HomeMy WebLinkAboutP2022-0331 - Permitse`'�WPOR' City of NeWoor't Beach
Community Development Department- Building Division
y y 100 Civic Center Drive, Newport Beach, CA 92660
S Permit Counter Phone: (949) 644-3288
Inspection Requests Phone: (949) 644-3255
cg4conN�P newportbeachca.gov/inspections
II II I I II I II I II IIII�II I I II Plumbing Permit : P2022-0331
Plan Check No : 1007-2022
Work Class : Other
Issued Date : 11/1612022
Inspection Area: 2
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 204 PEARL AVE Legal Desc
: A TR BALBOA'ISLAND RESUB'.SEC 1 BILK 8 LOT 26
Description : PLUM: INSTALL GAS LINE FOR BBQ (X2022-1096)
Owner: SHELLEY STARR
Contractor
Address : 204 PEARL AVE NEWPORT BEACH, CA 92662
Address-`.
Phone:
Phone:
Con State Lie
Applicant: SHELLEY STARR
Lie Expire
Address : 204 PEARL AVE NEWPORT BEACH, CA 92662
Bus Lie:
Phone: (310) 409-7577
Bus Lie Expire:
Workers' Compensation Insurance
Owner/Builder : SHELLEY STARR
Carrier :
Address: 204 PEARL AVE NEWPORT BEACH, CA 92662
Policy. No:
Phone: (310) 409-7577
W. C. Expire:
Code Edition : 2019
Fire Hazard Zone : NO
Type of Construction : I-
Occupancy Groups
Building Setbacks : Front: 6, Side: 3, Side: 3, Rear: 5
Flood Zone : X; AO 1
Use Zone : R-BI - Two -Unit Residential, Balboa Island
PROCESSED BY: ( KDQ,�--
SPECIAL CONDITIONS: HIGH DENSITY ZONE
It t
as Owner of the property, or my i
Susiness and Professions Code: The,
improvementsare not intended or offa
improved for the purpose of sate).,
�Gr,, as owner of the property, am ex;
apply to an owner of property who hull
0 1 am exempt from licensure under
By my signature below € acknowledge.
sell astructure that I have built asanr
Professions Code, is'available upon. re
Signature of Property Owner or Authoi
ipioyees'with wages ai
intmctors' State Licerts
d for sale. If, however,
License. Law for the r
isation, will do U all of or U portions of:I
rely to an owner of property who, through
orovement is sold within one year of comp
>rs to construct the project (Section 70",
for the projects with a licensed Contractor
M
as or improves me property, proviaea mat the
3 the burden of proving: that it was not built or
The Contractors' State -License -Law does not.
a License Law}.
I hereby afrm under penalty of perjury that I am licensed. under provisions of Chadter 9.(Commencing with Section 7000) of Division 3 of the $usiness and Professions Cbde, And my license is in full force
and effect. License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECUKE WORKERV COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND.CIAL FINES UP TO ONE HUNDRED: THOUSAND: DOLLARS. p,100,400), IN ADOn'ION TO THE
COST OF COMPENSATION'. DAMAGES A$ PROVIDED FOR LN SECTION 37116 OF THE LABOR COPE, INTEREST, AND ATTORNEY'S FEES. .
I hereby affirm under penalty of perjury one of the tailowing declarationsr I
I have and will maintain a Certihoate of Consent to serf -insure for workers' compensall0n, issued by the Director of IndUstrial Relations as provided for by Section 3700 :of the Labor Code, for th
performance of the work for which this Permit is issued. Policy No.
I have: and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for wh.6ch this permit is issued. My workers` compensatio
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name ofAgent , Phone#
Di certify that, in the noftmance of the Work for which this permit is issued, I shall not employ any person in any manner so -a to become:subjectto the work mpensation laws of California, andagro_
Signature of Appifcant. U� comply with those provisions. rrl t (2 /� Z that, if I should becom s tactic work rs' compensa on. Provisions of Section 3700 of the Labor Code, I shall forthwith co
Date
DECLARATION REGAR iN NSTRUCTd0 ING AGENCY
I hereby affirm underpe ally of perury that there is construction lending ageneyfor the performance of the work. for Which IN permit is issued (Section 3097, Civil, Code),.
Lenders Name • Lenders. Address
• By my signature ROW, € certify to: each of the following: _
• • • I -am the pmperW owner or authorized to act on the property owners behalf:.
I have readtn3.%pplication and the information t e provided is Correct
• Lagree to cymplyWfth all applicable cFty and on ty or finances and: stern Raves relating to building construction,
• I authanzp reprsehtatives of this city ar Covn D En ? a e-identdpropetty4or1nspWkmOurposes.
igraAgent
( /
aiure of R14p6. Owner or Authorized A enf Print Properly Owner's or Authcnzed Agent's Nam
• AC•TION •... GATE 9Y DECLARATION O MPLIANCEWITH CODE OF FEDERAL FOR OFFICE USE ONLY
• • REGULATIONS PART 61OF TITLE 40ANIDAQMD RULE
APPLICABLE TO