HomeMy WebLinkAboutP2017-0380 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 7 0 3 a 0
Permit Counter Phone (949)644-3288 '
PLUMBING Permit: P2017-0380
Project No
Inspection Requests Phone (949)644-3255
Job Address: 619 VISTA BONITA Bldg: 1 Floor: Suite:
Description of Work: PLUMB/INSTALL CLEAN OUT
Inspector Area: 8 Code Edit2016
Legal Description: TR 5877 (L.L.84-214030) PAR 13
Owner: TOMLINSON CAROL Contractor: ROTO ROOTER
Worker's Compensation Insurance -
Address: 619 VISTA BONITA Address: 1183 N KRAEMER PL
Carrier: FEDERAL INSURANCE'
NEWPORT BEACH, CA 92660 ANAHEIM, CA 92806
Policy No:54309480
Phone: Phone: 714-476-3603
Expire : 0712912018
Con State Lic:290688
Issued Date:08/16/2017 Lic Expire: 08/31/2017
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Bus Lic: BT00000858
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Processed By: � Lic Exp Date: 12131/2017
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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:
0
$0.00
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
Lndryfrrap:
0
$0.00
Backflow, over 2":
0
$0.00
Sewer Alter/Repair:1
$33.00
Issuance:
$33.00
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:
$66.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance: $66.00
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.
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 for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) 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 sate. 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 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 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 one year prior to completion of the improvements covered by this permit, I cannot legally
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 law, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
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 Pr s Code, and my license is in full force
and effect.
License Class License No DateJ% Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: 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
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 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 the
performance of thq wa for which this permit is issued. Policy No.
have and will aintaat,n workers' cor
rance carrier in oolidv number are:
1e of AgentC J'N__Sl
certify that, in the performanc
if I should become subjgttfa the
insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
Date
for which this permit is issued Iball-nofemploy any person in any manner so as to become subject to the workers' compensation laws of California, and
compens ns of Section 3700 of the Labor Code, I shall forthwith comply with those provis.Ans.
nature of Applicant
CLARATION REGAR N ONSTRUCTION LENDING AGENCY
Ireby 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).
Ider's 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 proved is
I agree to comply with all applicable city and coun mantes and state la relating to building construction. � 1 I CU
I authorize representatives of this city or cou o nter the above -id property for inspection purposes. UT V �W
�ISignature of Property Owner or Authorized Agent X P, Ii t Property Owner's or Authorized Agent's Name Y IJatk I
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART fit OFTI TLE40AND
AQMD RULE 1403,
PERMITEXPIRED
❑ I SUBHTTEr)AS9EST05 NO71F1CATIO.J TO:
❑ EPA
❑ AQMD
PERM, IT CANCELLED
PERMITEXTENDED
ASBESTOS NOTIFICA
P❑RROPOSED DEMOLITION. 710N15 NOT APPLICABLE TO
PERMITFINAL
/ /
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CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED