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Home My WebLink AboutP2019-0052 - PermitsCirj of Newport Beach - Building Division IIIIIIIII IIIIIIIIII rt rr 10(, Civic Centcr Dove, Nevporl Brach, CA 92660 P 2 0 FXnit Eo�nt®r �n4eM9)644-3288 Job Address: 1106 SEA LN Blag: 1 Ffoo`r: ' ` Suite: Description of Work: GAS LINE TO 2 FIRE PITS v o�o°� $ Inspector Area Code Edit 2016 Legal Description: N TR 2202 LOT 9 _ S1 ><O Owner: KIESSELBACH MARK Contractor BLACK MOUNTAIN POOLS Address: 1106 SEA LN Addre 39695REDONDA MESA RD CDM CA 92625 a li MURRIETACA 92562 Phone: Issued Date: Processed E °: Bathroom Fixtures Toilet: 0 $0.00 Bidet 0 "'0.00 Urinal 0 .00 Bath Tub: 0 $ 0 Shower Stall: 0 - $0. Wash Basin: 0 $Q00' Hydra -Mass Tub:0 $&qo Floor Sink: 0 $0.00, <_ PLUMBING Permit: P2019-0052 Project No: 0325-2019 Worker's hone. 714 926 9121 Con State Lic 822100 00,90 Lic Expire: 07/31/2019 e()1 Bus Lic 13T30057 Lic Exp Date 02/28/2019`',_y0 It* Kitchen Fixtures Kitchen Sink: 0 $0.00 Ga age Disp: 0 $0.00 .^ ink: 0 $0.00 Ve le Sink 0 $0.00 4'ker. 0 $0.00 Dis washer 0 $0.00 Lndry egul ^� -eI 'Ail Floor Drain: 0 $0.00, - wn r r: 0 0.00 TOTAL: $00 spy/ (gip ID tilr Inspection Requests Phone (949)644-3255 ATE C P' ' 0:1891732 12/01 /20 19 Misc. sc. \�5p Other Wat ing: 0 $0.00 Roof in' 0 $0.00 �' 3 oftener: 0 $0 G s ap: 0 $0.00 $0.00 err Heater: 0 .00 r e Interceptor:0 $0.00 �G s up to 4 outlets: $7.0 - rap: 0 $0.00 Record Mgmt Fee: $0.00 over 4 outle 0 0 Sewer Investigation: $0.00 ackflow up 2": 0 $0,00v Sewer: 0 $0.00 Plan Check: $0.00 "0.00 BackX Sewer Alter/Repair:0 $0.00 Issuance: $35.00 Ho$0.00 Sewer Abandon: 0 $0.00 Supplemental Fee: $0.00 in0 $0.00 Additional Fee : $0.00 P Check Fee : $0.00 Fee Due at Permit Issuance : $42.00 EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. OWNER -BUILDER DECLARATION ': ` I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reas ) indicated below t One'b}t�,nark,$) I have placed'nextto the applicable item(s) (Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, ' rove, demolish, or � CC r an true 4,a, prior ;o Ls issuande, it mc. fires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' ate License Law (Cy}�4Er 9 (cam net' 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. violation of Sectioor'ogg'.f(( .tfia'�a 5 by any pl npermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). �Q�• c('��1 i ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do II of or rtiwork, and a structures t inE d,d d� offerer' fcs s,:le (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an er of pr who, (hrugh employ ' or personal effo I::Idd�or improves Poe property, provided that the improvements are not intended or offered for sale. If, however, the building or improve is sold none e6ir f completi ,the Owner -Builder wi11 •In tftebc:den of proving that it was not built or improved for the purpose of sale). �010 '.'.: ❑ I, as owner of the property, am exclusively contracting with licensed Contracto construct the pro' ection 7 44 usiness and Professions Code: The oMraOtors' State License Law does not apply to an owner of property who builds or improves thereon, and who contra or the projects wit h�a 'tensed C r ctor pursuant to the Contractors' State Li I;6'1' w). ❑ 1 am exempt from licensure under the Contractors' State License Law the follow!reason: r - By my signature below I acknowledge that, except for my personal resid a in which ust have resided fgi3t east one year prior to completion of the ingkrovemerr vei'gd by this permit, I cannot IegalF sell a structure that I have built as an owner -builder if it has not b constructe n Its a �.lrety by licegse7Ll contractors. 1 understand that a copy of tl7@�iOjl4cable law, cti 7044 of the Business and Professions Code, is available upon request when this applic is sub or at ttr€R"ollowing lN`site:http://www.leginfo.ca.gov/calaw.html. (61/.` :M Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTO DECL TION tb, I hereby affirm under penalty of perjury that I am lice d unit A ions of Chapter 9 (commencing with Se /7000) of Division 3 o e usi ss and P f ssio ode n y'•license is in full force and effect. l /� License Class ense 1` _ Dater •`` / �oay�Kir WORKERS' COMPENSATION DECL TION e V ��CCCCCC'''''' WARNING: FAILURE TO SECURE WORKERS' CO NSATION CO BE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER tO CRIMINAL PENAL-71Eg�CIVIOL�fiItTL`� UP TO ONE H DR/EaD� A LLAR5 ($700,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES ASPR ED FOR INS ON 3766 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES `(( I hereby affirm under penalty of p ry one of t allowing declarations (�\�� kI ave and will malntai certific ( - compensation, Y 1I�isi RW Y consent to�self insure for workers' cam ensation, Issued b the Director of I dal Relatio as vlded r b Section 3700 of the Labor Code, for the mance of the work;[o hich t rmit is' ed. P.pl>o. .may, �.� ave and will mamt .W �ers' comp atio urance as required by Section 3700 of the Labor Code, for the performanc f the w fhich this permit is issued. My workers' compensatiol nte carrierand you "hum r are:r olicy NumtieF it n Date Name of Agent'4'�• �'+ P e # b1 certify that, in the performan . She or w ' permit is Issued, I shall not eJP any person in any Inn ner so o ome subject to the workers' laws of California, and agree that, if I should become subj to or ' co Isions of Section noflbe kl`or Code. I sh orthwith m with those provisions. !// a/ Signature of Applicant e DatelI wo Ireby affirm under penalty Vf perjury that l re construction lentii{.a�9hepWy fqW-49'performan of the w fo ich this permit is issued (Section 3097, Civil Code). Ider's Name �.„/7 1_••ender's Ad ss my signature below, I certify to each of the f3 vin I am the property owner or authorized to act ort."tha arty s behalf. ^ r, I have read this application and the information' vide is correct. U r I agree to comply with all applicable city and c nty.ardl as a ate_aws I to it construction. I authorize representatives of this city or coun a t b e-id d rty r 1 ction purposes. nature of Property Owner or Authorized Agent. 1, Print Property Owner's or Authorized Agent's Name ` ! _ Date ACTION DATE 'sr CLARATION OF COMPLIANCE WITH CODEOF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART fit OFTITL.E40AND AQMORULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITEXPIRED PERMITCANCELLED PERMITEXTENDED ❑ ASBESTOS U077RCATIONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL CERTIFICATE OF SIGNATURE:OCCUPANCYISSUED