HomeMy WebLinkAboutP2021-0003 - PermitsCity of Newport Beach - Building Division IIIII1116111NIIIIIIIIIIIINIIIIIIIIIIINIIINIIIIIIII ProjectBING Permit:
2P2021-0003
0too Civic Center Drive, Newport Beach, CA 92660
�k 0211
Permit Counter Phone (949)644-3288
�. Inspection Requests Phone (949)644-3255
Job Address: 2037 OCEAN BLVD Bldg: 1 Floor:
Suite:
Description of Work: PLUMB - GAS LINE TO FIRE PIT
Inspector Area: 1 Code Edit 2019
Legal Description: N TR 518 BILK D LOT 22
BC HOME BUILDERS Worker's
Owner: JAMES FAMILY TRUST/EL-MOUSSA T
Contractor:
Compensation Insurance -
Address:
3202 W WARNER AVE
Carrier: CYPRESS INS CO
Address: 2037 OCEAN BLVD
SANTA ANA CA 92704
Policy No:BCWCO21844
NEWPORT BEACH, CA 92661
Expire: 1212612021
Phone: Phone: 714-754-0709
Con State Lic:940362
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Issued Date:01/05/2021 Lie Expire: 05/31/2021
NOCONSTRUCTION
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Bus Lie:
BT30072996
Processed By: Lie Exp Date: 09/30/2021
3�q!
N SATUR
FEES
Misc. Other
Bathroom Fixtures Kitchen Fixtures
Kitchen Sink: 0
Misc.
$0.00 Water Piping:
0
$0.00
0.00
Roof Drain: 0 $0.00 $0 00
Toilet: 0 $0.00
0 $0.00 Garbage Disp: 0
$0.00 Water Softener:
0
$0.00
Grease Trap: 0 $0.00
0.00
Bidet
Urinal 0 $0.00 Bar Sink: 0
$0.00 Water Heater:
0
$0.00
Grease Interceptor: $ 0 Record Mgmt Fee: $0.00
P-Trap:
Bath Tub: 0 $0.00 Vegetable Sink: 0
$0.00 Gas up to 4 outlets:
1
0
$7.00
$0.00
Sewer Investigation: $0.00
Shower Stall: 0 $0.00 Ice Maker: 0
$0.00 Gas over 4 outlets:
Backflow up to 2":
0
$0.00
Sewer: 0 $0.00 Plan Check: $0.00
Wash Basin: 0 $0.00 Dishwasher: 0
0
$0.00
$0.00 Backflow over 2":
0
$0.00
Sewer Alter/Repair:0 $0.00 Issuance: $37.00
$0.00
Hydro -Mass Tub:0 $0.00 Lndry(frap:
0
$0.00 Hose Bibb:
0
$0.00
Sewer Abandon: 0 $0.00 Supplemental Fee:
Floor Sink: 0 $0.00 Regulator:
0 $0.00 Lawn Sprinkler: 0
$0.00 Drinking Fountain:
0
$0.00
Additional Fee : $0.00
Floor Drain:
Plan Check
Fee:
$44.00
Fee Due at Permit Issuance: $0.00
TOTAL: $44.00
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.
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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 far a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
111, as owner of the property, or my employees with wages as their sole compensation, will do U all of or L) portions of th 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 propert improvements are not intended or offered for sale. If, however, the building or improvement is sold within
who, through'employees' or personal effort, builds or improves the property, provided that the
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).
111, 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 lioensure 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 legalll
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
Professions Code, is available upon request when this application is submitted or at the following Web site:hftp://vvww.leg nfo.ca.gov/calaw.html. law, Section 7044 of the Business and
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION Date
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se ,tion 000) o Division 3 of the Business and rofessions
and effect. nit-rR�alt ense is in full force
License Class License No Da
YORKERS' COMPENSATION DECLARATION ContractorSign t r �1 ° 1 A
1ARN
;DST OF FAILURE TI SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (E100,0001, 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:
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 th
ance of the work for which this permit is issued. Policy No.
e 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' compensatio
Isur ce carrier and policy number are:
of Agent
Policy Number
certify that, in the performaAAce of thew for which
if I should become subjec�tp the wo ,re
iature of Applicant
is issued, I shall not employ any person in any manner so
;ions of Section 3700 of the Labor Code, I shall forthwith c
Date
to become subject to the workers' compensation laws of California, and
31y with those provisions. i 1
=reby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued
rders 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.
1 agree to comply with all applicable city and county ordinances and state law re ting to building construction.
I authorize representatives of this city or count ��'`,�r the above- rty for inspection purposes.
nature of Property Owner or Authorized Agent xOL.�CJ-'�SL� Print PraoerN ownere
ACTION DATE BY DECLARATION OF COMPLIANCE WITF1 CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE40 A
PERMIT EXPIRED AQMDRULE 1403:
PERMIT C,4.N-CELLED ❑ I SUBMITIEDASBESTOS NODRCATION TO:
❑ EPA
PERM€TEXTENDED ❑ AQMD
PERMIT FINAL Z Z .I„ _ ��ASSE5TOS NOiiRCAiiONiS NOT,�YL)fAF
OCCDPANCYISSUED
3097, Civil Code).
_ I 1 Date l I q2 I
FOROFRCEUSE.ONLY
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