HomeMy WebLinkAboutP2022-0049 - Permitswt„ City of Newport Beach - Building Division 111111111111111111111111111111111111111111111 111111
100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 2 2 0 0 4 9
µ, Permit Counter Phone (949)644-3288
4:
Job Address: 609 DONALD PL Bldg: 1 Floor: Suite:
Description of Work: PLUM FOR FIREPIT & BBQ
Inspector Area: 3 Code Edit 2019
Legal Description: N TR 10156 LOT 1
Owner: MILLER ROBERT
Contractor:
RICK DORN CONST
Address: 609 DONALD PL
Address:
P O BOX 10047
NEWPORT BEACH, CA 92663
WESTMINSTER CA 92685
Phone:
Phone:
714-585-7322
Con State Lic:357535
Issued Date:03/11/2022
Lic Expire:
05/31/2023
Bus Lic:
BT30074323
Processed By:
Lic Exp Date:
02/28/2023
PLUMBING Permit: P2022-0049
Project No : 0654-2022
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : STATE COMP INS.
Policy No:CWC00207000
Expire : 09/28/2022
'0
t,
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
GarbageDisp:
0
$0.00
Water Softener:
0
$0.00
Grease Trap: 0
$0.00
se.oGJ�
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
$8.00
P-Trap: 0
$0.00
Record Mgmt Fee:
$16.00
• ° '°° °
Shower Stall:
0
$0.00
Ice Maker:
0
$0.00
Gas over 4 outlets:
0
$0.00
Sewer
Investigation:
: 9$0.00
Wash Basin:
0
$0.00
Dishwasher:
0
$0.00
Backflow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
` $0.60
......
Hydro -Mass Tub:0
$0.00
Lndry/Trap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
w$�36A0
• ....
Floor Sink:
0
$0.00
Regulator:
0
$0.00
Hose Bibb:
0
$0.00
Sewer Abandon: 0
$0.00
Supplemental Fee:
WOO
Floor Drain:
0
$0.00
Lawn Sprinkler:
0
$0.00
Drinking Fountain:
0
$0.00
Additional Fee :
$0.00
TOTAL:
$46.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance : $46.00
PERMITS EXPIRE 160 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 item4,a)
(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 ($500).
LJ I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portior
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, t
improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year
improved for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section'
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Col
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contra(
Professions Code, is available upon request when this application is submitted or at the following Web site:http://v
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secho
and effect.
License Class License No Date
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURF�fC&tVRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
COST OF COMPENSW"*DAMAGES AS PROVIDED FOR IN SECTION 3T06 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
et"fli m Imdecpenalty of perjury one of the following declarations:
I have and wilt Mafitain a certificate of consent to self -insure for workers' compensation, issued by the Dire(
a q(glance of thework for which this permit is issued. Policy No.
I we and wir malgtain workers' compensation insurance, as required by Section 3700 of the Labor Code, for
rea'ce carrierdfltl�olicy number are:
rref, "' ' Policy Number
ce'r$fy that, ig the jetformance of the work
• •:if Fshould.t ec eme subject to worke
of
this permit is issued, I shall not employ any person in any
ation provisions of Section 3700 of the Labor Code, I shall
iECLARATIOW49134R61NG C2tl:�FrCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work foi
ender's Name Lender's Address
ly my signature below, 1 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 provid d is correct.
I agree to comply with all applicable city and county or antes and state laws relating to building construction.
I authorize representatives of this city or county to ter th entified property for inspection purposes.
lignature of Property Owner or Authorized Agent -'.!� Print Property Owner's
of the work, and the structure is not intended or offered for sale (Section 7044,
)ugh employees' or personal effort, builds or improves the property, provided that the
completion, the Owner -Builder will have the burden of proving that it was not built or
Business and Professions Code: The Contractors' State License Law does not
Ir pursuant to the Contractors' State License Law).
year prior to completion of the improvements covered by this permit, I cannot
I understand that a copy of the applicable law, Section 7044 of the Business
leginfo. ca.gov/calaw.html.
Date
of Division 3 of the Business and Professions Coda, and-infK license is in full force
Contractor Signature
TIES AND CIVIL FINES UP TO ONE HUNDRED FHOI/$AND DOLLARS ($100,000), IN ADDITION TO THE
of Industrial Relations as provided for by Section 3700 of the Labor Code, for
performance of the work for which this permit is issued. My workers'
Date
so as to become subject to the workers' compensation laws of California, and agre(
i comply with those provisions.
Date
this permit is issued (Section 3097, Civil Code).
Authorized
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE40 AND
AQMD RULE 1403. 1
PERMITEXPIRED
❑ ]SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD'
PERMIT CANCELLED
PERIVIITDkTENDEO
❑ ASBESTOS NOTIHCATIONISNOT APPLICABLE TO
PROPOSED DEMOLITION,
PERMIT FINAL
CER77FICATEOF
SIGNATURE:.
OCCUPANCYISSUED