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Home My WebLink AboutP2023-0292 - Permits04'. City of Newport Beach Community Development Department - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone: (949) 718-1888 enewportbeachca.gov/civic Plumbing Permit Plan Check No : PC2022-2014 Work Class : Other Issued Date : 0B/02/2023 Final Date: Permit Status: Issued Inspection Area : 3 P2023-0292 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 : 1945 SANTIAGO DR Desc Description : PLUM INSTALL GAS LINE FOR 8B0 & FIRE Owner: KLOENNE FAMILY TRUST Address : 1100 VIA VERDE SAN DIMAS, CA 91773 Phone : Applicant: DEWALD BEZUIDENHOUT Address: 87 VERMILLION IRVINE, CA 92603 Phone: (949)649-9447 Owner/Builder: KLOENNE FAMILY TRUST Address : 1100 VIA VERDE SAN DIMAS, CA 91773 Phone: Code Edition : 2019 Type of Construction : N TR 4710 BLK LOT 5 8f Contractor : z3 Address Phone: Building Setbacks : Front: 20, Side: 6, Side: 6, Rear: 6 Flood Zone : X Use Zone : R-1-6D00 - Single -Unit Residential (6000 indicates minimum lot area) PROCESSED BY: SPECIAL CONDITIONS: �t W1116�� Con State Lic Lic Expire Bus Lic : Bus Lic Expire: Workers' Compensation Insurance Carrier : Policy No W. C. Expire: Fire Hazard Zone : NO Occupancy Groups : DECLARATION I hereby affirm under penally 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 items) (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 70D0) of Division 3 of the Business and Professions Code) or that he or she is exempt from Ilcensure and the basis for the alleged exemption.. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($50D). ❑ I, as owner of the property,. or my employees with wages as their sole compensation, will do L) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Businass and Professions Code: The Contractors' State License Law does not apply to an owner of property Wno, 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 is was not built or improved for the purpose of sale). ❑ I, as owner of the properly, 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 art exempt from licensure under the Contractors' State License Law for the following reason_ By n>.y signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion ofthe Improvements covered by this permit I cannot lagall soil a structure [hat I have builtasan owner-buildar If it has not boon 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 ilw .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 Professions Code, and my license is In full force and effect. License Class License No Date Contractor Signature WORKERS' COMPENSATION DECLARATION NARNING: 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 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEYrS FEES, hereby affirm under penalty of perjury one of the following declarations: 1 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 If Tarformance of the work for which this permit Is issued. Policy No. have and will 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' ranee carrier and policy number are: Policy Number of Agent 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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ignalure of Applicant Date __ _ _ , ,,,,......�_. �ECLARAT[ON REGARDING CONSTRUCTIDN LENDING AGENCY 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). enders Name _ Landers 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. I have read this application and the information I have provided is correct. I agree to Comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above -identified property for inspection purposes. ISignature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name Date _ ACTION DATE By '.. DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY RECON ATIONS PART 61 OF TITLE 40 AND AGMD RULE i 1403 PERMIT CANCELLED PfRMITEXTENDED PERMIT FINAL CERT[FfCA TE OF OCCUPANCY ISSUED ASBLSIOS N011FICATION IS Nor APPLICAW TO PROPOSCD DEMOLITION SIGNATURE: