTOS NOIIFICA710MIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
OCCUPANCYISSUED
SIGNATURE.