HomeMy WebLinkAboutP2017-0450 - PermitsCity of Newport Beach - Building Division 111111III IIIIIp1111111111111111111111111p11111111111
100 Civic Center Drive. Newport Beach, CA 92660 P 2 0 1 7 0 4 5 0
E: Permit Counter Phone (949)644-3288
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Job Address: 1820 SANDALWOOD LN Bldg: 1 Floor: Suite:
Description of Work: REMOVE/REPLACE (E) GAS LINE FROM MAIN TO WATER HEATER
Inspector Area: 3 Code Edit 2016
Legal Description: N TR 3763 LOT 52
Owner: COX BRIAN
Contractor:
RANDIN PLUMBING CONTRACTORS
Address: 1820 SANDALWOOD LN
Address:
P 0 BOX 3342
NEWPORT BEACH, CA 92660
HUNTINGTON BEACH CA 92605
Phone:
Phone:
714-894-3667
Con State Lic:790701
Issued Date:10/11/2017
Lic Expire:
12/3112018
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Bus Lic:
BT30060796
Processed By: ' O
Lic Exp Date:
10/31/2018
PLUMBING Permit: P2017-0450
Project No :
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : STATE COMP. INS
Policy No:9139291
Expire : 08/07/2018
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:
1
$6.00
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
Lndry[Trap:
0
$0.00
Backflow over2":
0
$0.00
Sewer Alter/Repair:0
$0.00
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:
$39.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance : $39.00
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 `) 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 sale. 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 legall,
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.htm].
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 Businesand Professiog a se is in full force
and effect.
License Class License No Date 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 ($700,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I 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
erformance of the work for which this permit is issued. Policy No.
and I 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'
carrier im!{ policy numDpf.are: _
Date
of
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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. i
of Applicant
hereby 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)
ender's Name Lender's Address
y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf. �n�
I have read this application and the information I have provided is correct. lw vh h.
1 agree to comply with all applicable city and county ordinances a d to I lating to building construction.
I authorize representatives of this city or county t9, enter the I ropeny for inspection purposes. ��
of
_ Print Property Owner's or
ACTION
DATE r
BY
DECLARATION OF COMPLIANCE WITNCODEOF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40AND
ACIA11) RULE '493.
PERMIT EXPIRED
L7 SUBhUTFEDASBESTDS NOIII-ICATION TO.'
7 EP4
❑ A0,14D
PERMIT CANCELLED
PERMITEXTENDED
❑ ASBESTOS NO17FICATIONIS NOTAPPLICABLE TO
PROPOSED DEMOLITION.
PERMITFINAL
CERTtRCATE OF
SIGNATURE:
OCC/PANCYISSUED