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Home My WebLink AboutP2012-0095 - PermitseBwP°q� Op� i V ca4)oRP�� City of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Job Address: 6 CAVAILLON Bldg: 1 Floor: Suite: Description of Work: PLUM/REPLACE WATER HEATER Inspector Area:2 6 Code Edit2010 Legal Description: Owner: CHAU NELSON Contractor: FAST WATER HEATER PARTNERS Address: 6 CAVAILLON Address: 12601 132ND AVE NEWPORT BEACH CA 92657 KIRKLAND WA 98034 Phone: Phone: 425-636-7084 Con State Lic:931237 Issued Date:02/14/2012 Lie Expire: 04/30/2013 / Bus Lie: BT30036541 Processed By: Exp Date: 0813112012 -Lie PLUMBING Permit No: P2012.0095 Inspection Requests/Telephone (949)644-3255 Worker's Compensation Insurance - Carder: TRUCK INS EXCHANGE Policy No:A09304455 Expire: 12/01/2012 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 . J.GG Urinal 0 $0.00 Bar Sink: 0 $0.00 Water Heater: 1 $15.00 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: $1.00 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 over t": 0 $0.00 Sewer Alter/Repair:0 $0.00 Issuance: $34.00 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 TOTAL: $50.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $50.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION ER -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 (_) all of or U 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 sale. If, however, the building or improvement is sold within one year of completion, the Owner-Builderwill 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). ❑ I 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 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 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://ww .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 Prof ssion Code, and my lic ise�s it III force and effect. II License Class License No Date �� 1 Contractor Signature - NORKERS' COMPENSATION DECLARATION YARNING: FAILURE ru SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00D(, IN ADDITION TO THE :uST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: ha:e and will ma.ntain 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 [,prance of the,work for which this permit is issued. Policy No. and will mamrain 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' carrier a,ld policy number are: ier Ie of Agent Policy Number Date certify 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 t,ecome subject to the veorkers' compensatign proWsiclln4 of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. re of :reby affirm under penalty of perjury that there is a construction IendFttg 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 provided is correct. I agree to comply with all applicable city and county 9rdinances and state laws relati to building construction. I authorize representatives of this city or county ter th� abboo( entifiedp1pro a for inspection purposes. nature of Property Owner or Authorized Agent aalLfla-t-(� Print Property Ownel AC77ON DATE BY DECEARATION OF COMPLIANCE WITH CODEOF FOR OFFICE USE ONLY FEDERAL REGULATIONSPART 61 OF TITLE40AND AQMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS A1077FICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMIT EXTENDED [3 ASBESTOS NOTIFICARON IS NOT APPLICABLE TO PROPOSEDDEMOLITION. PERMIT FINAL — _ LZ ,t�L— r�l- 9 CERTIF/CATEOF OCCUPANCYISSUED SIGNATURE: