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HomeMy WebLinkAboutP2016-0444 - Permitswry - City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIII��IIII�� II 100 Civic Center Drive, Newport Beach, CA 92660 P NIIIIII Permit Counter Phone (949)644-3288 Job Address: 1724 ANTIGUA WAY Bldg: 1 Floor: Suite: Description of Work: PLUMBING GAS LINE X2015-3666 ttCf 35r- a c„ apur� Inspector Area: 3 Code Edit 2013 Legal Description: N TR 4224 LOT 282 Owner: NETHERTON DREW & LAUREEN Contractor: OWNER/BLDR Address: 1724ANTIGUA Address: NEWPORT BEACH CA 92660 Phone: Phone: Con State Lic:O/B Issued Date:08/16/2016 Lic Expire: Bus Lic: Processed Lic Exp Date: PLUMBING Permit: P2016-0444 Project No:2761-2015 ••®• ....• Inspection Requests Phone (949)&W-2ft 0 ..... • ••••e• a• m U,C-.T • ..•.• pi� •.. s o • • 000c�m• a • 0 o o,a�o• •••• Worker's Compensationlnsurance- • • ..©o Carrier ®® Policy No: Expire : FEES Bathroom Fixtures Kitchen Fixtures Misc. Misc. Other Toilet: 0 $0.00 Kitchen Sink: 0 $0.00 Water Piping: 0 $0.00 Roof Drain: 0 $0.00 $0.00 Bidet 0 $0.00 Garbage Disp: 0 $0.00 Water Softener: 0 $0.00 Grease Trap: 0 $0.00 $0.00 Urinal 0 $0.00 Bar Sink: 0 $0.00 Water Heater: 0 $0.00 Grease Interceptor:0 $0.00 Bath Tub: 0 $0.00 Vegetable Sink: 0 $0.00 Gas up to 4 outlets: 1 $6.00 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:0 $0.00 Lndry[Trap: 0 $0.00 Backflow overt": 0 $0.00 Sewer Alter/Repair:0 $0.00 Issuance: $32.00 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: $38.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $38.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION OWN ER-BUILIPFF DECLARATION I hereby afAr"gry%r 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) 0 Se, VQn 7031.5, 134gness 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 asigned 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 Rrofegsions Code). r 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 �ot%grl than fivefiundred dollars ($500). U I, as owner 9two4operty, 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, BO;SiV8ss 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 era mot 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 W oved for the purpose of sale). �: �s owner of file 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). .tfro I am exempt fromlicensure under the Contractors' State License Law for the following reason: 9; "Yo4nature IiiWo of 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 Iegall •se'IPa structLte ffW I have built as an owner -builder if it has not been constructed in its entirety by liqenjed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request w h I ration is submitted or at th fol wi b ite:htt ://www.le info.ca. ov/calaw.html. / L P Q 9 P 9 9 \� Signature of Property Owner or Authorized Agent Dater — ll/ LICENSED CONTRACTOR'S DECLARATION I hereby 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, and my license is in full force and effect. License Class License No Date -_-_ Contractor Signature VORKERS' COMPENSATION DECLARATION IARNING: FAILURE TO SECURE 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 :DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for thr performance of the work for which this permit is issued. Policy No. have 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' rance carrier and policy number are: Policy Number of Agent Date �I Artify 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' compensation laws of California, and "If I should become subj t to the workers' fcompensation provisions of S ctio 37n03700, of the Labor Code, I shall forthwith comply with those provisions. �� /^ , ignature of Applicant s7L7Vt1�-/l � — .I DECLARATION REG'AR ING CONSTRUCTION LENDING AGItNCY hereby 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). 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 owners 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 la s relating t buildin construction. I authorize representatives of this city or cou�nty�to/�nrt^epr the above-identifie',(yv�prope/rty m o ignature of Property Owner or Authorized Agent�L 1 I Art ,E�{.�'� /\ X nt P arty Owner's or Authorized Agent's NamLf.L AC77ON DATE BY DECLARATION OF COMPLIANCE WTTN CODE OF FOR OFRCEUSE ONLY FEDERAL REGULATIONS PART 61 OF 7I7LE40 AND AOMDRULE 1403. PERMITEXPIRO ❑ I SUBMITFDASBESTOS M077FICATIONTO: ❑ EPA -` AQMD PERMITCANCELLED PERRMITEXTENDED BESTOS N OPOS DDE LITION TiON15 NOT APPLICABLE O SIGNATURE PERMITFINAL CFRTIFICATE OF OCCUPANCYISSUED