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Home My WebLink AboutP2023-0183 - Permits�WPORr City of Newport Beach p d Community Development Department- Building Division n 100 Civic Center Drive, Newport Beach, CA 92660 6 = Permit Counter Phone: (949) 718-1888 Cq�ORN`P newportbeachca.gov/civic 1111111111111111111111111111111111111111111111111111 jjPlumbing Permit : P2023-0183 Plan Check No Work Class : Other Issued Date : 05/30/2023 Inspection Area : 7 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 : 39 CHANNEL RD Legal Desc : T MHP LIDOPA MSP 127 Description: PLUM GAS LINE FOR RELOCATING FURNACE TO ATTIC (H2O23-0351) Owner: GLORIA FOLLICO Address : 39 CHANNEL RD NEWPORT BEACH, CA 92663 Phone: (949)233-2456 Applicant : BEN MEDINA Address: 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362 Phone: (818)735-7876 Owner/Builder : Address Phone: Code Edition : 2022 Type of Construction : Building Setbacks: Flood Zone Use Zone : PROCESSED BY: SPECIAL CONDITIONS: X PC - Lido Peninsula - Amendment413 Contractor: SERVICE CHAMPIONS HTG Address : 3150 E BIRCH BREA, CA 92821 Phone: (714)777-7777 Con State Lie : 799170 Lie Expire : 10/31/2023 Bus Lie: BT01080105 Bus Lie Expire:07/31/2023 Workers' Compensation Insurance Carrier : EVEREST PREMIER INS CO Policy No : RM8WCOOD54231 W. C. Expire: 8/1/2023 Fire Hazard Zone: NO Occupancy Groups: OWNER -BUILDER DECLARATION 1 hereby affirm underpenalty 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 io 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 he permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors` State License Law (Chapter$ (commencing with Section 7000) of Division 3 of the Business and rrofessions Code) or that he or she is exempt from licensors 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 penatty of lot more than five hundred dollars ($$DO).. 1 1, 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 oroffered for sale (Section 7044, Business and Professions Code: The Contractors' State License Low does not apply to an owner of property who. through employees' or personal effort,builds or improves the property, provided that the nprovements 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 P roved for the purpose of sale). ./ 1; 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 fppty 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 iicensure under the Contractors' Slate License Law for the following reason: fy my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one vast prior to completion of the improvements covered by this permit, I cannot legally ell 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 'rofessions Code, Is available upon request when this application Is submitted or at the following Web site:http:/lwww.leginfo.ca.govicalaw.html. lignature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 8 (commencing with Section 7000, 6yi$i the Business a na Code, and my license is. in full force and effect License Class License No Date J� Contractor Signature _ VORKERS' COMPENSATION DECLARATION IARNING: 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 ($100A00). IN ADDITION TO THE '.DST OF COMPENSATION, OAMAOFS A$ PROVIDED FOR IN SECTION ,TTAS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEEa. hereby affirm under penalty of perjury one at the following declarations: 3 1 have and oil 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 tabor Code, for IN etformance of the work for which this permit is issued. Policy No.. lava and wilt 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' compensatior prance carrier and policy number are: far Policy Number Expiration Date to of Agent Phone # 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 agree , it I should become subject to the is compensation provisions of Section 3700 of the Labor Code., I shall forthwith comply with those provisions. _ Mature ofi.Applicant ........., ....... ....,,m,,....�...,_,_ . __.._.. Date_51j Z'"� hereby affirm under penGWrZ(pequrytNatihero is a construction fending agencyfor the performance Of the work for which this permit is issued (Section 3097, Civil Code). entices Name Lender's Address iy my signature o rtify to each of the following: I am the property, awr•ar or authorized to act on the property owners behalf. r have read this application and the information I have provided is correct. I agree to cox Ipt, wit!-, all applicable city and county Ordinances and state laws relating to building construction. i auilonze representatives of this city or courtly to erflerthe above -identified property for inspe0on purposes. �! / „n . FOR OFFICE USE ONLY OF TITLE 40 AND ACiMD RULE prs44, P EXPIRE& tXMIT r. ,11 n�p / // ASBES'f0 NOTIFICATION 15 NOT APFt}GggLE TO GEAf}riGATE OF �L �V/�(/ PROPOSED DEMOLITION OCCUPANCY ISSUED SIGNATURE: