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Home My WebLink AboutP2016-0110 - Permits(1) City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 4 ROCKSHORE BLUFF Bldg: 1 Floor: Description of Work: PLUMIWATER HEATER C/O Inspector Area: 6 Legal Description: OwneCate:03122 Addr Phon Issue Processed Bv: Code Edit 2013 CAROLYN IORE BLUFF 'COAST CA 92657 Suite: P 2 0��►��6 010 II Contractor: WATER HEATERS ONLY INC Address: 970 E MAIN ST #200 GRASS VALLEY CA 95945 Phone: 530-274-3001 Con State Lic:374573 Lic Expire: 05/31/2017 Bus Lic: BT30050182 Lic Exp Date: PLUMBING Permit: P2016-0110 Project No : Inspection Requests Phone (949)644-3255 i�s�tc�o� Worker's Compensation Insurance - Carrier: DEPT OF IND RELATIONS Policy No:4503-049 Expire : 05/01/2016 f 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: 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: $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:O $0.00 Lndry/Trap: 0 $0.00 Backflow over 2": 0 $0.00 Sewer Alter/Repair:0 $0.00 Issuance: $32.00 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: $47.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $47.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 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). ZI I, as owne• 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 jwrer, 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 f,om Iicensure under the Contractors' State License Law for the following reason: By m; 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.html. Signature of P, operb, Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirr. unGar penalty of perjury that I am licensed under provisions of Chapter 9 (commencjagwith Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force dlld effect. _ic„LJ/g�� se Class _ License No )3 ontr ctor Signature UOALhERS' COMPENSATION DECLARATION VARNING: 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 :ORT OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hemhy affirm Jnder Ddnalty 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 ante of the work for which this permit is issued. Policy No. iav 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' compensa e carrier and policy number are: of Agent Policy Number Expiration Date 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 if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those grevysions. of 3 DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I 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). Lender's Name Lender's Address By 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. 1 agree to comply with all applicable city and county ordinances and state laws relating to buil nstruction. I authorize representatives of this city or county to ante t abo a -id nfiified property for in ection urposes. ignature of Property Owner or Authorized Agent's-Gl V ✓l perty Owner's or Authorized Agent's Name - `� Dat�p AC77ON DATE BY DECUIRATION OF COMPLIANCE 4YITN CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED ❑ ASBESTOS NOTIFICATIOIVIS NOTAPPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL _Z - CERTIFICATEOF SIGNATURE: OCCUPANCYISSUED